Nursing Workforce Shortage: England

Jim Shannon Excerpts

Tuesday 3rd March 2020 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Member for Bedford (Mohammad Yasin) on securing this debate. Although this debate is about nursing shortages in England and health is a devolved matter in Northern Ireland, I believe we are experiencing the same problems in Northern Ireland that exist in Wales, Scotland—as mentioned by the hon. Member for Caithness, Sutherland and Easter Ross (Jamie Stone)—and the whole of the United Kingdom. The solution must be UK-wide.

The Minister has responsibility for England, but I want to refer to things that are happening in Northern Ireland, which I believe the UK Government can change to the benefit of the devolved Administrations. We are currently facing a crisis in nursing care. Although nurses in Northern Ireland have received a pay increase, which they deserve, that does not ease the conditions in which we are asking them to work. Those conditions are the same as in England, Scotland and Wales.

During the election, nursing was perhaps the largest issue I was confronted with on the doorstep, along with the dysfunction of the Northern Ireland Assembly, which, although we are not directly responsible for it, people still wanted to talk to us about. When we got past the misinformation that had been fed to people in a deliberate attempt to skew the vote, it was clear from speaking to nurses that, although the pay issue had been an insult to them, they had genuine concerns about staffing levels—the subject of this debate. The concerns I heard on the doorstep were clear to me, as I am sure they were to all hon. Members from across the United Kingdom of Great Britain and Northern Ireland. There was a genuine concern that the everyday nurse felt guilty about taking annual leave; they felt that they were letting people down by having their hard-earned time off. That should not be so.

The health service in Northern Ireland has a registered nurse vacancy rate of 11.6%, equating to precisely 2,103 empty posts, as well as a shortage of 421 nursing assistants. The cost of employing nurses via agencies has increased from £10 million in 2012-13 to £32 million in 2017-18. I know that the last few years, with a non-functioning Assembly, were an issue regarding the employment of agency staff.

I had a meeting with the Royal College of Nursing some six weeks ago in my office, and I welcome the fact that the Northern Ireland Assembly is up and running. I also welcome the fact that the Minister who has responsibility for the Health Department in Northern Ireland, Robin Swann, has committed to recruiting more nurses. I understand that 700 nurses will be recruited, which will go a long way to addressing some of the empty posts. However, that will still be only a third of the way to filling all the vacancies that exist; the other two thirds of vacancies also have to be filled.

[Jamie Stone]

The hon. Member makes an extremely interesting point. At the last election, constituents and voters said to me on the doors that they would prefer that nurses were employed by the public purse—by the Government—rather than via an agency, which, by definition, makes a profit on the salaries for those nurses. I suggest that the general public does not like that and, if I am reading him correctly, he does not like it either.

[Jim Shannon]

I thank the hon. Gentleman for his intervention, and that is exactly what I am saying. I know that the Health Department in Westminster does not have responsibility for recruiting nurses in Northern Ireland. The Minister in Northern Ireland now has, and he has made the first step towards addressing that issue. It is hoped that over the next couple of years the number of vacancies—over 2,100 nursing posts, as well as 400-odd nursing assistant posts, making about 2,500 vacancies in total—will be addressed. We hope that the cost of agency staff and the extra financial burden created by the fact that agencies are profit-making organisations—this is how they make their money—will be addressed in a way that helps to reduce the shortcomings.

This situation means that nurses cannot simply work their 37.5-hour working week. They are called in on days off and asked, “Can you do the twilight shift? Can you give me a couple of hours?” That is not the fault of the ward sisters; they need the floors covered and are under pressure. It is simply that we do not have enough full-time working nurses in the NHS. That means that conscientious nurses, who do not want to leave the ward or the district short, are working additional hours themselves, and not in the short term to save money for a holiday or a renovation of their house. Instead, they are consistently working overtime to help on the wards, and so they are not getting their family time, their social time and—more importantly—their rest time

I have had glimpses of this situation. Some 6,500 nurses live in my constituency, so I have regular contact with them. I got a brief glimpse of the work of a nurse during my surgery and was in awe of how they stayed on their feet, and remained both sharp and compassionate —as they do. Doing all that with no rest is simply unsustainable. So, for a better system and a better caring system with better nurses, who are more able to work within that system, we need to address the shortage of nurses.

It used to be the case that bank nurses were only used in an emergency, but now they are used ever more frequently and their use is becoming the norm. They are no longer just used in the emergency. Using them is now just the fall-back position: “Let’s just do it”. That is not good either for morale or for finances—the current finances clearly indicate that it is not. It is more costly to have agency staff in than it is to have nurses on full-time pay.

I will give another example, of a nurse who approached me in my office and asked me to clear up rumours about nurses, their employment and so on. She is a young nurse in her early 20s who has been working at the Ulster Hospital in Dundonald—the main hospital in my constituency—but she has been left as a staff nurse in charge at night on numerous occasions. What she said to me was simple; she just said to me, “Jim, keep the pay rise and please give me an extra nurse per shift.” That was her initial reaction, because she can feel the pressures of delivering this system, and was saying, “I physically can’t do it all for much longer”.

This is a lovely young girl who is dedicated and good at her job, but who knows that when she has kids she will not be able to work 60 hours a week. She is asking me to do something about that, and today I am on the path towards doing something; I am highlighting this issue. I am very happy to do so.

[Scott Mann]

The hon. Gentleman is making an excellent point about that young lady. There is one way that the NHS might be able to support her. NHS Property Services owns huge amounts of land around the country on the public estate, and I know that the Government are putting together a key worker policy, for there to be a 30% discount for local people in the housing policy, like a local homes discount. Does he think that if we included nurses within that category that we might be able to address some of the challenges that we face, by giving people discounts and getting them into the profession?

[Jim Shannon]

I thank the hon. Gentleman for that intervention. I was not aware of that proposal until now, but it certainly seems like a way of incentivising people—for some people. Let us be honest; it will not suit everybody’s circumstances, but it will suit some people’s. Whatever we can do to incentivise nurses to stay in the profession is good. I will give a third example, if I may, of the reasons why nurses are not staying in the profession, but some of the things that the hon. Gentleman referred to would be helpful.

I met one woman in her 30s in my office who wanted to go into nursing, but she could not do so because her tax credits would not allow to stop work while she got her national vocational qualifications and other qualifications. So, reluctantly, she gave up and we lost her. She is not the only one we have lost; we have lost many more than that.

I know that in Northern Ireland this issue is not the responsibility of the Minister who is here today, the Minister for Care, the hon. Member for Faversham and Mid Kent (Helen Whately); I understand that. However, will she ask the Minister who has the portfolio for tax credits to review the circumstances around tax credits and the circumstances of those nurses who are trying to get their NVQs, and have to stop work to do so? If we are losing nurses because of an anomaly in the system, let us try to address that anomaly, to allow us to retain the nurses who want to be retained.

My mother was a nurse. That was a long time ago; my mother is coming up to 89 now. I know that for her nursing was a vocation, as it is for many other people. In today’s busy life, it is important that we try to help those who want to be in nursing for the rest of their lives to retain their position. However, that was a young girl in her thirties in my office who wanted to go into nursing and unfortunately we lost her.

We lost someone who wanted to train as an intensive care unit nurse, because the current system could not work with her and her four children. Can we do better in helping mature people to come out of retail and enter education, while still having their children cared for? There are many such people across the nation and across my constituency. There are also a great many people who are former nurses, and we should try to recruit them back into the system as well. There comes a time in their life, perhaps when their children are a bit older and they find themselves with a bit more time on their hands, so what are we doing to attract the more mature nurse into the profession that they once wished they were in?

There must be a way of doing that. I believe that it is up to us in this House to address these two issues, which are so closely linked: getting more nurses; and making a clear way forward to allow mature people to choose nursing, not simply as their job but as their vocation and their calling.

--- Later in debate ---

[The Minister for Care (Helen Whately)]

I congratulate the hon. Member for Bedford (Mohammad Yasin) on securing this debate. I thank him for his tone and his constructive approach to the challenges. I also thank him for giving me this opportunity to speak about a subject that I am truly delighted to have as my responsibility as a new Minister in the Department of Health and Social Care, and about which I feel very strongly—namely, the NHS workforce.

