Infected Blood Inquiry

John McDonnell Excerpts

Tuesday 19th November 2024 Commons Chamber

[John McDonnell (Hayes and Harlington) (Ind)]

On a point of order, Madam Deputy Speaker. I apologise for raising a point of order out of sequence, and I will explain why I am doing so. It relates to the case of Mr Alaa Abd el-Fattah and a point of order that I raised over a week ago. Some Members may recall that he is a British citizen who was imprisoned for his human rights campaigning in Egypt. He has served his sentence of five years and should have been released in September, but was not. His mother, a well-known academic at Cairo University, has been on hunger strike for 50 days. Anyone who has had any experience of hunger strikes knows that this is a critical period.

A number of us wrote to the Foreign Secretary over 10 days ago about this case, urging him to make further representations to the Egyptian Administration to secure Mr el-Fattah’s release. As of close of play today, we have not received a response. Through you, Madam Deputy Speaker, could I urge the Foreign Secretary to respond and, more importantly, take action? I am now fearful for the life of Laila, Mr el-Fattah’s mother, because as I said, the hunger strike has entered its 50th day.

[Madam Deputy Speaker (Judith Cummins)]

The very serious matter raised by the right hon. Member is not one for the Chair, but he has placed his concerns on the record in the hearing of the Foreign Office.

Children’s Hospices: Funding

John McDonnell Excerpts

Wednesday 30th October 2024 Westminster Hall

[John McDonnell (Hayes and Harlington) (Ind)]

I congratulate my hon. Friend the Member for Liverpool West Derby (Ian Byrne) not just on securing the debate, but on his work over the past couple of months or so on raising the funds for Zoe’s Place. He rounded up every Scouser he knew, including those of us who live in exile, and asked them to contribute in some way.

My contribution, to which my hon. Friend made reference, was to do a rendition of “You’ll Never Walk Alone” on the trombone—[Interruption.] “Oh dear”, I agree, but let us be charitable about this. The video was used to say, “If you don’t pay the money, we will keep on playing it.” My brother Brian, an ardent Liverpool supporter, contacted me to ask, “Why were you playing ‘Three Blind Mice’?” This man, my hon. Friend, has nearly raised the money, but I want the message to get out there: we are not yet over the line, and we need it for such a valuable resource.

I also congratulate my hon. Friend the Member for Mitcham and Morden (Dame Siobhain McDonagh) for her work in the all-party group for children who need palliative care. She and Lord Balfe met the Minister, and I believe it was a helpful ministerial meeting. I reiterate the requests that she made of the Minister: the idea of at least extending the £25 million is key, and ensuring that it is ringfenced. It is not that we do not trust the ICBs—eventually they will get into action and will be geared up—but if the money goes directly to them, this will be compete against their other priorities and it is difficult to see how it could be maintained and secure for the future.

Another petition has been raised as well, by Corin Dalby, who wrote to me, calling for £100 million of the money that is raised in fines by the Financial Conduct Authority to be transferred to hospice funding. I think that is worth looking at to fill a short-term gap in the coming period, but the long-term issue is exactly as my hon. Friend the Member for Mitcham and Morden said: we need a comprehensive plan. We accept that that could be a 10-year plan, but people want security over time. I want to see that money integrated into Government funding. Of course, charities raise funds, but additional funds—overall, I think it has to be core funding.

I want to make one final point. I chair a group of unpaid carers, and have done so for the past two years. For someone who is an unpaid carer in this country at the moment, whether they are looking after someone who is sick or a child with a terminal diagnosis, they have almost certainly been thrust to the edge of poverty, because the carer’s allowance is so little. That causes untold worry and stress for those parents, which is unnecessary.

We will see what happens in the Budget today, but I put in a plea and hope that the Government will address the carer’s allowance. It needs a dramatic uplift, which would help to alleviate some of the stress and pressures placed on parents looking after children with a terminal diagnosis.

Ehlers-Danlos Syndrome and Hypermobility Spectrum Disorders

John McDonnell Excerpts

Wednesday 22nd May 2024 Westminster Hall

[The Minister for Health and Secondary Care (Andrew Stephenson)]

It is a pleasure to serve under your chairmanship, Mr Dowd. I congratulate my hon. Friend the Member for South West Bedfordshire (Andrew Selous) on securing this debate on such an important issue, underlined by the sheer number of MPs who have attended this 30-minute debate today. He is a tireless campaigner for people living with Ehlers-Danlos. He was right to bring some of them to the House back in November, and he was right to bring campaigners again today to sit in the Gallery to ensure that their voices are heard. I also pay tribute to my hon. Friend the Member for Watford (Dean Russell), who spoke from the heart about his wife’s personal experience.

May is awareness month for EDS, and I thank the outstanding charities that do so much to support people living with the condition all year round, especially Ehlers-Danlos Support UK. My hon. Friend said that many people may not have heard of the condition. As Minister for Health and during my constituency work, I come across many people living with debilitating diseases, but it was difficult for me to read some of the stories collected by Ehlers-Danlos Support UK that are collated on its website. Multiple stories show what can be achieved when the correct support is provided, such as the story of Ellie Ovens, who began using a wheelchair in 2018 but returned to France two years later to ski again. That underlines what the hon. Member for Blaydon (Liz Twist) said about how the conditions affect different people in very different ways.

As has been said, although there is no cure for EDS or HSD, treatment can help an individual to manage their symptoms and prevent the condition from worsening. Early diagnosis is key to ensuring that patients are offered the most appropriate treatments and are supported to make lifestyle changes to improve their outcomes. NHS England commissions a national diagnostic service for certain rare types of EDS that can be diagnosed using a genetic test. We do not yet have a genetic test for every type of EDS or HSD, but as the Minister for life sciences I am hopeful about what the future may bring—a point made powerfully by my hon. Friend the Member for North East Bedfordshire (Richard Fuller).

[John McDonnell (Hayes and Harlington) (Lab)]

I thank the Minister for giving way; I know that he has limited time. May I add to the four requests that were made by the hon. Member for South West Bedfordshire (Andrew Selous)? With other conditions for which the Government have appointed an individual MP as the champion, we have seen some remarkable results because of that focus. Will the Government look at appointing a particular champion? I think we have seen the person who is in line today.

[Andrew Stephenson]

That is certainly the kind of thing we would want to consider, among a whole range of things.

In the limited time available, I will try to respond to the specific points made by my hon. Friend the Member for South West Bedfordshire. At the moment, diagnosis for these conditions is based on signs and symptoms, usually by a GP. As my hon. Friend knows, NHS England recommends care for patients with non-inflammatory but painful conditions, and that should be provided in primary and community care settings. That brings care closer to home for those patients, in line with our ambition to get every patient the right care in the right place.

World ME Day

John McDonnell Excerpts

Wednesday 1st May 2024 Westminster Hall

[John McDonnell (Hayes and Harlington) (Lab)]

I congratulate the right hon. Member for Bromsgrove (Sir Sajid Javid) not just on securing the debate, but on the groundbreaking work that he did in establishing the delivery plan. We are all grateful for that.

We all come to this debate with our own experiences. My first constituency case was nearly 30 years ago. I remember it well. It was heartbreaking: a young women who had a full-time job, was bringing up her family with two children and was active in her local community and trade union, went down with a condition that she never understood. It was not recognised for a long time, even by a local doctor. There was a lot of stigma attached to it at that time—I think a few members of the media were running stories like that. It took her years and a lot of support before she could come to terms with it and re-engage fully with her life.

Debates like this give us the opportunity to share those experiences, but they also prompt organisations to send us briefings. I congratulate Action for ME on the excellent briefing that it has circulated. It has brought us up to speed on a whole range of issues and focused us in advance. I want to respond in support of the half a dozen demands made by my hon. Friend the Member for Putney (Fleur Anderson). The first is about the recognition of the consequences and scale of ME in our society. One area that we have not explored enough is the mental health consequences of ME. In the cases that I have dealt with, ME has led people virtually to breakdown, because of the frustration of no longer being able to live an active life, as well as facing all the barriers and the stigma. We do not fully understand the range of consequences.

I fully agree with the point about research. Demand is doubling, at least. I was shocked that the figures in the briefing were so low after all this time and all the debates that we have had. Long covid has also brought a new dimension to the debate. I am receiving lots of representations from constituents about long covid; it is like we are going through the ME process all over again. I congratulate Action for ME. As the right hon. Member for Bromsgrove said, the establishment of the centre of excellence in Edinburgh is a huge breakthrough; it will be a world leader.

I thought that the NICE guidelines were being rolled out more effectively, so I was shocked that 76% of ICBs do not have a specialist service. We need to think about how that has gone wrong and what will put it right.

My hon. Friend the Member for Putney made a point about benefits. The Government are yet again reforming the benefit system, and I am worried about the reforms. I have met with a range of disability groups, and people are petrified. There is real fear out there, including among people with this particular condition. Anyone who has assisted a constituent through the appeal process understands how difficult it is to get it across that someone has a fluctuating condition, as was mentioned. I do not criticise clinicians, but there is still a lack of thorough understanding among some clinicians about the condition.

I want to make one further point, which has not been raised. I have come across case after case in which protection at work has not been in place, and people have lost their jobs, promotion, or access to training and so on. The reasonable adjustments that we thought we had built into the legislation have not been made. That needs to be reviewed going into the next period. There will be new employment legislation, certainly if there is a change of Government, and perhaps whether or not there is a change of Government. There are issues about the quality of employed life that have to be addressed, and this is one of them.

I am grateful for the debate, because I will be able to report back to constituents that Parliament has discussed the matter. I have the same confidence that the right hon. Member for Bromsgrove has: when a group of MPs works on a cross-party basis and makes noise like this, civil servants and Ministers listen. I hope that the Minister can report today particularly on the timing of the delivery plan, which will give us so much hope.

[Dame Siobhain McDonagh (in the Chair)]

I will call Jim Shannon next. If he would not mind, I ask him to voluntarily restrict his comments so that at 5.08 pm I can call the Opposition spokesperson for five minutes and the Minister for 10 minutes, because I think people want to hear what the Minister has to say.

--- Later in debate ---

[The Minister for Health and Secondary Care (Andrew Stephenson)]

It is a pleasure to serve under your chairmanship, Dame Siobhain. I pay tribute to my right hon. Friend the Member for Bromsgrove (Sir Sajid Javid) for bringing forward such an important debate ahead of World ME Day on 12 May. As Health Secretary, he laid the foundations for our cross-Government delivery plan, and from the Back Benches he has been a tireless champion for people living with ME. I join him in welcoming his cousin to the House today. I also pay tribute to the ME Association, Action for ME, Forward ME and many other outstanding charities that do incredible work in this area.

I thank the right hon. Members for Barking (Dame Margaret Hodge) and for Hayes and Harlington (John McDonnell), my right hon. Friend the Member for Romsey and Southampton North (Caroline Nokes), my hon. Friend the Member for Devizes (Danny Kruger), the hon. Members for North Shropshire (Helen Morgan), for Putney (Fleur Anderson) and for Strangford (Jim Shannon), the SNP spokeswoman—the hon. Member for Glasgow North West (Carol Monaghan)—and the shadow Minister, the hon. Member for Denton and Reddish (Andrew Gwynne), for their thoughtful contributions. I particularly pay tribute to the SNP spokeswoman for the work she has done on the APPG, and to the shadow Minister for coming here today despite his own health challenges.

I will do my best to address as many of the points raised as possible in the time allowed. To start, I will address one of the points made by the right hon. Member for Barking. This is very much a cross-Government piece of work. I will be working very closely particularly with the Department for Education, and others, to ensure that we get this right. It is correct that this is a Health lead, but it is right that it is a cross-Government piece of work.

ME, or chronic fatigue syndrome, is a complex medical condition with a wide array of symptoms. Some people with ME struggle to do even the most basic things that we all take for granted, such as going to the office, seeing a GP, or even taking their children to football. This debate comes at a critical time, as new studies are beginning to pinpoint parts of the brain that affect the condition. A recent report has shown the yearly cost to the UK economy could be above £3 billion. While our understanding is improving, people with ME must receive the right care and support to manage their symptoms and, where possible, to be able to move on with their lives.

Sadly, as my right hon. Friend the Member for Bromsgrove (Sir Sajid Javid) has so eloquently set out today, there has been a real lack of awareness among some medical professionals and the wider public, as also highlighted by my hon. Friend the Member for Devizes and the right hon. Member for Hayes and Harlington. For so long, people were dismissed, ignored or even told their symptoms were all in their head. However, as anyone who lives with ME knows, it is so much more than just feeling very tired; for a quarter of sufferers with severe symptoms, it is truly debilitating.

This is why our delivery plan is vital. As my right hon. Friend the Member for Bromsgrove knows, it has two core principles at its heart. First, we must know more about ME if we are able to improve outcomes. Secondly, we must trust and listen to people with ME to improve their experience. That is why the Government published the interim delivery plan last August, proposing a set of actions on research and education, but also tackling those old attitudes and adapting the language we use to describe the condition. Since then, we have consulted on the interim delivery plan to understand where the plan is strong and where we need to go further. I would like to thank the more than 3,000 people and organisations right across the United Kingdom who took part.

As we speak, officials are analysing thousands of responses and we will publish a summary shortly. These responses will be instrumental in developing the final cross-Government delivery plan, which will be published later this year. I completely understand my right hon. Friend’s frustrations, and he makes a powerful case for publishing the plan before the summer. While I cannot make that commitment at this time, I have assured him privately, and I will do so again today publicly, that I will do all in my power to ensure that the plan is published as soon as possible.

Our consultation had a huge response, which is fantastic, as we wanted the broadest range of voices to inform how we shape the plan, but the responses have also shown just how complex the challenges are. Once we have published our response to the consultation in the spring, it is vital that we go back and work very closely with patient groups to finesse the final plan, which could take some time.

As my right hon. Friend has said, people with ME have for too long been ignored and dismissed. That is why we want to take the time to properly understand the challenges they face and listen to the solutions they propose. It is so important that we get this right. I have heard my right hon. Friend, and I will continue to work hard with officials to come up with a plan that delivers for people with ME as soon as possible.

[John McDonnell]

It would be really helpful if the Minister could write to us about the areas that require the finessing for the eventual final plan.

[Andrew Stephenson]

I am happy to provide an update to Members. I hope that when we provide the summary of the 3,000-plus responses, it will shine a real clear light on that, but I am more than happy to write to everyone who has engaged in today’s debate to provide an update, and perhaps to address any points that I am not able to in the time allowed.

Patients can receive the care they deserve only with timely and accurate diagnosis. Sadly, there is no specific test for ME, which can be challenging to diagnose as it shares some symptoms with other conditions, as set out by the shadow Minister. That is why in 2021 the National Institute for Health and Care Excellence published the new guidelines on the management of ME that several Members mentioned. That was a step forward in helping medical professionals understand the condition so that people could be diagnosed as soon as possible. It also set out best practice for healthcare professionals in the management of ME, and the care and support they should offer patients.

Preventable Sight Loss

John McDonnell Excerpts

Tuesday 30th April 2024 Westminster Hall

[John McDonnell (Hayes and Harlington) (Lab)]

I congratulate my hon. Friend the Member for Wirral West (Margaret Greenwood) on securing this debate. That was a comprehensive and detailed, but succinct, assessment of where we are at. Sometimes, the role of Members of Parliament is to identify an issue before it comes into crisis so that we can advise Government on the action that is needed, and that is exactly what my hon. Friend has done.