Our NHS is truly fantastic and we as a nation are proud of it. However, as we know, the NHS is really its people. The people of the NHS are the NHS—from the most senior doctor, to the newest healthcare assistant and everything in between. That is particularly true of nurses, who make up nearly one quarter of the NHS workforce, and good healthcare depends absolutely on good nurses.

The NHS should be looking after its nurses, but over many years visiting hospitals and community services—this goes back a long time—I have had too many conversations with nurses who feel that the NHS, or their employer, has not been looking after them. The biggest problem that comes up, going back over many years, is that of staff shortages.

I completely agree with the hon. Member for Bedford that the vacancy rates among NHS nursing teams are too high. They are particularly high for some specialties, such as mental health. There are variations across regions. For instance, in the north-east, Yorkshire and the north-west, the highest vacancies are in ambulance trusts. We also know that there are particular challenges in rural areas, as mentioned by my hon. Friend the Member for North Cornwall (Scott Mann), and across the nations of the UK. As we heard from the hon. Member for Caithness, Sutherland and Easter Ross (Jamie Stone), there are challenges in rural parts of Scotland. We heard from the hon. Member for Strangford (Jim Shannon) about the challenges in Northern Ireland, and there are also parts of Wales that are struggling. This is not just a problem in England, but nevertheless I recognise the problem in England. We need plans to address that, and we have plans, which I will come to.

The hon. Member for Bedford also flagged up the importance of safe staffing in the NHS. I absolutely agree that our first priority must be that the NHS is a safe place for patients, and that care is safe. As he will know, trusts call on bank and agency staff, to make sure that they have enough staff to make wards safe. We must appreciate the work of those staff, who do a really important job of stepping in, but, as I have heard from many a ward sister, although they welcome having agency staff to fill the gaps, that is not the same as having a fully staffed team. That is what we really want in the health service. It will make the NHS a great place to work and enable it to provide the best possible care for patients. That is why the Government have committed to 50,000 more nurses, so that staff shortages and those high vacancy rates will be a thing of the past.

Before I talk about how we will find thousands of new nurses, I want to discuss the most fundamental thing we have to do to succeed, which is to keep the nurses that we already have in the NHS. Some hospitals and teams do not have a problem with staff retention, and some have very low attrition rates. In others, we know that staff turnover is a real problem. There is no point in the NHS training up lots of new nurses if we cannot hang on to those who have already been trained.

In order to retain nurses, we need to make sure that each day is a good day. We need to look out for each and every nurse, which is the day-to-day job of the trusts that employ nurses. I want those trusts that are struggling with high attrition rates to adopt more of the good practices of successful trusts. The Government are also going to help.

First, as we have discussed today and as we have heard directly from nurses, more investment in ongoing training and continuous professional development would make a big difference. That is why the Government have committed to giving every NHS nurse a £1,000 training budget on top of the training that employers usually provide. That extra funding should help nurses to advance their careers, to move more easily between different roles and, of course, to provide better care to patients.

Secondly, there will be a new offer for all NHS staff. It will be released alongside the NHS people plan, which will set out the support each and every NHS staff member can expect from their employer, including for professional development and for more choice and control over shifts and working patterns. As several hon. Members have said, NHS staff want more control and flexibility. The hon. Member for Strangford mentioned the importance of flexibility. Nurses may have other caring responsibilities. Some trusts are doing well in this area, others not so well. We want all employers to do what they can to give staff more flexibility and control over their working hours.

[Jim Shannon]

I thank the Minister for her comprehensive response. I know that tax credits, NVQs and time out are not her responsibility, but would she be willing to speak to the Minister with that portfolio to see whether there is any flexibility in the system to enable nurses, especially those with young children, to continue?

[Helen Whately]

My understanding is that the system in Northern Ireland is different from that in England, so I do not have the answer at my fingertips. I am, however, happy to take up the hon. Gentleman’s question and get back him.

Thirdly, on improving the retention of staff in the NHS, we need to tackle the level of bullying and harassment. The recent NHS staff survey had some really positive results on how NHS staff feel about their work. The Secretary of State and I, however, are greatly concerned about ongoing reports of bullying and harassment that staff experience at the hands of other staff, patients and, sometimes, their families. That is simply not acceptable. We must send out a message, loud and clear, that we will not tolerate the bullying and harassment of staff, whether from other staff or from patients and their families. As a society, we should all be grateful to our NHS staff. Hand in hand with that, we absolutely will not tolerate racism, which is an ongoing problem in some parts of the NHS.

Fourthly, pay has never been the top thing brought up by nurses when I have spoken to them about their concerns, but clearly it is part of the picture. By April this year, we will have increased by 12% the starting salary for new nurses compared with three years ago. More than 200,000 nurses are benefiting from pay rises under the “Agenda for Change” pay deal. Nurses below the top of their pay band have been receiving increases of at least 9%, and those already at the top of their pay band are receiving a pay rise of 6.5% over the course of the “Agenda for Change” pay deal.

I just want to pick up on the point about returning to nursing. The issue of retention also applies to nurses who have, for many reasons, taken time out of nursing. We are very keen that more of those nurses return to work. We are supporting nurses who want to bring back their valuable experience to the NHS. I also want trusts to develop posts that will make the most of those nurses’ experience and to ensure that there is enough flexibility in their shift patterns and ways of working to fit any caring responsibilities they may have.

[Jim Shannon]

For that to happen and for them to return, there would need to be a database of all former nurses. I am mindful that there will be a statement later about the coronavirus, and a Health Minister has mentioned having a list of people who could come in and help in the event of a pandemic outbreak. If there is such a list, then there must also be a list of former nurses who have left the sector but wish to come back. Is there such a database?

[Helen Whately]

I am just digesting what the hon. Member said.

[Jim Shannon]

I talk very fast.

[Helen Whately]

I have not seen a database. The hon. Member refers to the coronavirus plans, which are very much on my mind as we talk about the immediate and longer-term plans to increase the number of nurses in the NHS. Clearly, we also have the short-term challenge of ensuring that the staff are there, and that work is absolutely in hand. Returners are an important part of it and we need to ensure that we make use of nurses who have already been trained, to boost the NHS workforce. All in all, we want to ensure that the NHS is a great place to work for nurses who return to it and for those working in it right now. The absolute foundation for ensuring that we no longer have nursing shortages is to look after the nurses that we currently have. On that foundation, we can seek to recruit and train new nurses.

--- Later in debate ---

[Jim Shannon]

The Minister has mentioned the Government’s commitment to increasing national health service funding. It is important to state for the record that we acknowledge the good things they have done.

[Helen Whately]

I thank the hon. Gentleman. As he says, I have spoken not only about how much we value the NHS workforce, but about our commitment to increasing NHS funding. The two go hand in hand.

A few Members have mentioned that the number of vacancies stands at well over 40,000. Although I absolutely recognise that those numbers are still far too high, the latest data shows a steady downward trend over the past year. I state for the record that as of the third quarter of 2019-20, the number of vacancies was under 39,000.

I will finish with one more piece of good news: the increasing number of nurses in the NHS. As of November 2019, the latest workforce data shows that we had 290,474 nurses in the NHS in England, which is an increase of 8,570, or 3%, since November 2018, and an increase of nearly 17,000, or 6%, since 2010. The numbers are going in the right direction. We have a long way to go but I am determined that we should get all the way to the extra 50,000 nurses in the NHS, so that nursing staff shortages will soon be a thing of the past.

Medicines and Medical Devices Bill

Jim Shannon Excerpts

2nd reading & 2nd reading: House of Commons & Money resolution & Money resolution: House of Commons & Programme motion & Programme motion: House of Commons & Ways and Means resolution & Ways and Means resolution: House of Commons
Monday 2nd March 2020 Commons Chamber

[Dr Whitford]

That is an excellent point, which I will come on to shortly, and I absolutely agree with my hon. Friend.

The Bill puts attractiveness as a place to do trials and supply medicines almost on a par with safety and drug availability. What exactly does that mean? The shadow Health Secretary was right to seek a definition of that phrase. Is it about cutting red tape? If so, I would point out that one man’s red tape is another man’s life and limb. The Association of the British Pharmaceutical Industry says that the industry does not want divergence or lower standards, or standards that change all the time. Alignment with the EMA and the FDA in America keeps costs down, reduces delays and keeps bureaucracy down. The industry here will have to match EU standards for the bulk of its production and will not be keen on doing small-batch production for the UK only if that has a totally different set of standards.