When some of my constituents identified this topic as the subject of an Adjournment debate, they approached me to raise an issue I have been dealing with for the last 20 years: people whose eyesight has been damaged as a result of refractive eye surgery, or laser treatment, as some know it. The refractive eye surgery sector is now a huge profit-making industry. Many gain through the use of refractive eye surgery, and their eyesight is benefited, but there are many others—in fact, thousands every year now—whose vision is damaged as a result of the surgery.

Many years ago, a campaign called My Beautiful Eyes was launched by a woman called Sasha Rodoy. Some people will know of her if they have dealt with these laser treatment issues in any way. She is a heroine. Each year, we organise a lobby of Parliament called Bad Eye Day. We bring together individuals whose eyesight has been damaged by refractive eye surgery and their families. When I say “damaged”, for many of them, it is to the point where their eyesight is nearly lost. Many others have heartbreaking stories of losing their employment or being severely disabled.

In 2004, Frank Cook, who was then a Labour MP, introduced a private Member’s Bill to address the issues confronting people whose eyesight had been damaged by refractive eye surgery. I co-sponsored the Bill, which basically called for regulation of the sector. In 2013, I produced a ten-minute rule Bill that reflected many of the proposals that Frank had put forward. We have had debates, meetings with the royal colleges and ministerial meetings. All we have been asking for over the past 20 years is greater regulation—effective regulation—but progress has been limited. Even in the Government’s own inquiry into cosmetic surgery, Sir Bruce Keogh identified laser surgery as something that should be subject to further regulation. To be frank, nothing has followed from all those ministerial meetings and debates, from all the legislation we put forward or from the Government’s own inquiry.

We need effective regulation that runs through every aspect of the process. The first aspect is the marketing and advertising of these treatments. As Sasha Rodoy says, the industry is notorious for making outlandish claims about the effectiveness of surgery. On a few occasions, we have taken companies to the Advertising Standards Authority and they have been found guilty of exaggerating their claims about the treatment.

Secondly, we want regulation of the advice provided to people who commission the surgery. It is about getting appropriate advice, and about whether the individual’s eye is appropriate for the type of surgery. At one stage, we found that advice was being provided by members of staff who were not qualified and were simply selling the product. We want the provision of advice to be regulated, supervised and monitored.

We also want surgical practices and professional standards to be supervised and monitored. I have dealt with several cases in which professional standards have fallen below what we would expect and people have been harmed as a result. When things go wrong, the company will often fail to put things right adequately. It will delay its response and will often try to get beyond the limit when legal action can be taken. Those individuals then have to fall back on the NHS.

Time and again, the NHS has to address complex injuries as a result of laser treatment, yet the financial burden falls not on the companies but on the NHS itself. We have argued that the performance records of those private companies and, if necessary, of the surgeons involved should be published to identify where harm has been caused as a result of action taken. Where NHS involvement is needed to correct or address the concerns that people have been left with, maybe there should be a levy on those private companies so that the cost burden does not fall on the NHS.

We are now 20 years on from that first piece of legislation, which Frank Cook brought forward because—if I recall rightly—he had gone through that experience and was interviewed by the media about it. All of a sudden, he received a flood of correspondence from people saying, “The same thing’s happened to me: I’ve had the same sort of injuries.” When I raised the issue in 2013, I had literally hundreds of emails coming in. We have a national lobby each time, and some of the stories are absolutely heartbreaking.

I know that there are demands on the Minister’s time, but it would be really useful if, like some of his predecessors, he met victims of refractive eye surgery who have become campaigners and the professionals they work with, so that we can address the current situation, get an objective overview of where we are and then agree a programme for reform. All that people are asking for is adequate regulation based on monitoring of professional practices, so that they feel protected. At the moment, as my hon. Friend the Member for Wirral West said, there is a real risk of eyesight loss. It is one of the worst things that can happen to people, because they become completely isolated from the world. It is incredibly distressing.

That request fits with the demand for a national eyesight strategy, which is desperately needed. What my hon. Friend described is happening across the country. There is a fear that if we do not address it now, we could quickly get into a crisis as a result of the loss of professional staff to the NHS in particular. My hon. Friend the Member for Leeds North West (Alex Sobel) also mentioned the postcode lottery of access to those services. I hope that the Minister will agree to meet campaigners on this issue, which is worth addressing, so that at least they can have their say and he can take advice on the programme of reform that we need.

[Sir Mark Hendrick (in the Chair)]

We now move to the Front-Bench contributions.

--- Later in debate ---

[Andrew Stephenson]

As a proud Unionist, I am always happy to learn from different parts of the United Kingdom. After I was appointed to my role, one of the first things I did was to go to Edinburgh and visit various universities and companies across Scotland, and I saw some of the great work going on in Scotland. I also met the then Health Secretary, Michael Matheson, to talk about areas where we can work together, particularly on things such as research. However, we can also trial different things in different parts of the country. Many people in this House talk about regional variations, which can be a concern. Nevertheless, one of the benefits of being able to trial different things in different regions is that we can learn the lessons, learn what works and then build on that best practice.

As well as helping our primary and secondary care sectors to reach their full potential, we have a long-term plan in place to support our workforce and put it on a sustainable footing, which is the first ever long-term workforce plan for the NHS. We have again increased training places for ophthalmologists in 2024 and improved training for existing staff, helping them to deliver for patients while reaching their full potential.

The right hon. Member for Hayes and Harlington raised what sounded like a very important and serious issue. He will forgive me for saying that this area is not my specialist subject, but I am happy to raise his concerns with my right hon. Friend the Member for South Northamptonshire. However, I will say now, in response to his comments on laser eye surgery, that refractive laser eye surgery is not generally available on the NHS. Doctors who perform such surgery must be registered with the General Medical Council and the Care Quality Commission. All locations where refractive eye surgery is carried out should be monitored and are required to report any adverse events. As I say, I will be happy to relay his concerns to my right hon. Friend.

[John McDonnell]

I appreciate the Minister’s response; that is really helpful. It would also be useful if a Minister met some of the families who have experienced issues in this area, because over the last 20 years we have had the same ministerial response with regard to regulation, and there have just been too many examples where that regulation and monitoring have not worked and therefore people have been endangered. That is why in the Government’s own report Professor Sir Bruce Keogh recommended further regulation; I think we need to revisit that.

[Andrew Stephenson]

I thank the right hon. Gentleman for making those points. I am not instinctively anti-regulation; indeed, just a few weeks ago I put through this place the statutory instrument on the regulation of physician associates and anaesthetist associates. There are certain parts of the healthcare sector where regulation is very much needed and I would very much advocate for it. As I have said, I will defer to my right hon. Friend the Member for South Northamptonshire. This is her ministerial responsibility, and I am sure she will read the right hon. Gentleman’s comments with interest and may want to take the discussions further.

Finally, on research, the Government are backing scientists and researchers to take strides in understanding sight loss and in making new treatments available. Two years ago, we awarded £20 million to Moorfields Biomedical Research Centre to undertake another five years of vision research, and almost £6.5 million to Moorfields Clinical Research Facility to support cutting-edge treatments for all eye conditions.

Eye care services face challenges and we are taking decisive action to address them, both now and in the long term. The hon. Member for Wirral West and I will never agree on the use of the independent sector. I strongly believe, and think the Labour Front Bench team strongly agrees, that using the independent sector enables us to fully realise our healthcare system’s capacity and to reduce the time that patients spend on waiting lists. I would argue that that does not represent any move to privatise our NHS. As I have said on the record before, the overall proportion of NHS England’s spend on independent sector providers has not increased significantly in recent years. In 2013-14, 6.1% of total health spending was spent on the purchase of healthcare from independent sector providers; in 2022-23, the proportion was 6.5%.

This morning, the shadow Minister in the first Westminster Hall debate, the hon. Member for Denton and Reddish (Andrew Gwynne), talked about making better use of the independent sector to help to ensure that we deliver the best outcomes for patients, and the shadow Minister in this debate, the hon. Member for Birmingham, Edgbaston, reiterated that point. On the use of the independent sector, then, I gently say that it is something on which there is broad cross-party support. While recognising that there are always challenges with the use of the independent sector, it is not in any way a privatisation of the NHS.

I firmly believe that through prevention, innovation and investment in our workforce, we will deliver for all our people across the United Kingdom access to the important healthcare services, including ophthalmology services, that they deserve.

Hospice Funding

John McDonnell Excerpts

Monday 22nd April 2024 Commons Chamber

[John McDonnell (Hayes and Harlington) (Lab)]

I am a trustee of Harlington hospice, and have been for the past decade. I hope to stand down shortly, because we have recruited four excellent new trustees and I am terrified that someone might ask me to run a marathon or something like that.

[Eddie Hughes (Walsall North) (Con)]

Together with my hon. and learned Friend the Member for Eddisbury (Edward Timpson) and the hon. Member for Glasgow North (Patrick Grady), I did run the marathon yesterday —on behalf of St Giles hospice, for which I raised more than £3,000. May I invite the right hon. Member to join us in that endeavour next year? Let us not allow the opportunity to pass.

[John McDonnell]

I set myself up for that, didn’t I? I congratulate all those who did run, but running a marathon might well see me off.

Over the last year or two, our hospice has merged with the Michael Sobell sports centre. We now provide a bedded unit, daycare facilities, respite care—particularly for unpaid carers—and a hospice-at-home service. My hon. Friend the Member for Hammersmith (Andy Slaughter) said that debates such as this allowed us to pay tribute to organisations, and I certainly pay tribute to Harlington hospice. I pay particular tribute to the volunteers, including the chairs over recent years. I hope they will not mind my naming them: Brian Neighbour, who was formerly one of our local councillors, Carol Coventry and, now, Michael Breen. These volunteers give up their time and bring their professional skills to this work. We have a wonderful medical director, Ros Taylor, and an incredibly hard-working chief executive, Steve Curry. Their efforts provide the services and have enabled us to survive, but it has been tough. Like the hospices mentioned by a number of other Members, we have just had to lay off some staff. There is nothing tougher than having to lay off staff who are so dedicated.

The issue for us, as always—this has been reflected throughout the House today—is the need for core funding on a sustainable basis. We need something like a five-year plan that we could work to. I know that sounds a bit Stalinist, but sometimes they work; sometimes they do produce the tractors! We need consistency over a period. As Members on both sides of the House have said, including my hon. Friend the Member for York Central (Rachael Maskell), if we could rely on staff funding from the state, that would lift the burden to a certain extent. We will continue the fantastic fundraising that is currently happening, but in a working-class community like mine, during a cost of living crisis, it is not that people do not want to give, but they do not have the resources to give. We have had a bit of a rough time now and again. A number of corporate organisations have helped us through, but even then, when they are looking at their margins during an economic recession, or when times get hard, there is a downturn for us as well. We just need the consistency of funding over a period that will enable us to build on our services.

At present our services are swamped, and the range of services is becoming more complex as well. We were providing a lymphoedema service at one point. The complexity of the millions with which we are dealing requires more specialists, and that in turn requires more funding. Although there have been percentage increases in NHS funding, they have gone nowhere near meeting the real costs that are challenging us at present. We have a good relationship with our ICB—we work with bids for contracts, and with other community organisations delivering on the ground—but we want consistency of approach.

We have organised a conference for 8 May. It is called “Death, Dying and all that Jazz!”, and it will bring together a range of clinicians and others, along with Hillingdon Hospital and other volunteering services, under the auspices of Harlington hospice. We will look at what we are undertaking, what is needed, and how we plan for the future. If the Minister would like to visit the conference or send representatives, we would welcome that. We want to engage in discussion. We are coming up to a general election, but I hope that this will not become a general election issue, because what we have seen in the House and in the work of the all-party parliamentary group, which I commend, shows that there is consensus on the core principles of the way forward.

If we could secure a long-term commitment on a cross-party basis, we could go back to our hospices, talk to our executives and trustees, congratulate them on what they are doing, and give an assurance that they will have a rock-solid financial base on which they can build, thereby allowing them to rise to the challenges in our communities.

My final point is about the demand that we face. Eight people die in hospital for every person who dies in a hospice, yet most of those eight people would prefer to die either at home or in a hospice. That is the challenge we face, and we have seen tonight that we have the wherewithal to meet that challenge, and ideas on how to do so.

--- Later in debate ---

[Jim Shannon (Strangford) (DUP)]

I thank the hon. Member for Hastings and Rye (Sally-Ann Hart) for setting the scene so well, as well as all those who have made substantial contributions. Hon. and right hon. Members have been incredible in their joint efforts to support hospices across this great United Kingdom of Great Britain and Northern Ireland, and I want to add my bit from a Northern Ireland perspective.

There will be no Member in this House who has not had some form of contact with hospice care, either through our roles as Members of Parliament or in a more personal nature, as many of us have. I will tell the House a quick story about that. We cannot talk about hospice care without acknowledging the level of care that is provided by the world- class staff in hospices. Every one of us knows that, having dealt with those who give that care. Having seen the work that they carry out and the compassion with which they do so, I know that it is certainly a calling, because money could not pay enough to deal with the emotional toll of this work.

I knew a lady who worked as an occupational therapist in the national health service, and we got on quite well. She went on holiday to Greece one September, and she came back and went to the hospice. She was not feeling well, and the doctor told her that she had only four weeks to live—she had cancer of the liver. I remember going to see her at the Marie Curie hospice care headquarters on Knock Road, Belfast; it was my first introduction to hospice care. I said to the girl on the desk, “Would you tell Anne that I came to speak to her?” And the lady said, “Just a minute, and I’ll go and see if she wants to speak to you.” I said, “No, don’t worry about that, because it’s not important—just tell her I called.” I realised that day that Marie Curie hospice care is incredible, having seen what it did for Anne and her family.

As I said in my intervention on the hon. Member for Hastings and Rye, I believe that faith and family are important whenever our heart is breaking and our world is falling apart. The Marie Curie hospice in Belfast makes sure that people have faith to help them through those difficult times, which is important.

From offering light-hearted banter while helping people in embarrassing situations to being the scapegoat for anger or frustration, to being the last person to hold a person’s hand when their family do not make it in time, being a care giver in a hospice is more than a job. From the bottom of my heart, and from the bottom of all our hearts, I thank all those who do what most of us could not do—love and serve to people’s last breath, day in and day out. I thank every healthcare attendant, every nurse, every doctor, every porter and every pharmacist, and the entire team who provide the best end of life care and offer a support system to lost and grieving families.

[John McDonnell]

The shops that do the fundraising for our hospices have been mentioned, but an unmentioned group of heroes are the shop volunteers who provide a wonderful service in my constituency—a wonderful recycling service, as well—and funding for many of our hospices.

[Jim Shannon]

That is good to remember. I will mention the volunteers.

The hon. Member for Walsall North (Eddie Hughes) is no longer here, but he mentioned a sponsored walk and encouraged the right hon. Member for Hayes and Harlington (John McDonnell) to be involved. Like the right hon. Gentleman, I could not run a marathon, and I probably could not walk it, but he and I could probably dander it—that is the third category. We are danderers. I could do 26 miles, but it would be at my own pace. I am sure everyone else would be on their way home whenever he and I crossed the line—that is a story for another day.

We cannot pay hospice workers enough, but we have a responsibility to ensure that there is enough money to pay them. I do not feel we are currently doing enough, as other Members have said very clearly. The consensus is that we all want to see them paid better, and we want to see the care continue.

Northern Ireland Hospice provides specialist palliative care for more than 4,000 infants, children and adults in Northern Ireland with life-limiting conditions. The charity, which includes the only children’s hospice in Northern Ireland, says that it faces a number of challenges,

“not least of which is the ever-growing cost of this service. Government funds approximately 30% of service costs”.

The hon. Member for Darlington (Peter Gibson) spoke about Foyle hospice, which has to find 65% of its service costs. Well, every other hospice in Northern Ireland has to find 70%, relying on the

“goodwill and generosity of voluntary donations and other fundraising activities.”