It is important that the new measures on falsified and counterfeit medicines be taken. The unique identifier number, including barcode scanning, is important, as are tamper-proof containers. There is a whole market out there in counterfeit drugs and it endangers patient safety, which is vital in all of this. As part of that, we will have to negotiate data sharing with the EU and the EMA to enable pharmacovigilance on a bigger scale and make it possible to recognise much earlier patterns of side effects and complications.

How will the Government provide the extra funding and support to the MHRA, which is to take on an extensive area of extra work? How will it combine that with delivering quicker assessments and licensing so as to encourage companies to launch their devices or other drugs in the UK? As has been referred to, there is a need to replace the clinical trials directive, which in the original version was indeed very bureaucratic. As a clinical trialist within breast cancer, I found it to be often quite off-putting. The new clinical trials regulations create an EU-wide portal—a single point of digital registration of trials and collaboration on design, recruitment, data, entry and analysis. Unfortunately, UK-only regulations will not replace that when it finally goes live in 2022.

International collaboration is critical to research, and the European research network is the biggest in the world—bigger than China and bigger than the US. As mentioned by my hon. Friend the Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron) and the hon. Member for Bolton West, that collaboration is vital for rare diseases, where the number of patients in any one country is low. That is why we have made so much progress in rare diseases, childhood diseases and childhood cancers in the past decade or so—because of funding from the EMA and collaboration on an extensive Europe-wide basis. As regards cancer, my own specialty, half of all UK cancer trials are international, and 28% of Cancer Research UK trials involve at least one other EU state. The BEACON trial for recurrent neuroblastoma involves 10 countries. It was designed in the UK, but the principal investigator is in Spain. Some of the original funding came from the UK, but the drug comes from Switzerland. Ten countries are contributing to trying to find hope for children and families suffering from this horrible disease, for which we are struggling to find a cure. There were 4,800 UK-EU trials between 2014 and 2016. How will the Government maintain that sort of collaboration and involvement?

Part 3 of the Bill relates to medical devices, and I totally agree it is not before time. The EU has also moved to bring in regulations regarding medical devices. It is important to apply similar rules to devices as are applied to drugs. Until now, it has been far too lax. As was mentioned, manufacturers pay for assessments, and I would suggest the same apply to digital health apps. At the moment, the companies that design them assess them themselves. We need instead a neutral and independent system of ensuring that they are safe. Just because something is AI or digital does not mean it will give patients good advice.

Registered clinical trials of devices should report all findings. It is far too common, where there are negative findings or findings of no advantage, that they are not published and that therefore in essence the information is hidden. As we have heard, there should be no tabletop licensing of devices whereby a device is simply migrated from one form to another without being retrialled. This was exactly the problem with vaginal mesh, where in essence the end operation, compared to the original operation in the trials, was unrecognisable. The Cumberlege review should give us food for thought and help us focus on safety and not market expediency. It is also important that there is a system to report complications to the MHRA, like the yellow card system with drugs, so that problems are spotted sooner. Again, across a bigger population that is likely to be quicker.

Implants should also have a unique identifier number that can be scanned as a barcode to the patient’s electronic records, to the hospital episode system and to any registers. A register will be data that is just sitting there and which can be interrogated if someone needs to recall patients with certain implants because of a problem. Following the scandal around PIP implants, which did not have medical grade silicon in them, I remember having to wade through the case sheets of patients who had had breast reconstruction. It was not an implant we had ever used in our hospital, but we had to be 100% certain that no patient treated in the plastics unit in Glasgow had had the implants either. It is critical that we avoid such chaos in the future, and if a register has an expert steering committee, it can become a registry, a dynamic beast that can monitor practice and bring knowledge back to medical practitioners, researchers and so on. One of the earliest and biggest examples is the national joint registry.

The Bill includes provisions to extend low-risk drug prescribing to other healthcare professionals. We all recognise the changes in the workforce that have already happened and which are coming in the future. There are processes for assessing competency and certifying that someone—an advanced nurse practitioner, for example—can prescribe in their own right. The Royal College of Surgeons and the Royal College of Physicians have raised the issue of physician associates and surgical care practitioners. They feel that if prescription powers are to be given to such individuals it is critical that they are registered and regulated, but while these new professions are developing they are not registered or regulated. If this is the future of the NHS workforce across the UK, it has to be dealt with—they need to be registered practitioners.

[Jim Shannon (Strangford) (DUP)]

The hon. Member refers to physicians and others and to the shortage of doctors, but is there not also a role for pharmacies to play in diagnosing people early on? Is that not something that should be done as well?

[Dr Whitford]

In Scotland, we have had the community pharmacy system since 2005, which includes that, and the range of protocols for a pharmacist to prescribe against has been increased, but I agree it has further potential. One advantage is that pharmacies are usually open all day Saturday and often have longer hours. For people who are working who have a relatively minor condition, being able to get both advice and treatment from a pharmacist makes a big difference.

[Jim Shannon]

I forgot to mention that I also believe pharmacies could play a role in diagnosing sight loss, glaucoma and other things—small things that can be done in pharmacy. Is that something else that could be addressed?

[Dr Whitford]

In Scotland, we put a lot of effort into sweating the assets, if you like, within the community, so optometrists can carry out that job. They no longer refer through a GP. If they diagnose cataracts, for example, they refer directly, and they provide a lot of out-of-hours care for people with acute eye problems, foreign body inflammation, infection and so on, to the point that very few patients now go to A&E with an acute eye problem. We have all sorts of expertise in our communities, and we should use it, so I agree with the hon. Gentleman.

I welcome the Bill’s reference to internet pharmacy provision, but I think that there should be a step up—a whole step change—in the form of stronger action to control internet pharmacy providers, especially in the context of what are described as prescription-only medicines. The son of a constituent who came to see me was able to obtain large quantities of dihydrocodeine, a fairly addictive painkiller, over the internet simply by filling in an online form, having not seen a GP and without producing a prescription. I asked the constituent to find out what the website was so that I could report the organisation, but the website had gone. That is the problem with the internet: it is ephemeral. Unfortunately, that young man has now become addicted to dihydrocodeine, and is trying to be weaned off it. As in the case of other versions of online harm, we need to deal with people who are hiding in the internet: we cannot allow the supply of counterfeit or addictive medicines to patients without any form of control.

I have some concerns about the Bill. For instance, I agree with the hon. Member for Leicester South (Jonathan Ashworth) about the extensive delegated powers. The Secretary of State said that the same powers had been in place when the United Kingdom was in the European Union, but their purpose in the past was to enact EU directives which had been debated and consulted on in the European Council and the European Parliament. They had been worked out before agreement was reached, and were therefore purely about enacting something that had been hammered out and agreed within Europe. That is not the case here. Almost every clause in the Bill simply hands over a delegated power, but I think some of the major changes that are being introduced in the Bill are significant and should be in primary legislation. Of course regulations will flow from that and will be covered by delegated powers, but for radical changes to made purely in relation to such powers represents a missed opportunity, and they should be limited.

Part 3 provides for the maximum sentences for offences against the Bill to be set at six months. In Scotland, the maximum sentence in a summary case is 12 months. Removing that sentencing power in Scotland with no consultation does not seem right, and a presumption against sentences below 12 months there would make custodial sentences less likely. What kind of prevention and what kind of warning will there be if it is clear to people that imprisonment is never going to happen? The civil penalties presided over by the Secretary of State prevent criminal prosecution if either the maximum or a lower sum is paid in advance. That fetters the operation of the Scottish criminal justice system, because those involved in it would lose the right to prosecute if they felt that the issue was serious enough. The Lord Advocate in Scotland should have been consulted on both issues, and I suggest that that should be corrected as the Bill proceeds.

Part 4 does indeed call for consultation prior to any new regulations, but there is no formal mention of Ministers in the devolved Government, despite their responsibility for healthcare. In other Bills with which I have been involved, it has been normal for the Ministers of the devolved nations to be listed specifically. When legislation is to impinge on such a major devolved competency, it is important for them to take part in discussions. I also think it important to have a structure enabling medical bodies, experts and industry to contribute to the consultations, to ensure that all aspects have been considered.

There is no choice but for the Bill to go ahead because of the legislative gap that will result from our leaving Europe and the European Medicines Agency, particularly at the end of the transition period. We will therefore not force a vote, although I hope that we will be able to strengthen some aspects in Committee. Having to leave the EMA is just one example of what we are losing because of Brexit. Far from cutting red tape, Brexit will increase bureaucracy and costs for the pharmaceutical industry, the NHS and patients—and that is even before the possible impact of a United States trade deal on drug costs.

I am concerned by the threat to walk away from negotiations in June and move towards a no-deal outcome yet again. That would increase the risk to patients. Simply calling it an Australian deal does not cut it, because the Australians do not have a trade deal with the EU. I should like to know whether the Prime Minister or the Secretary of State has somehow solved the problem of supplies of insulin and medical radioisotopes, not just for a couple of months around the transition point but in the long term. The UK does not produce insulin or medical radioisotopes, and any friction at the border—which at present looks inevitable—will increase costs and delay access.

I also find it concerning that despite covid-19, which initiated a Cobra meeting this morning, the UK apparently does not even want to remain in the PANDA—Protocol for the Assessment of Nonviolent Direct Action—early warning and response system of the EU post-transition. Such isolationist policies are dangerous for everyone: for our constituents, and for our patients. We cannot get away from it: Brexit is a loss to healthcare and research, and the Bill cannot stop that. The principle of collaboration is central to the EMA, the European research network and, indeed, the EU itself, and it will be hard to replace that if we are throwing up barriers.

[Dr Luke Evans (Bosworth) (Con)]

I congratulate the hon. Member for Central Ayrshire (Dr Whitford), who has made me feel rather nostalgic. Listening to her speech gave me a flashback to when I used to go to Grand Ronde and hear someone speak so eminently plausibly in many a debate of which I had very little understanding.

Let me make this declaration now: I am a simple GP. When I entered the House, I always said that I would speak about the coalface and what really affected me at that point, and that is why I felt that I needed to speak about the Bill today. I welcome it because I approve of the emphasis on the creation of a world-leading research-driven, standards-based clinical care framework that can drive the UK forward, but two aspects have struck me in particular. The first is prescribing, and the second is trials and tests.

Members on both sides of the House have broadly welcomed the provision for new prescribers, and the flexibility for that within the framework. As the workforce and the demand grow and as the roles change, that new prescription will be necessary. I agree about the importance of ensuring that those prescribers have the necessary due diligence, training and registration, which, after all, will provide the safeguards and the accountability that are needed when it comes to writing a prescription. However, I think that the Bill has missed the issue of prescription waste, or waste medication. On numerous home visits doctors see piles of unused medication, and that does not apply only to their patients: there is a crossover in hospitals and, of course, in care homes. Some of it is purely coincidental as people are taken into hospital or from hospital into a care home, but there is a huge amount of it, and, anecdotally, doctors see it all the time. I have seen patients hand in up to 100 boxes of, say, warfarin, and that cannot be right.

When I consulted the House of Commons Library, it came up with a figure of £300 million a year in losses from 2011 on the basis of only one study. That suggests to me that, over a decade, it is hard to find sufficient information. Last week I spoke in the debate on the Environment Bill, one of whose first principles is that any other legislation should consider environmental impacts. I think that this Bill would do well to take account of prescription waste, which it could do that in a couple of ways.

Pharmacies and, indeed, any dispensers could be asked to legally collect the statistics on returns. That would allow us to see how big the problem actually is, and allow us to create solutions. It might sound strange for someone who has worked in the workforce and had lots of paperwork to be suggesting more paperwork, but at least if we open up the statistics, I am confident that my medical colleagues would look at them and see a way to resolve this.

I would also argue that we should review the charitable donation of medications. I freely admit that there are issues over their storage and over how to check the safety of this practice. However, the problem is not insurmountable if the medications are returned in their original state. If the Government do not address the matter in this Bill, I suggest that they might want to consider it going forward. We could, however, consider a more severe statutory obligation on pharmacies, care homes and dispensers to be far more vigorous in the way in which they dispense their medications and follow up, particularly for repeat prescriptions. Things such as emollients, moisturisers and day-to-day painkillers often pile up and end up on repeat prescriptions, and it is quite hard to monitor them. As someone who has written hundreds of prescriptions in a day, I know that it is very easy to sign them off rather than check them, and if there is no obligation for me to check whether the patient actually needs the medication, who does that responsibility fall to? It is arguably the patient, but if that is not happening, and if there is as much waste as we think there is, I suggest that the Government might want to consider that issue.

[Jim Shannon]

I recognise the fact that the hon. Gentleman is a GP. I declare an interest, in that I am a type 2 diabetic. At my surgery, my doctors and those who are in charge check my prescription every time to make sure that I am not over-ordering or getting more than I should be getting. Some GPs are doing that already and thereby controlling what medications people get.

[Dr Evans]

Absolutely, and I agree with the hon. Gentleman that that is exactly what a GP should be doing. However, when a GP is dealing with hundreds of requests for repeat prescriptions, it is unlikely that they will have time to phone every single one of those patients to say, “Is this what you need? Have you already got it?” That has been the role of clinical pharmacists, particularly in relation to people who have multiple prescriptions for four, five or six medications, at the time of their medication review, which I entirely agree with. A GP will indeed look at a medication review, but when someone asks for a repeat prescription, they usually do it either electronically or by making a simple mark or cross on a piece of paper that they take to the GP surgery. It is unlikely, if the prescription has already been set for six or 12 months, that there would be a review of the prescription each month. That is the whole idea of having an annual review. In the old days, people could be on medications for months, if not years, without ever being checked. The reason for doing that was convenience. If a patient had to come in to see their GP every month to justify why they wanted their medication when their condition, say diabetes, was stable, that system would not be sustainable, given the current pressures on the NHS.

My second point relates to trials and tests. For me, another element that is missing from the Bill is a duty of care. I would like to give an example of a patient who came to see me who had had her genome sequenced. She came in with a report, and she said, “Dr Evans, I have been told I have a 50% chance of having cardiovascular issues and an 80% chance of having Parkinson’s disease. Please can you help me out?” That was very difficult to deal with. First, there is as yet very little we can do to influence Parkinson’s. Secondly, at that point I had had no training on counselling someone who had had genomic testing. The cardiovascular side was easier: we know some remits, and we can make a difference with cholesterol, exercise and lifestyle advice. But this is just the tip of the iceberg, and as the tests become more advanced and more people have them, I would like to see emphasis being put on ensuring that those doing the tests have a duty of care to ensure that there is follow-up and comeback for the person who has the test.

--- Later in debate ---

[Jim Shannon]

It is important that is put on the record. There was a question in the other place today on this very issue of organ harvesting. The hon. Lady and I, like others in this House, recognise that commercial organ harvesting is happening in China. Is it not important for our Government, and for all responsible Ministers, to contact the Chinese authorities directly to ensure that organ harvesting does not take place? It is not just the Uyghur Muslims but Christians and those of other ethnic minorities, too. They are all being discriminated against for being alive.

[Ms Rimmer]

The China tribunal report was issued yesterday, and it clearly states that organ harvesting is being done in a commercial, business-like manner. It is absolutely horrendous. People are being taken into prison for nothing, and their DNA is taken. A doctor who now drives an Uber taxi in London was forced to remove the liver and kidneys of a Uyghur Muslim while he was still living, which is horrendous. I and a number of others intend to get this resolved. We must ensure that medicines entering the United Kingdom have not been tested on or developed using those organs or any other human rights abuses, and I am sure the Government are aligned with me on this issue.

If appointed to the Public Bill Committee, I hope to move an amendment on this issue, on which there is cross-party support in both Houses. In the light of this week’s stories in The Guardian and The Daily Telegraph about major companies profiting from Uyghur slave labour, it seems there is no indignity, no suffering, that those poor people are not forced to endure. The trade in their organs must surely be one of the most wicked crimes against humanity of the 21st century. This Bill will provide the House with one small opportunity to strike a blow on their behalf.

Domestically, we must ensure that regulators are properly equipped with the resources and financial support to take on the new responsibilities outlined in this Bill so that we do not place more stress on an already overstretched NHS system. We must also better understand how the Government intend to monitor the effectiveness of those regulations and regulatory bodies, as well as the nature of their role in doing so.

The NHS is one of our nation’s greatest achievements, and any attempt to make it stronger is always to be welcomed. We must make sure that the United Kingdom’s health industry and the NHS help to make the lives of our citizens and those abroad safer, healthier and more dignified.