Eating Disorders Awareness Week

John McDonnell Excerpts

Thursday 29th February 2024 Westminster Hall

[John McDonnell (Hayes and Harlington) (Lab)]

I congratulate the hon. Member for Bath (Wera Hobhouse) not just on securing this debate, but on her dogged pursuit of this issue over the years. The Minister should be aware that the all-party parliamentary group on eating disorders is one of the most active and effective in Parliament, as a result of her work. She has collected around her hon. Members, such as my hon. Friend the Member for Sheffield, Hallam (Olivia Blake), who are extremely committed in representing their constituents.

We all come to this issue as a result of dealing with our constituents and the hardships that they have faced. I thank Hope Virgo for her work, her campaign and the book she has written. If it was not for her, I do not think we would have been on this agenda as effectively as we have been in recent years.

I thank the Government as well because, early on, they recognised that there was an issue and brought forward some resources. I am grateful for that, but this is one of those issues where things are moving so rapidly in terms of the scale of the problem. We will have to come back to the Government regularly to look at how we top up those resources.

Much has been said about the statistics. I heard the figure of 1.25 million people mentioned and others have said 1.6 million, but it seems like a bottomless pit. The health survey was really interesting. If I remember rightly, it looked at those who had the potential for an eating disorder, so it was trying to get ahead of the numbers, and it said that 16% of the population—19% of women and 13% of men—could be at risk. One of the issues that the APPG has been really good at breaking through on is that this is not just about women; a large number of men are also affected by this problem, and that needs to be addressed.

In all these debates, we try to get across the impact and, to a certain extent, highlight to our constituents that we understand how their lives are affected. Of course, the mental health issues are fundamental. There have been suicides and deaths, but there has also been an outbreak of self-harm among people suffering from this condition. People have reported that there has been an impact on their ability to work, meet socially and engage in a full life. What has worried me most is the huge increase in the numbers being admitted to hospital—I think there has been a fourfold increase in recent years.

As has been said, this is the mental health condition with the highest mortality rate. Part of that is because there is a mismatch between the scale of the problem and the resources available, and that includes the number of hospital beds. I understand that there are only 450 specialist beds, but the admission rate is about 20,000, so there is a startling difference between what is needed and what has been provided.

[Wera Hobhouse]

Does the right hon. Gentleman agree that the biggest problem is that for too long, this condition has been seen as a lifestyle choice rather than an illness? We still need to make a breakthrough on that.

[John McDonnell]

Thanks to the work that the hon. Lady, the campaigners and others have done, the media reporting of this issue has, to a certain extent, changed dramatically, but that has taken years to achieve. I agree that this is still seen as a lifestyle choice. It is not seen as serious; people do not relate deaths to this condition, but we all know from dealing with our constituents that that is what happens.

The other issue about the access to hospitals and clinics is that we have all had to map out, across the country, where constituents can go. Often, what happens is that they are discharged from one unit and it is then almost impossible to get them into another, particularly if there are specialist concerns.

The issues that we are reiterating today include the fact that the funding needs reviewing again, because the situation has moved on since we last discussed funding with the Government. There is also a lack of clarity, so we need a concrete action plan for the coming period. One of the issues is how we bring people together. There is a real concern about the lack of monitoring. One of the proposals, which I think Hope Virgo first raised, is to have a discussion about how we are monitoring this situation, both in terms of incidents and the effectiveness of different treatments. A proposal from one of the discussions we had is that it is time to bring together again those with experience of the condition and the key clinicians in the field, so that we can stand back and objectively look at where we are at. When we have dealt with homicides and suicides in other fields, we have set up independent inquiries because of the seriousness of the matter. In some instances, I feel that we need some form of inquiry to see where we are at and what is needed in the future.

The hon. Member for Bath and my hon. Friend the Member for Sheffield, Hallam mentioned the staff. The impression I get from the discussions I have is that, because of the increasing demand, staff are experiencing a level of exhaustion and a morale issue about simply being able to cope with the numbers and severity of the conditions they are dealing with. One thing we can do today, as others have, is to acknowledge the commitment and dedication of those staff, while recognising that they need greater support, in terms of both numbers and pay, to demonstrate just how valued they are.

The issue around the NICE guidelines has already been raised, and my experience is the same as others’, really. It is hit or miss; there is a postcode lottery in the provision of treatment under the guidelines. The Dump the Scales campaign by Hope Virgo and others has been effective at moving the debate on from just talking about BMI, so that a wider range of discussions are now taking place, which I really welcome. However, there is still no recognition across services that eating disorders are a mental health issue, and that therefore mental health practices that have been effective elsewhere need to be applied here. I argue very strongly for the need to fund cognitive behavioural therapy, which has a success rate of 70%, I think. It has also reduced readmission rates down to about 15%, so it is a huge money saver for the NHS. Again, we need to look at the levels of investment, both in training staff for that and in ensuring access.

I want to mention another issue that has been raised before. We have found too many examples of the provision of palliative care to eating disorder sufferers, which we are hoping will end. Palliative care should be offered only if there is another life-threatening condition; it should not be offered just because of this condition. We hope that that has now been ended, but it needs monitoring again to ensure that the message is out there. Our overall view is that, with the right support and early enough intervention, people’s lives can be saved, and that their lives can be transformed as a result, but it does need adequate funding.

The hon. Member for Bath mentioned the ringfenced fund that is needed for research. At this stage, it is time to stand back, bring together sufferers and clinicians, and look at what the strategy should be. We need an adequately funded, concrete strategy that we can all sign up to. This is a cross-party issue; it is not party political. As I say, I welcome what the Government have done so far. We are now at the stage where we know so much more about the escalation of the problem and the need for therapeutic interventions, and about what works and what does not.

My final point is to pay tribute, as others have done, to all the campaigners who have put this issue on the agenda and provided support throughout. I pay tribute to all the clinicians, of course, and to one group in particular, which is the school nurses—Members may recall that we held a session with them. They brought forward their programme for how they would provide advice and assistance to pupils, which proved to be incredibly effective. Of course, I also pay tribute to all those who have supported the all-party parliamentary group of the hon. Member for Bath with such expert advice, as well as consistent nagging.

[Mr Philip Hollobone (in the Chair)]

We now come to the Front Benchers, the first of whom will be Patricia Gibson for the SNP.

Podiatry Workforce and Patient Care

John McDonnell Excerpts

Tuesday 20th June 2023 Westminster Hall

[Peter Dowd (in the Chair)]

I will call John McDonnell to move the motion, and I will then call the Minister to respond. As is the convention for 30-minute debates, there will not be an opportunity for the Member in charge to wind up.

[John McDonnell (Hayes and Harlington) (Lab)]

I beg to move,

That this House has considered the podiatry workforce and patient care.

The background to this debate is a meeting I had with a number of local podiatrists representing the Royal College of Podiatry, so let me thank them for the briefing that the royal college has sent me. I want to talk about the development of a workforce strategy for podiatry.

To explain for those who may take an interest in the debate, podiatrists are highly skilled healthcare professionals. They are trained to assess, diagnose, prevent, treat and rehabilitate complications of the foot and lower limbs. They manage foot, ankle and lower-limb musculoskeletal pain, and skin conditions of the legs and feet. They treat infection, and assess and manage lower-limb neurological and circulatory disorders. They are unique in working across conditions and across the life course, rather than on a disease of a specific area.

A podiatrist’s training and expertise extends across population groups to those who have multiple chronic, long-term conditions, which place a high burden on NHS resources. The conditions largely relate to diabetes, arthritis, obesity and cardiovascular disease. In addition to delivering wider public health messages in order to minimise isolation, promote physical activity and support weight-loss strategies and healthy lifestyle choices, podiatrists keep people mobile, in work and active throughout their life. They contribute to the wellbeing of our economy and workforce.

Podiatry is intrinsic to multiple care pathways too, and podiatrists liaise between community, residential, domiciliary, secondary care and primary care settings. They specialise in being flexible and responsive, ensuring focused patient care, irrespective of the clinical setting. Podiatrists are at the forefront of delivering innovation in integrated care. They deliver high-quality and timely care, as well as embracing safe and effective technologies that lead to improved patient outcomes.

The role of podiatrists in managing diabetic foot complications is key. They play a vital role in the prevention and management of diabetic foot complications, which, at the last estimate, cost the NHS in England £1 billion a year. In the three-year period from 2017-18 to 2019-20, there were over 190 minor and major amputations per week in England. Of the people affected, 79% will be confined to one room within a year, with 80% tragically dying within five years. That is a shocking outcome for patients, and it is even worse than the outcomes for the majority of cancers we seek to deal with.

The impact of lower-limb amputations on patients’ quality of life and chances of survival are shocking, so we must do everything we can to prevent diabetic foot complications. We have to act in a timely and targeted manner to ensure that people have the best possible chance of living long and fulfilled lives.

It is estimated that by 2025, 1.2 million people with diabetes in the UK will require regular podiatry appointments if they are to remain ulcer, infection and amputation free.

[Jim Shannon (Strangford) (DUP)]

I declare an interest as a diabetic, so I understand exactly what the right hon. Gentleman is saying. I am aware of the silent but vital work carried out by podiatrists throughout the United Kingdom. In my constituency of Strangford, a nursing home where funded podiatry appointments were cut was still visited by a podiatrist. He was able to attend, but he treated people without taking any money. Does the right hon. Gentleman not agree that access to podiatry for the elderly in care homes should be fully funded and that they should not have to rely on family or kind-hearted podiatrists to get their health needs taken care of?

[John McDonnell]

What I have discovered on my journey of finding out about podiatry, which I knew very little about before I met podiatrists in my constituency, is that of course people need professional care, and that care needs to be properly funded. There are volunteers, but we should not have to rely solely on volunteers; we need professionals leading the way. Podiatrists are skilled and trained in the prevention and management of diabetes-related foot complications. That is why many of us believe that they must be at the heart of the NHS plan to eliminate unnecessary amputations and the consequent avoidable deaths.

As I said, the broader cost of diabetic foot ulcers to the NHS is more than £1 billion per year—the equivalent of just under 1% of the entire NHS budget. Effective and early intervention for diabetic foot complications prior to ulceration could save thousands of lives and millions of pounds each year.

The situation in my area in Hillingdon exemplifies what is happening elsewhere in the country, which the hon. Member for Strangford (Jim Shannon) has mentioned. Hillingdon’s community podiatry service is part of the Central and North West London NHS Foundation Trust. It is suffering from severe workforce issues, which is having a detrimental effect on the people delivering the service and those suffering from foot ulceration, infection and amputation.

The service is currently failing to meet its timescales for seeing patients at high risk of developing a foot ulcer. What should be a team of 13 clinical podiatrists is now just 3.5 full-time equivalents and three support workers. The immediate concern is the pressure that puts on the staff who remain and the impact it has on the patients who need a minimum of weekly wound re-dressings to enable healing and prevent infection and life-changing amputation. The opportunities to prevent life-changing and life-threatening complications are minimised by the shortage of staff.

We also have concerns that support workers are being asked to triage and treat people beyond their scope of practice due to the staff shortage. That is not a criticism of them, but it is the reality. We should be filling the service with professionals who are fully trained to deal with the range of complications that they might come across. The workforce challenge facing podiatry is the real issue.

There is a need for focused recruitment. As I said, it is estimated that by 2025, 1.2 million people with diabetes in the UK will require regular podiatry appointments if they are to remain ulcer and amputation free. In the absence of that, there will be a greater risk of premature disability and death. There are currently just under 10,000 podiatrists registered with the Health and Care Professions Council. That is just one per 5,500 residents in England, and that number is due to decline as a result of demographics.

Following the removal of NHS bursaries for student podiatrists in 2016, the number of undergraduates studying podiatry has declined by 38%. Prior to that, the student bursary was set at £9,000 a year and it covered the cost of tuition for a year. In 2020, in a welcome move, the Government reintroduced student bursaries, but at £5,000. That has caused a slight improvement in recruitment to the profession, but it falls far short of ensuring the future of the podiatry workforce that will be required to deal with the oncoming wave of severe diabetic complications coming out of the pandemic.

Another issue is that the average age of podiatry students on graduation is 32. The majority of students are pursuing a second degree, and the need for a second student loan is having a damaging impact on universities’ ability to recruit undergraduates to train as podiatrists. By leaving it up to the market, we face the prospect of not training the workforce required to meet the needs of an ageing population.

The other issue raised with me is the limited career progression in NHS settings. Of the podiatrists currently qualified in England, approximately 40% work in the national health service. It is projected that many of those podiatrists not heading for retirement are likely to move to work in the private sector in the next five years. The reasons cited for that include lack of career development opportunities; repetitive workloads, with limited skill mix; and high demand and low capacity to meet it, leading to what people consider are unsafe staffing levels and to staff burnout.

Expansion of the podiatric workforce across primary, community and secondary services may address some but not all of those issues. Support for workforce growth is critical, but support for those already qualified to progress to advanced clinical practice and consultancy is also critical to workforce retention and ensuring adequate capability in senior clinical, leadership, education and research roles.

We need policy to ensure closer working across providers and the delivery of a foot health strategy. There is significant opportunity to expand the foot health workforce to include non-registered roles, supported by qualified, expert podiatrists. There is also opportunity to consider alternative workforce models that are inclusive of podiatrists working in private practice or the wider foot health workforce in the third and voluntary sectors, for example. A clear workforce strategy is desperately needed now. It needs to explicitly underpin how the foot health workforce is optimally configured, funded, implemented and trained and what the core outcomes of foot health services must be to meet the needs of our future population.

Currently, there is no workforce strategy, no clear statement of aim, and no standardised set of core outcome measures informed by public health or policy. Clear foot health policy is urgently needed to maximise all the benefits that podiatry can offer across an integrated care system, before the profession becomes—as we predict it will—unsustainable, with staffing levels even more unsafe and avoidable patient harms, amputations and deaths relating to lower-limb disease rising dramatically.

I therefore have three key asks. First, I ask the Government to reinstate the £9,000 bursary for student podiatrists. If podiatrists are to be able to support the millions of people who will require their expertise, the Government must reinstate the full podiatry student bursary of £9,000 a year. That is essential if the workforce is to be secured and expanded for future generations. In the absence of long-term funding confidence, allied health professions such as podiatry are unable to commit substantial and consistent investment towards maximising recruitment and retention, both of which will be crucial in securing the future viability of this vital profession.

My second ask is for national collection of podiatry vacancy rates and inclusion of podiatry in workforce planning. Publishing a national workforce plan that considers future need for allied health professionals such as podiatrists must be a priority for the Government. That plan must take into account current trends in recruitment and retention and, for future needs-based public health, comorbidities and their impact on disease prevalence. A national workforce plan will also act as a crucial evidence base for the allocation of long-term workforce funding.

My third ask is for the guidance on integrated care system membership to be strengthened to include allied health professionals. The absence of national guidance or recommendations regarding which organisations and individuals should be included in integrated care partnerships has resulted in a patchwork of involvement for allied health professionals, including podiatrists, in integrated care decision making. Without their meaningful engagement in those discussions, there is a danger that the invaluable contribution podiatrists can make to the delivery of care might simply be overlooked. Strengthened national guidance on the make-up of integrated care partnerships, to include representation of allied health professionals such as podiatrists, should be developed and implemented at the earliest opportunity.

I conclude by thanking the professionals who work in my constituency, as well as those who work nationally. I recognise the pressures they are under and the valiant way that they cope with them.

[Peter Dowd (in the Chair)]

I remind the Minister that the debate must conclude by 4.41 pm.