Coronavirus

Jim Shannon Excerpts

Wednesday 26th February 2020 Commons Chamber

[Matt Hancock]

I am very happy to do that. More broadly, I am open to ideas on how to improve our response, including learning from where things have not gone well. Our approach is to make the UK response the best it can be—that is my only goal—and when there are good ideas, such as that one from my hon. Friend, we will act on them.

[Jim Shannon (Strangford) (DUP)]

I congratulate the Secretary of State on his clear leadership on this matter and his determination to deal with the issues. He referred to schools in Northern Ireland. Some of them have concerns about upcoming trips that they have planned and paid for in advance. What advice can he give to schools in Northern Ireland and across the United Kingdom? Should they travel?

[Matt Hancock]

The critical thing is to follow the Foreign Office travel advice, which is informed by the evidence, including evidence from scientists. It is kept constantly under review and is clearly published on its website.

East Leake Health Centre

Jim Shannon Excerpts

Tuesday 25th February 2020 Commons Chamber

[Ruth Edwards (Rushcliffe) (Con)]

I am most grateful for the opportunity provided by tonight’s debate to highlight the situation in East Leake health centre in my constituency, where patients are in great need of an upgraded new facility. I will highlight the problems and constraints that they face with the current building. I will also set out the huge opportunity we have to co-locate primary, social and community care services, offering patients a wider range of services in one place within their community and taking away the need for them to travel to Nottingham for out-patient services, and in doing so relieving pressures on nearby hospitals such as the Queen’s Medical Centre, providing care for a much larger population, which will increase further in the next few years, and enabling the delivery of joined-up services in line with the Government’s objectives for primary care networks.

I thank the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Bury St Edmunds (Jo Churchill) in advance for responding to the debate today. I would be grateful to hear what plans the Government have for investment in the primary care estate and the mechanisms and timetable by which such funds might be made available. I also invite her to see the strength of our bid in person by visiting East Leake health centre with me.

East Leake is a large village in the south-west of my constituency. It has seen significant growth due to the building of 1,300 new houses in recent years and is earmarked to take a minimum of 400 more in the current local plan period. Local people are worried about the fast rate of new housebuilding. They are concerned about whether the number of school places and GP appointments can keep up with demand. East Leake health centre is rated as outstanding by the Care Quality Commission and by its patients. Residents tell me that their care at the centre is excellent, but they are concerned about how busy it is becoming. I would like to take this opportunity to put on record my gratitude to the doctors, nurses and all the support staff for the excellent job that they do for their patients in challenging conditions.

The current health centre is owned by Rushcliffe clinical commissioning group. It is the oldest in Nottinghamshire. It is a prefabricated building constructed 60 years ago, and it is no longer fit for purpose. There are problems with the fixtures and the services on the site. There are constant leaks when it rains, leading to regular flooding. As a result, parts of the already over- crowded practice are often unsuitable for patient use and have to be closed off.

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Lady on getting her first Adjournment debate. It will be the first of many, I have no doubt. I congratulate her as well on fighting hard for her constituents. I spoke to her beforehand.

[Mr Speaker]

And she will always have Jim intervening.

[Jim Shannon]

To support the hon. Lady; that is why I am here.

Does the hon. Lady agree that a vibrant and smoothly functioning health centre is a key facet of any local community, that if more funding were given to this frontline service there would be less unnecessary pressure on A&Es and that we really must get back to having GPs and nurses in place and functioning to provide an acceptable standard of the national health service?

[Ruth Edwards]

I thank the hon. Gentleman for his sensible intervention and his points, which I completely agree with. I shall be going on to make those points myself in a couple of moments.

The Minister may have received a photograph from me showing half of the waiting room in East Leake screened off, the floor filled with buckets and water; we had leaks coming in through the ceiling. If a new building is not constructed, substantial sums will still be needed for essential maintenance just to keep the current one functioning. Simply maintaining what is already there will not offer the best value for money, given the huge increase in the number of patients the practice is now serving and will need to serve in years to come.

Wuhan Coronavirus

Jim Shannon Excerpts

Tuesday 11th February 2020 Commons Chamber

[Matt Hancock]

This will be new money to those NHS organisations bidding for it, and we have not put a cap on it. We are inviting bids from NHS organisations and will very rapidly assess those bids.

[Jim Shannon (Strangford) (DUP)]

With universities in Northern Ireland cancelling trips to China individually, can the Secretary of State outline whether the Government intend to issue guidelines to stop travel between and to infected areas? Further, is there any intention to do routine tests on anyone recently returned from the infected areas?

[Matt Hancock]

We have enhanced monitoring in place on flights from the areas I mentioned, which is important, and of course we keep all options under review, because the most important thing is to follow the scientific advice wherever possible and to keep people in this country safe.

GP Provision: Pilsley

Jim Shannon Excerpts

Monday 10th February 2020 Commons Chamber

[Jim Shannon (Strangford) (DUP)]

The hon. Gentleman is illustrating an issue that is apparent in not only his constituency but across the United Kingdom, including in my constituency. The availability of GP appointments is fast becoming a nationwide crisis, which is adding to pressure on minor injuries units and A&E departments. Does he agree that there must be direct funding to encourage medical students to commit to a five-year placement in a GP practice, in exchange for student loans, Province-wide and UK-wide? That may be a possibility.

[Mark Fletcher]

It is a delight to receive an intervention from the hon. Gentleman. As I understand it, he is slightly notorious for doing so. He strayed slightly from what I wish to speak about this evening, but I thank him for his support, as do the people of Pilsley.

As I was saying, on the face of it, this is about difficulties in recruiting and retaining GPs. That is why this Government have committed to recruiting 6,000 more GPs and 26,000 primary care staff other than GPs. We know that there is a particular issue with meeting increased demand at GP surgeries, and we are addressing that challenge head-on with a three-pronged approach: recruiting more GPs; recruiting other staff such as nurses and pharmacists, who can often deal with more routine appointments; and finding new ways of working, such as telephone appointments. That is why I wrote to the Secretary of State asking for a meeting with myself and Staffa Health, to discuss alternative ways of working—a meeting that I believe he is happy to arrange.

But if I were being a cynical man, I would suggest that the top line about GP recruitment is a cover for other reasons why Staffa Health wishes to go ahead with this closure. In the frequently asked questions section of the consultation letter, there was a section headed,

“How would it help Staffa Health by closing the Pilsley surgery?”

Five reasons are given. The first is, as previously covered:

“Enabling us to review and improve access to GP appointments without having to spread staff thinly over four sites”.

The second is:

“Allowing us to redesign the way we provide some aspects of the service. We plan to improve access to same day urgent care, telephone and online consultations”.

I am at a bit of a loss as to why the closure of a surgery is required for that to happen. The third reason stated is:

“Reducing some of the activities that are duplicated across multiple sites, providing greater efficiency”.

I suspect that that might be the most important reason. I think that the finances of the closure may be a considerable factor in this proposal, and if I am right, I wish that Staffa Health would come out and say so, rather than hiding behind other factors.

The fourth and fifth reasons given are:

“Giving the Practice a greater ability to support doctors, nurses and pharmacists in training by supervising them on fewer sites”

and

“Making the practice a more attractive place to work due to a more supportive, less stressful and less isolated working environment”.

What both those points skirt over is the impact that this will have on residents in Pilsley, who are unanimously against this closure. Of course it is important to think about the morale of staff and the quality of their training, but if doing so results in the plummeting morale of patients, is that a good decision? There are serious concerns about the impact the closure will have on the residents of Pilsley, especially those who cannot drive or suffer mobility issues. The village has a higher proportion of elderly residents than most of my constituency, and there are three major issues that I want to raise today.

The first is public transport. The consultation document points out that the other Staffa Health surgeries are only a couple of miles away from the Pilsley surgery, and that there are two public transport routes to them. My inbox and postbags are full of residents’ communications presenting a very different picture. As one email from a Pilsley resident stated:

“Our village has lost one bus service and what is left is erratic and unreliable. I am 72 and currently drive but wonder what will happen in the years to come.”

Do we really want our elderly patients who cannot drive waiting in the freezing cold in bus shelters for a once-an-hour service that is far from reliable? Will this improve their health, or would we prefer them to shell out for a return taxi that will cost about £20, or are we to rely on a commitment to home visits that will surely put considerably more strain on the workforce?

The consultation document says that the practice

“recognises that not all patients would be able or willing to travel to one of the other surgeries. Any patients who may choose not to remain registered with Staffa Health would be fully supported and offered advice on how to re-register with a different Practice.”

However, this is far from adequate. It knows that it is the only surgery available, and those wanting a local doctor will have no alternative. That was the one part of the consultation I was somewhat offended by.

The second issue is the new housing being built in the village. Because it is a fantastic place to live, Pilsley is popular for new housing developments. The Pilsley surgery has 2,800 patients registered at the practice, which has increased by 500 patients since 2017 due to new housing in the area. Other developments, such as the Rockliffe housing development on Green Lane and a site on Gladstone Lane, have been identified for more housing. It is perverse to build new housing in a village while at the same time losing vital infrastructure. We need to have a much more joined-up approach between the local authority, the CCG and Staffa Health, and I suggest that some of the developers building in Pilsley should be contributing financially to local services such as the GP practice.

The new houses will create more demand, and we are going to end up in a position in a few years’ time where we will need to reopen this practice, so let us just cut out this closure. I was particularly amused to read that, because of concerns over parking at one of the other surgeries—in Tibshelf—the plan was to close the Pilsley surgery to patients, who will then have to travel to Tibshelf, but to move administrative staff from Tibshelf to the now closed Pilsley service so as to free up car parking space in the short term at Pilsley. It brought to mind the episode of “Yes Minister” when Jim Hacker visits a new hospital that has no patients, and Sir Humphrey proudly tells him that it is one of the best performing hospitals in the country on many measures.

The third concern I want to raise is the consultation, a lot of which was done online. Not all residents are online and not all residents in Pilsley feel they have been kept up to date on the process. Two brilliant ladies, Sheila Baldwin and Wendy Hardwick, took matters into their own hands and organised a petition against the closure, collecting 600 signatures in three weeks. I applaud their efforts, particularly as Sheila is not online, yet she has galvanised Pilsley into action. She is one of a number of people who have tried calling the surgery in recent weeks only to discover that the options system for the practice automatically transfers them to the test results option. This has added to the confusion and Chinese whispers that are inevitable in a situation of high anxiety.

I brought the consultation up in business questions a few weeks ago, and I know that the CCG is of the opinion that the consultation process for the proposed closure was satisfactory, but I question whether it has explored more than the papers put in front of it. It is clear from speaking to residents in Pilsley that they feel very unsure about who is making decisions, when they are coming, and what impact they will have. We are far too reliant on websites for this sort of thing, and it annoys me that those of us who are tech-savvy gloss over the discrimination this presents to those who are not computer-literate. On behalf of all residents in Pilsley, I thank Sheila and Wendy for all that they have done.

I appreciate that the Government do not have control over this decision: responsibility lies with the CCG. Reportedly—this has not been confirmed to me in writing—a decision will be made at its next meeting on 26 February, although no time or location has yet been provided to me. Equally, I appreciate that a lot of this happened before I was elected. I also wish to state again that I have no ill will towards those who work for Staffa Health, who I am sure wish to do their very best to make their patients’ lives better; I disagree with them on this matter, but I do not question their passion for what they do. But it seems to me that the rationale for this proposed closure is short-sighted. It will adversely impact many vulnerable and elderly patients. It is deeply unpopular, and the best approach would be for us to find a way of keeping this surgery, such a vital part of the Pilsley community, open.

I also fear that the closure of the surgery could see a reduction in services or a potential closure of the local pharmacy, creating a real health blackspot in one of the finest parts of Derbyshire. I know the Minister is particularly passionate about pharmacies, and she knows how vital to communities these local businesses are.

I hope Staffa Health and the Derbyshire CCG will pause this proposal, meet me and the Secretary of State to discuss their issues and reassess what can be done. If any confirmation of the importance of this issue were needed, I might add that when I spoke to Sheila earlier today she told me that a last minute notice had gone out in the community because ITV’s “Calendar”—I am sure you are a big fan, Madam Deputy Speaker—was filming in the local area and wanted people to come out; at incredibly short notice 30 people made themselves available. This is a vitally important issue for the residents of Pilsley and I look forward to the Minister’s response.

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

I congratulate my hon. Friend the Member for Bolsover (Mark Fletcher) on securing this debate about GP provision in Pilsley. We know that general practice is the lifeblood of the NHS, and we understand the essential role that local practices play in their community, and this is particularly the case in rural areas such as Pilsley.

Before I address the specific issue of the proposed closure of the Pilsley branch surgery, I would like to mention the local work that is being done in Derbyshire that partly explains some of the things that my hon. Friend was talking about. First, Derby and Derbyshire CCG has been active in working with NHS England to expand the local workforce, and I am very pleased that three new GPs have been recruited in Derbyshire, one of them indeed by Staffa Healthcare. Secondly, the CCG has made progress in ensuring that GPs remain in the NHS and within general practice in particular, An example of that progress is the “GP Aspire” programme launched by the GP taskforce in Derbyshire. The programme started as a pilot back in 2018 and now provides support to all GPs across Derbyshire at any stage of their career. That includes, among other things, one-to-one careers guidance, signposting for wellbeing, mentoring, leadership and mental health advice. Since its launch, the programme has had some 116 individual contacts from Derbyshire GPs.

Retaining experienced GPs and encouraging more into the profession is the way we will be able to deliver more services across the nation and get more appointments into primary care, so people can get the right care from the right healthcare professional. On that, I add that I understand my hon. Friend’s point about pharmacies because the right appointment with the right healthcare professional for individuals will be hugely important as we begin to understand how to better work with the national health service across all the different healthcare professions.

I turn to the proposed closure of Pilsley branch surgery. As my hon. Friend outlined, the closure of a GP surgery is considered and decided by the local CCG, following the application from a GP provider. Such a decision understandably stirs up strong emotions within the local community, as he explained so well.

An application to close Pilsley branch surgery was submitted by Staffa Health in 2019. On the recommendation of the CCG, the public consultation was launched on 24 June. Staffa Health employed a wide range of feedback approaches during the 60-day period, including: meetings with staff; meetings with stakeholders and the patient participation group; issuing a letter, a “frequently asked questions” sheet and a questionnaire to all registered patients; text-message alerts to raise awareness of the consultation; and three face-to-face drop-in sessions. However, I understand what my hon. Friend said about the use of modern technology and how that may not always cover all patients who access local surgeries.

In addition to the consultation, the local petition calling for the closure to be halted, which got 592 individual signatures, was presented, and I join my hon. Friend in paying tribute to Sheila Baldwin and Wendy Hardwick, who organised it. I commit here and now to ensuring that my officials write to the CCG to ask it to set out how it has fully taken on board the views of the ladies and the broader petition and the action that it intends to take in response. Those local views can often help to deliver the most sensible solutions for everybody.

Following the conclusion of the consultation, Staffa Health decided to continue with its application to close the Pilsley branch to ensure the long-term sustainability of its whole practice across the three other local settings. A report was compiled and submitted to the CCG engagement committee for review on 8 January, and it commended the consultation for being “robust”. The report was also submitted to Derbyshire County Council’s improvement and scrutiny committee, and the final decision regarding the future of the Pilsley surgery will now be made by Derby and Derbyshire CCG’s primary care co-commissioning committee. The committee has been asked by Staffa Health to approve the closure, but to postpone it for a year from the date that approval is given. That postponement is to allow time to increase the number of consultation rooms at the neighbouring Tibshelf surgery and to address car parking issues. Those specific concerns have been raised through the consultation to date.

The committee met on 22 January and decided at the meeting to defer its decision to the next meeting on 26 February, which I understand will be after my hon. Friend has met the Secretary of State with Staffa Health. In the run-up to and following the PCCC’s decision, the CCG and Staffa Health are urged to continue to listen to the concerns that have been raised and to ensure that appropriate action is taken to reduce the impact on the community, which my hon. Friend laid out so eloquently.

As I stated, improving access to general practice is a leading priority for our Government and, consequently, I have asked that I be kept informed about developments regarding the future of Pilsley branch surgery. I understand that workforce shortages have been cited as a reason behind the application to close, as my hon. Friend said, and I appreciate how challenging the situation is for GP surgeries across the country. As the hon. Member for Strangford (Jim Shannon) outlined, it affects all of us, north to south, east to west, and particularly those trying to deliver across large rural areas and multiple sites, where delivery is extremely challenging. As such, I reassure my hon. Friend that tackling this issue lies at the heart of our determination to strengthen general practice and support those who work in it. We are committed to increasing the workforce, providing about 6,000 more doctors and 6,000 more primary care professionals such as physiotherapists, pharmacists and physician associates, on top of the 20,000 primary care professionals to whose funding NHS England is contributing.