--- Later in debate ---

[Will Quince]

I thank the hon. Member for his intervention, and I pay tribute to all those who volunteer. This is not the only area in our national health service where volunteers play an important role, but it is important that they are add-on and add value—supporting professionals as opposed to replacing professionals. That is why, at the heart of this debate, we must ensure that we have the podiatry workforce that we need across all four nations—although this debate is specifically focused, understandably, on England.

As the right hon. Member for Hayes and Harlington pointed out, demand for the NHS continues to grow. That is why we have already done a significant amount to invest in the education and training of our future workforce. NHS England—until recently, this was done by Health Education England—has worked extensively to enhance and modernise the podiatry profession. One central factor, which the right hon. Gentleman alluded to, is the development of the foot health standards for the education and training of the foot health support workforce.

However, I am certainly conscious that we have more to do. As part of that process, we developed the podiatry apprenticeship, which is a degree apprenticeship, and supported the implementation of that route into the profession. The numbers are still small, but they are growing, which is great to see. We are keen to promote that route into the profession, not least because it comes with significantly reduced costs for those taking part in the training.

With the promotion of more podiatry apprenticeships, we are offering a more diverse number of training options for students. Furthermore, the learning support fund, which the right hon. Member for Hayes and Harlington pointed to, provides all eligible nursing, midwifery and allied health professional degree students—including podiatrists—with a non-repayable training grant of a minimum of £5,000 per academic year. I say “minimum” because there is an additional hardship element to that of up to £3,000 per year, and additional support is available for childcare, dual-accommodation costs and, where appropriate, travel. The right hon. Gentleman specifically asked for an increase; there are no plans for that at present, but I will of course take that away and have a look at it.

[John McDonnell]

I am here if the Minister needs any assistance in—I was going to say beating—negotiating the Treasury into submission.

I think I mentioned a figure of one podiatrist to every 5,500 people, but I think that I have got that wrong; I think it is actually one to every 55,000 people. That is a huge demand that is placed on podiatrists.

On the Minister’s point regarding the bursary, the British Society of Rheumatology pointed out in one of its briefings that an estimated £15 million a year would be saved on the costs of rheumatoid arthritis if sufficient support was given, particularly through podiatrists. In our argument or discussion with the Treasury, this is therefore an investment that will save money, and we know that directly from the evidence that has been provided.

[Will Quince]

I thank the right hon. Gentleman for his intervention. We are constantly looking at those spend-to-save arguments in areas in the health service where it makes sense to invest. Following this debate, I will gladly look at the podiatry courses and see how over-subscribed or under-subscribed they are, because that may—or may not—help to make the case.

I just spoke about training. Training is important because, of course, we need to see new podiatrists coming in to practise. However, as the right hon. Gentleman mentioned, retention is as important as recruitment. As important as increasing numbers of podiatry trainees is, it is also important to retain the highly qualified, highly skilled, experienced people we already have practising podiatry in the NHS.

I am determined—I know that the Secretary of State is too, because we have had this conversation many a time—to ensure that staff in our NHS feel supported and that the NHS works to ensure that staff feel valued, both by individual organisations and across the system. We are working closely with NHS England—and indeed, through NHS England, with individual trusts—to ensure that that is happening. We regularly meet staff to get a better understanding of how they could better feel valued and supported in their workplace.

The actions of the NHS people plan and the NHS people promise are helping us to build the kind of culture that will go a long way towards helping to support and hold on to dedicated and hard-working colleagues. That very much includes a stronger focus on health and wellbeing and, importantly, on strengthening leadership. People often say that they do not leave trusts or organisations but their managers, so we must make sure that management culture is right. We also know from speaking to staff that it is vital to increase opportunities for flexible working.

One of the right hon. Gentleman’s other asks was on the long-term workforce plan. He is absolutely right. To help us ensure that we have the right numbers of staff with the right skills to transform services and deliver high-quality services that are fit for the future, we have commissioned NHS England to develop a long-term workforce plan for the NHS for the next five, 10 and 15 years.

That high-level workforce plan will look at the mix and number of staff required across the country and will set out a number of actions and reforms that are needed to reduce those supply gaps and, importantly, improve retention. We have committed to publishing that plan shortly—and it will be shortly; I know it is soon. I am very keen to ensure that it is published, because I know how much work NHS England has put into it. In addition, the Chancellor committed that it will be independently verified. We have to make sure that we get it right.

The plan will also include projections for the number of professionals that will be needed, which goes directly to the right hon. Gentleman’s point—it will include podiatrists—and will take full account of improvements in retention and productivity that we plan and hope to see. I thank the right hon. Gentleman for securing this important debate. Through long-term planning, we are ensuring that the NHS has the robust and resilient podiatry workforce that it needs for the future.

The third and final question the right hon. Gentleman posed was on integrated care system guidance relating to allied health professionals. As tempting as it is to make policy on the hoof, that does not sit within my portfolio. I will commit to raise that with the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Harborough (Neil O'Brien), who is the Minister with responsibility for primary care. I will ask him to write to or meet the right hon. Gentleman.

We are working to ensure that we have the right people with the right skills in the right places and are working to ensure that they are well supported and looked after, so that they in turn can look after those who need our great NHS services and can keep delivering the great standard of care that people need now, but also in the future.

Question put and agreed to.

National Carers Week

John McDonnell Excerpts

Thursday 8th June 2023 Commons Chamber

[John McDonnell (Hayes and Harlington) (Lab)]

I will try to get through my 10-minute speech as rapidly as I can, Madam Deputy Speaker.

I chair a group of unpaid carers, and have been doing so for the past 18 months. They are all Labour party supporters. It is a Labour carers group because we seek to influence our own party’s policy. It is not set up on a sectarian basis; it is just that that is the motivation for our coming together. I wish to report back on some of the issues that have been raised in our discussions, and they reflect much of what has been said already.

One key issue is ensuring that carers are properly recognised. Recognition should then lead to the assessments. The reports that we get are that it is almost impossible in some areas to secure an assessment. We have to be honest in this debate. I am not trying to be party political here, but this is, I am afraid, about the cutbacks in local government. Councils are not capable of undertaking the assessments themselves, because of the loss of staff over recent years. Unfortunately, lack of assessments means lack of access to services themselves. That lack of a passporting mechanism is causing incredible suffering.

Another issue is that, even where there are assessments, there is a real concern about the lack of fully trained staff in the range of specialisms to deal effectively with the people involved. What that means is that the assessments are sometimes crude—this is not a criticism of the staff—and do not reflect the reality of what is needed. Again, this comes back to the resourcing of both the local councils and the NHS.

The other issue is exactly as reflected in the debate so far, which is that unpaid carers are often living in absolute poverty. Many of them have given up their own careers to care. They do so willingly, because they want to care for their loved ones, but at the moment many of them cannot survive on the benefits that they are receiving. We are grateful for the meetings that we have had with my hon. Friend the Member for Leicester West (Liz Kendall). The request of many in the group is clear: they want a real living wage to reflect the care that they provide. In the short-term, a measure that could be introduced fairly rapidly is at least for the carer’s allowance to reflect other caring allowances, such as maternity leave. Benefits in the past have been linked to earnings, but, because of the break with earnings, some benefit levels have been undermined over the past 20 to 30 years. If this carer’s allowance had kept pace with earnings, it would be double what it is at the moment, which would be somewhere near to the levels of maternity leave payments.

The other issue that has come up in our discussions is the plight of external carers. There is almost a sympathy for them—or an empathy with them—from the unpaid carers. As has been said, carers who go into homes are underpaid, not recognised and often disrespected. We must acknowledge that care has largely been privatised, which means that many of the workers are on very insecure contracts. The result of what I can only regard as exploitation is that they cannot provide the care that is needed in many instances, or that they struggle to do so.

I will not dwell too much on the issue of respite, which has been covered. None the less, the lack of access to, and the withdrawal of, respite in many areas because of cutbacks is causing real concern. The Government could focus on that as a priority in the development of their initial strategy.

Another concern, which is heartrending to hear about, is from those carers who are elderly or getting on. They are worried about the succession planning of care for the children or the people whom they care for when they are no longer around.

[Hannah Bardell (Livingston) (SNP)]

Does the right hon. Gentleman agree that the Primodos case highlights the tragedy that our constituents face? I have constituents who have suffered at the hands of Primodos and they are genuinely concerned as they get into their elderly years about how they will be able to care for their children, while the Government remain intransigent and refuse to support them.

[John McDonnell]

I am glad that the hon. Member has raised that issue. I have constituents in the same situation, and that overhanging worry has come out in our conversations. People worry about what happens when they are no longer here, or are not capable of caring. Having some form of succession plan in place is critical.

Briefly, there is a demand from the group that I work with—I think this is felt across the political spectrum—for an independent living and national social care service. The argument is that this should be based on the NHS principles: free at the point of need and paid for directly through taxation. The proposals that I have heard so far, including those from the Fabian Society which were published today, are somewhat limited and do not live up to the challenge that we face. They are somewhat anaemic.

We must be honest with everybody about the scale of the costs involved and how that can be funded. I am happy to run through a whole range of taxation measures, but I shall just put on the table equalising capital gains tax with income tax, which, the TUC estimates, would provide £17 billion. That would cover the cost of introducing social care and independent living services. That requires political will and political courage, so there is the potential to go forward and form a cross-party alliance to secure a future for social care and support for unpaid carers.

I congratulate the hon. Member for Gosport (Dame Caroline Dinenage) on securing this debate. After the session yesterday where we met the different caring organisations, I would say that, if anyone wants any motivation, all they have to do is sit down with a few of those carers to realise how urgent and how desperate the situation is at the moment—and what willingness there is across this House to secure quite radical transformative change on the issue.

Brain Tumour Research Funding

John McDonnell Excerpts

Thursday 9th March 2023 Commons Chamber

[John McDonnell (Hayes and Harlington) (Lab)]

There is a tradition in the House that people say it is an honour to follow the hon. Member who has just spoken. Usually, most of us do not mean it, but it really was a privilege to be in the Chamber to hear the speech by my hon. Friend the Member for Mitcham and Morden (Siobhain McDonagh). Some Members may not have got the subtleties with regard to Margaret. Margaret is not someone who will take no for an answer. In fact, you are lucky if you are still standing when you have said no to Margaret on many issues—I want to make that absolutely clear. We all send Margaret our love and wish her the very best. I thank my hon. Friend for sharing that, as I know how difficult it was.

We are all coming to the debate with different experiences. I want to thank a lady called Sonya Kean, who approached me some time ago to ask whether I would involve myself in campaigning for brain tumour research funding. Sonya has a son called Conall who suffers from brain tumours. It really brought home to me the distress that this illness causes for the sufferer and for the whole family, but also the incredible courage and fortitude that families display when they have to rise to the challenge and cope with seeking treatment and supporting the family member.

My experience with Sonya and others is that there is a real struggle to be heard at times. There is a struggle in access to treatment but also to find support for some basics. One example is time off for family members when they are taking another member for treatment, and financial support is another. The financial impact can be quite devastating on a family. That relates to the inadequacy of the welfare benefits system, particularly support for carers and carers allowance, to follow on from what my right hon. Friend the Member for Leeds Central (Hilary Benn) said.

What comes across is how wonderful the support and treatment is from incredibly dedicated, devoted, caring and hardworking doctors, nurses, oncologists and others. Paul Mulholland has been mentioned time and again by a number of people, as an example of the standard of care that everyone should receive throughout the NHS. I want to profoundly thank Sonya, Conall and the family, and all the staff and professionals who have been working so hard. I also thank the chair of the APPG, the hon. Member for St Ives (Derek Thomas), and all its members. We have hundreds of APPGs but that is possibly one of the most effective. As a result of its diligent commitment, we have in front of us an extremely professional report that the Government now can use as the guide and agenda for their work. I thank the APPG for all that it has done.

I will not go through all the points that have been made, but there are some fundamental steps that need taking. We have been having a debate for some time around these particular areas of work. The reality is that all the health imperatives require a foundation of funding—conditional funding, I accept that. Last year we debated cancer treatments overall, and the figures are worth getting on the record. Nearly £150 million has been spent on breast cancer research; £130 million on leukaemia research; £130 million on prostate cancer research; £24 million on brain tumour research. The issue today is not just the allocation of funds but access to funds. The report very succinctly but effectively demonstrates what barriers exist and how they could be overcome.

The sufferers and families I have met are at a loss as to why the money that has already been allocated has not really reached the frontline of research. The report gives reasons for that, but it also demonstrates how the hurdles could be overcome relatively easily. It is about ensuring an element of co-ordination. I was shocked to read on page 12 that a number of researchers are simply moving away from research in the field, as my right hon. Friend the Member for Leeds Central and others have mentioned, because they cannot overcome the hurdles in access to funding support.

The next step, as the report mentions, is to address the profound need for leadership. The appeal for a champion who sits across the two key Departments—the Department of Health and Social Care and the Department for Science, Innovation and Technology—is fundamental. We need someone who can bring everything together dynamically and drive the report’s agenda. Frankly, there are plenty of ex-Ministers on the Government Back Benches with enough experience to drive that agenda effectively.

One of the first steps, exactly as the chair of the all-party group says, is to have a ministerial meeting to go through the agenda with members of the all-party group and work with the appointed champion to chase the progress of its implementation. There have been too many reports on different conditions that have been well received but largely shelved because there has been no drive. The APPG has demonstrated that it can work effectively to produce a report, and I think it could work hand in glove with the new champion to ensure that the agenda is implemented effectively. It could happen relatively quickly: we could have an announcement within a fortnight, we could get the new champion in place, the APPG could meet that person and the Minister, and we would then have some drive.

The report makes a recommendation to look at the US system whereby reports are regularly submitted to Congress—in this country it would be this House—on the implementation of the agenda. I may have got this wrong, but I believe that the APPG report includes an element of legislative enforcement so a statutory duty is placed on all those participating.

Another point is about the co-ordination of the different groups, which the APPG seems to have brought together. Not only has it received information and evidence from the individual research bodies, but a discussion has clearly taken place with the pharmaceutical industry. The APPG has almost been like a summit meeting for the different agencies. Trying to formalise that in some form would be really helpful.

On pharmaceutical companies, I want to make a point that might sound discordant but is not. The report makes a recommendation about tax reliefs for pharmaceutical companies. Having looked at tax reliefs in other areas, I am not confident in the role that they have played. The argument is that they will attract venture capital towards the research and development of various drugs and treatments. I am not convinced about tax reliefs, however; I think it is better to award conditional grants, which I think are much more effective. My own view, for which I have been arguing for some time—I have to throw this in—is that we should have a state-run and owned pharmaceutical company so that we can have stable investment, rather than just investment driven by short-term profit.

What I see as the key element in the report, for which I am really grateful to the APPG, is the immediate review of the speed of decision making on the award and allocation of funding for research. That is critical. As my hon. Friend the Member for Mitcham and Morden says, it is also about the speed of access to treatment. People with nine months do not have time to wait for the decision-making processes that we have at the moment, which are literally costing people’s lives. We desperately need to speed up the overall process, and the report lays the foundations for that. I also agree with the report about the ringfencing of funding for research into child brain tumours: it is a tragically neglected area and so many people suffer as a result.

The report says, rightly in my view, that many brain tumour patients and their families are feeling let down by a lack of leadership and drive from the Government. When we explain to people in our constituencies that this is the biggest killer among the under-40s, they begin to wake up and ask why it is happening. Well, I do not want to be here in a year’s time for another debate like this, and another report from the APPG, and to hear that it is still happening because the current report has not been implemented in full. I urge the Government to meet the APPG, establish a champion and start work on this agenda in the next couple of weeks. If they do so, we may be able to turn this around, and perhaps prevent more tragedies such as those that many of our constituents have experienced in recent years.