[Jim Shannon]

Earlier, I referred to the possibility of a scheme allowing student doctors to commit themselves to five years in a general practice and thereby offset some of their student fees. Would the Department be prepared at least to consider that?

[Jo Churchill]

As the hon. Gentleman knows, we are always prepared to consider anything that will help to sustain the viability of the entire workforce. Offering appropriate career development, for instance, is important to ensuring that we retain doctors, nurses and other healthcare professionals. We do not just want to train them; we want to keep them as well.

Last year Health Education England recruited the largest ever number of GP trainees—some 3,540—but the system is under significant strain, and more trainees will be required to meet our target of 6,000 general practitioners. The five medical schools that are currently coming onstream will be to central to that objective. However, training new staff is only one piece of the jigsaw. As I have said, retention is just as important. The GP contract recognises that, and sets out an ambitious programme of initiatives which, by 2023-24, will support existing doctors. As well as introducing those workforce measures, we intend over the next 12 months to reduce the unnecessary burden of bureaucracy that often restricts GPs.

Our review has been agreed as part of this year’s contract, and will begin with a ministerial round table that will seek input from our partners across Government and general practice. Our aim is to free up valuable time for doctors and primary care professionals, while also ensuring that Government agencies, departments and patients have the necessary access to information. By recruiting and retaining more doctors in primary care, covering a wider range of specialisms, we will reduce the burden of bureaucracy placed on them and create additional capacity over the next five years. However, this is also about delivering care in the most appropriate setting as we strengthen general practice, and at the heart of each and every one of those settings is the patient. That can only work if we listen to the concerns and views of all involved in general practice, both staff and patients.

I commend my hon. Friend’s tenacity. He has lobbied both the Secretary of State and me to ensure that we know about the challenges at the Pilsley surgery, and that we listen and then continue a conversation that involves me but also, most importantly, the Secretary of State when he and my hon. Friend meet Staffa Health shortly. We will act on what we are hearing.

Question put and agreed to.

Historical Stillbirth Burials and Cremations

Jim Shannon Excerpts

Thursday 6th February 2020 Commons Chamber

[Ms Dorries]

I will. If my hon. Friend drops me an email at my departmental address, we will look into that, and the officials will take it away. I am grateful to him for raising that, because I was not aware of it.

I do not think I have missed out anyone who made a speech. We have heard today how important it is to many parents to find the final resting place of their stillborn children’s remains. Unfortunately, that is not always easy or possible, and I have explained that such records are not currently held by the Government. Rather, they are held by local hospitals that arranged for burials or cremations with local funeral directors or crematoriums. In some cases, records no longer exist, or they may not contain enough detail to be helpful.

Nevertheless, I reiterate that the Department of Health and Social Care expects all hospitals to provide as much information as they have available to them to any parents who inquire about what happened to their stillborn babies, no matter how long ago they died. I would like to praise the 800 parents who have attempted to find out where their babies’ remains are, because they have helped to raise the profile of this issue. As the hon. Member for Swansea East said, only by raising the profile do we manage to get something done. We need to continue to do that, because that is how we will make progress.

We have also heard today about the new regulations and systems to ensure that parents are involved, as they want to be, in the burial or cremation arrangements for their stillborn children. Parents are required by law to register a stillbirth, and once registration has been completed the registrar provides parents with all the certification they need to organise their babies’ burial or cremation, and a funeral service if they so wish. The required burial and cremation forms ensure that the wishes of parents are recorded and respected. Many NHS hospitals still do make arrangements for funeral services and support parents to consider various options and to make the decisions that are right for them. Some parents may wish to arrange a private burial or cremation with a funeral director. Most funeral directors do not charge for their services for stillborn babies. Thanks to the hon. Lady’s efforts, the new children’s funeral fund supports parents, as I said in my opening speech.

A funeral can sometimes be a catalyst for people to begin processing a deeply profound loss. At such a time, parents mourning their stillborn baby need as much emotional support, compassion and understanding as possible. However, the quality of support can vary from one maternity service to another. This is why the Government have funded Sands, the stillbirth and neonatal death charity, to work with other baby loss charities and the royal colleges to produce a national bereavement care pathway. The pathway covers a range of circumstances of baby loss, including miscarriage, stillbirth, termination of a pregnancy for medical reasons, neonatal death and sudden infant death syndrome. The NBCP is now embedded in 43 sites, and a further 59 sites have formally expressed their interest in joining the programme.

I would like to talk a little bit about mental health support. The hon. Member for Kingston upon Hull North is a campaigner on this, and she raised mental health during her speech. A couple of weeks ago, I visited nurses who are delivering perinatal mental health care support. As part of the new approach to and new funding for mental health, there are now specialist perinatal mental health community services in all 44 local NHS areas in England, and further developments are planned. Just in 2018-19, this has enabled over 13,000 additional women to receive support from specialist perinatal mental health services, against a target of 9,000.

I spoke to the nurses about the perinatal services that are being delivered, and in that particular trust they have helped 700 women who previously had no assistance whatsoever. It was incredible to hear the stories of how that assistance—the mental health support—is now being given to women. As I have said, all trusts now have in place those perinatal support services, which were never there before. Again, that is a huge step on the path towards delivering services that are focused on women and their needs.

Via maternity outreach clinics, we are also providing targeted assessment and intervention for women identified with moderate or complex mental health needs arising from or related to their maternity experience who would benefit from specialist support, but where it may not be appropriate or helpful for them to accept specialist perinatal mental health services, so we are even thinking further than that. In those services we are also assisting partners and families, so it is not just for the women, but for their partners and families.

A huge amount of work is being done in this area. I am not saying that we have finished—there is more to be done—but we are making progress. This actually fits in very well with our women’s agenda in the Department of Health and Social Care. The women’s agenda is not just about periods and menopause; it is about so many things. The particular area we are discussing today is a huge part of that.

Hon. Members present for the Baby Loss Awareness Week debate last October may recall that I undertook to write to Professor Jacqueline Dunkley-Bent, the chief midwifery officer in England, to ask if those bereaved by baby death could be included in the NHS long-term plan commitment to develop maternity outreach clinics that will integrate maternity, reproductive health and psychological therapy support for women with mental health difficulties arising from or related to the maternity experience. I am delighted to tell the House that I recently received a letter from the chief midwifery officer confirming that access to these services is available to women and their partners who are experiencing moderate or complex/severe issues, so we have listened and we have addressed that need. At this point, I should pay tribute to Professor Jacqueline Dunkley-Bent for her understanding of and support for my role in helping to deliver better services to women.

As I have said, a funeral can often be a catalyst for helping people to deal with death and stillbirth death, and I believe that that is so important today. It used to be about protecting women or just not holding them in high enough esteem to inform them about what happened, but we now know that actually the opposite is true. As my hon. Friend the Member for East Worthing and Shoreham mentioned, it is important to be involved not just in the death, but in what happened before, during and just afterwards. The question parents have at a time like this is: why? That question needs to be answered, and it does not get answered in a sentence or in a minute. Parents need to know and women need to know. They can only feel as though they have fulfilled their own responsibility to their child when they have explored every avenue and know every detail of what happened.

[Jim Shannon (Strangford) (DUP)]

This debate has been specific to England, Scotland and Wales, and not necessarily about Northern Ireland. I congratulate everyone who has made a speech on their very valuable contributions. After this debate, could the decisions, conclusions and the way forward on the strategy be conveyed to Northern Ireland, where this is a devolved matter, so that we can all work together to help everyone?

[Ms Dorries]

The hon. Member is quite right that this is a devolved matter. However, this is an issue that affects all women in the United Kingdom. He is quite right, so I will ask my officials what discussions take place with the devolved Assemblies and come back to him.

The stillbirth rate in England is falling. As I am sure the hon. Member for Swansea East knows, it was our intention to reduce the 2010 rate of stillbirths by half by 2025. I am delighted to report that we are ahead of that target: in January 2020, we were already ahead of what we are trying to achieve. Since my appointment as the Minister with responsibility for both maternity and patient safety, I have seen for myself how NHS maternity services in England are working hard to ensure that the care they provide is safe and personalised to women’s individual needs.

Many measures have been introduced in maternity services that are achieving this reduction in the rate of stillbirths, and the issues raised in debates such as this on baby loss also make a contribution. We all know that applying pressure and raising the issue pushes the agenda further along.

The efforts have resulted in a 20% decrease in the stillbirth rate between 2010 and 2018. Between 2016 and 2018, there were 760 fewer stillbirths in England than in 2015. That is an enormous achievement, and something that we should be very proud of. There are 760 fewer families who have to go through the painful experience of planning a funeral for a much-loved and wanted child. I think we all know that there is nothing more painful for a woman or a couple than to go into hospital to have their baby and to leave with empty arms and broken hearts. The fact that 760 fewer families are doing that now, as a result of the measures that have been introduced, is a huge achievement.

In closing, I pay tribute to the initiatives that have been stimulated by Members of this House to improve support for families experiencing a stillbirth. These include the national bereavement care pathway, the children’s funeral fund and the Parental Bereavement (Leave and Pay) Act 2018, which provides for at least two weeks’ leave for employees following the loss of a child under the age of 18 or a stillbirth after 24 weeks of pregnancy.

I also pay tribute to the clinical professionals and support staff working in acute and community maternity services. They work incredibly hard. I visit these maternity units and meet amazing midwives who dedicate their lives to being in that room at that moment when a baby is born, to ensure a safe delivery. Through their efforts, many more women and babies are being supported to have a healthy pregnancy, labour and birth. They will be supported nationally by the maternity transformation programme, which will continue to oversee the implementation of maternity safety initiatives, including those published in the NHS long-term plan and the new NHS patient safety strategy, published last July.

I would like to conclude by thanking the hon. Member for Swansea East yet again—we are truly in her debt for the issues she raises in this place—and my right hon. Friend the Member for South Holland and The Deepings for supporting her, or for being her acolyte, as he described himself.

Question put and agreed to.

Resolved,

That this House has considered historical stillbirth burials and cremations.

Children’s Mental Health Week

Jim Shannon Excerpts

Thursday 6th February 2020 Commons Chamber

[Preet Kaur Gill]

The right hon. Gentleman makes that point very well. A lot of research has been done on this by the Royal Society for Public Health. It is a contributing factor—one of which there are so many.

Looking after our children and young people requires children’s and young people’s mental health services to be properly resourced. At the moment, this is simply not happening. Almost a quarter of NHS child and adolescent mental health wards were rated as inadequate or requiring improvement by the Care Quality Commission in 2019. We also know that we have a huge shortage of mental health professionals, with a workforce that has hardly grown since 2010. According to the Royal College of Psychiatrists, we need an additional 4,370 consultant psychiatrists to meet current Government commitments. A recent British Medical Association survey revealed that almost two thirds of nurses said that on their last shift there was a shortage of one or more nursing staff. So can the Minister tell me how these shortages will be addressed?

[Jim Shannon (Strangford) (DUP)]

I thank the hon. Lady for this absolutely superb Adjournment debate on a very critical issue. While there is, as she says, an onus on Government to respond, does she recognise that, as the health charity Place2Be says in early-day motion 137, tabled only this week by me and others—it also says that the theme of this year’s week is Find Your Brave—schools, churches and voluntary sector youth organisations also provide help to children at a time when they need it?

[Preet Kaur Gill]

The hon. Gentleman makes a really important point. Far too often, we do not recognise the work that schools are doing, and the charity sector, especially, has contributed significantly. Importantly, the Green Paper does not recognise that.

Today I want to focus on the public health approach, utilising early intervention and prevention. This is far too often overlooked, but it is a vital part of any attempts to tackle the crisis we are facing. Furthermore, if we fail to support children at an early stage, we will inevitably feel the impact further down the line when emergency services will be forced to step in. That is what we are seeing at the moment, and change clearly needs to happen.

So what am I talking about and what does it look like in practice? Let us take local government. Because of huge cuts by national Government, 60% of local authority areas have seen a real-terms spending drop on mental health services for children that come under the “low level” bracket, which includes early intervention for things like eating disorders and depression. Or let us look at our creaking and failing criminal justice system. Research by Revolving Doors found that children of offenders are three times more likely to have mental health problems or to engage in antisocial behaviour than their peers—and, as I said, almost all 15 to 21-year-olds in custody suffer from a mental health disorder. Reducing reoffending and the number of parents experiencing incarceration is not just a good in itself but may prevent their children from having mental health problems and reduce the likelihood that the child is involved in offending in the future. Will the Minister explain why, in answer to my written question, the Department for Health and Social Care admitted last week that it had

“not made a formal assessment of the adequacy of mental health services or mental health assessment in Young Offender Institutions”?

Let us take community-based mental health services. The Care Quality Commission, in its review of healthcare and adult social care in England in 2018-19, found that 21% and 10% of community-based mental health services for children and young people are rated as “requires improvement” or “inadequate” for the responsive key question.

Take schools, which the hon. Member for Strangford (Jim Shannon) mentioned. Schools in Birmingham are facing a funding shortfall of more than £90 million in 2020, but they are still working hard to fund their own mental health support or arranging peer mentors. Why are they doing that? One reason is that waiting times for referrals—if the referral is even granted—are far too long. Last year, I conducted a survey of schools in my constituency of Birmingham, Edgbaston and discovered that 90% had seen an increase in staff and students suffering from mental health problems. That is not sustainable without a substantial increase in support for our schools. Take looked-after children. According to Government data, they are nearly five times more likely to have a mental health disorder than their peers.

Take poverty. The TUC found that poverty in working households has increased by 800,000 since 2010. Poverty contributes to mental wellbeing. The Centre for Mental Health’s Commission for Equality in Mental Health found that children from the poorest 20% of households are four times more likely to have serious mental health difficulties by the age of 11 than those from the wealthiest 20%.

NHS Funding Bill

Jim Shannon Excerpts

2nd reading & 2nd reading: House of Commons
Monday 27th January 2020 Commons Chamber

[Matt Hancock]

Let me make a little progress, because so many people want to speak.

The purpose of the Bill is to set a minimum amount for the money going into the NHS. I want to set out what the funding in the Bill will be used for and what it will pay for, and also what we are adding on top of that, because the distinction is important.

[Jim Shannon (Strangford) (DUP)]

The Minister heard earlier from another Member about mental health issues, which do not just affect adults but also affect children—those from 10 to 12 or in their teenage years. A great number of children suffer from mental health issues at school. What has been done to help those schoolchildren to address those issues, which needs to happen early?

[Matt Hancock]

The hon. Gentleman is right to raise what is an incredibly important issue. We are rolling out support for mental health practitioners in schools across England. We have just given the new devolved Northern Ireland Government a big funding increase to enable them to roll out those services. Obviously this is a devolved issue, so exactly how they do that is up to them, but we will ensure that the roll-out continues across England and that children get the support they need.

Wuhan Coronavirus

Jim Shannon Excerpts

Thursday 23rd January 2020 Commons Chamber

[Matt Hancock]

Anybody with concerns, be they a student in Hull or elsewhere, should contact their doctor. As the first port of call, 24 hours a day, they can call NHS 111, which has clinical advice available around the clock. All the 111 contact centres have been updated and will be kept updated with the most appropriate advice.

[Jim Shannon (Strangford) (DUP)]

First, may I thank the Secretary of State for his statement and his clear commitment? Throughout the United Kingdom of Great Britain and Northern Ireland, people like you and me, Mr Speaker—you are a type 1 diabetic and I am a type 2 diabetic—have a chronic disease. Those who are diabetic and many others across the United Kingdom worry about the killer impact of this virus.

I note that the United States of America has diverted flights to specific screening areas. I am sure that the Minister and many others in the House saw the news this morning, as I did. On the flight that arrived this morning, there were three different opinions among those coming off the plane: one said that they had had no advice or discussion whatsoever; the second one got a leaflet; and the third one said that they had some tests done before they left China. So it seems that mixed messages are coming out. It is important that we have a clear policy and that everyone flying here and every person here feels assured.

[Matt Hancock]

The hon. Gentleman is absolutely right. We had a divert in place for that flight to ensure that it went to a part of Heathrow where there are the procedures and processes to be able to deal with this issue. There was enhanced monitoring of that flight— not all of that is immediately obvious to the passengers themselves. Crucially, we understand that the Chinese Government have stopped future flights. We will of course keep all that under review.