Edenfield Centre: Treatment of Patients

Justin Madders Excerpts

Thursday 13th October 2022 Commons Chamber

[Will Quince]

I thank the hon. Lady for her question. I understand that a Bill to reform the Mental Health Act is in the Lords. I cannot give her a further update on that as I am not the responsible Minister, but it is important to stress that it is part of a number of measures that the Government have taken to improve on some of the challenges that she rightly pointed out. Whether that is the use of force Act, the NHS patient safety strategy, the mental health safety improvement programme, the patient safety networks that I mentioned, the new requirement for learning disability and autism training for staff or the HOPE(S) model, a lot is going on. I know that the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Sleaford and North Hykeham (Dr Johnson), will be happy to meet her to update her further.

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

If a test of the Government is how the most vulnerable in society are protected, I am afraid that this is yet another failure—as has been said, this is not the first time that it has happened. The CQC inspected the trust only a couple of months before the documentary was aired, which raises serious questions about the efficacy of CQC inspections. What challenge has it been given about its findings?

[Will Quince]

I thank the hon. Gentleman for his question. As a former Children’s Minister who every week read the serious incident notification report, I am a little bit disappointed in it for one reason. I mentioned some of the steps that the Government are taking, and yes, we always need to do more, but no Government can ever legislate for or produce procedure or guidance that will stop anyone who is not acting with empathy and kindness. In this case, we have seen some of the most horrific abuse. No Government can legislate to stop that, but we must do all in our power to identify it and prevent it. The CQC has an important role in that. My understanding is that, as soon as a whistleblower brought the matter to its attention, it investigated. We then understand that there was the BBC investigation. Of course, we will look at how the CQC responded and hold it to account.

Urgent and Emergency Care

Justin Madders Excerpts

Monday 5th September 2022 Commons Chamber

[Steve Barclay]

Far from there being a lack of planning, the very essence of integration between social care and the NHS through the ICSs is that we recognise the importance of both aspects working much more closely together. That is why we are bringing forward initiatives such as the federated data platform.

Monkeypox is outside the scope of today’s statement, but I know the issue is of particular interest to the hon. Gentleman. He will know that, fortunately, we have not yet had any fatal cases in the UK and the rate of infection has been falling. We purchased the maximum number of vaccines that we could; I wrote to the relevant charities with the details. Although smaller doses are being delivered compared with the initial 50,000, we still have doses in the system. We expect a further 20,000 very shortly and a further 80,000 later this month. We have procured doses, we are getting them out and it is fortuitous that cases are falling, but we are obviously keeping the situation under close watch.

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

This summer I have heard some horror stories from constituents with life-threatening conditions about the dangerous delays they have faced. When one constituent raised the issue with the NHS, she was told by the senior consultant at the A&E department that the NHS has collapsed. If senior frontline clinicians are saying that in the summer, God help us when we get to winter. I really fear where we are going to be, because there is no doubt that my constituent is very lucky to be alive. We have heard a lot of figures today about the number of excess deaths this year. Will the Secretary of State give us his estimate of the number of people who have died unnecessarily because they have been stuck in an ambulance waiting to get into A&E, or because an ambulance has not turned up at all?

[Steve Barclay]

Again, despite that colourful language, we have more doctors, more nurses and more paramedics. We are training more and meeting more demand, and significant additional funding has been applied to ambulance trusts, call handling and other parts of the system, including primary care. Part of reducing the demand on the ambulance system is related to GP capacity, which is why—to take that as an example—an additional £1.5 billion of funding has gone in.

Health and Care Bill

Justin Madders Excerpts

Consideration of Lords amendments
Monday 25th April 2022 Commons Chamber

[Matt Hancock (West Suffolk) (Con)]

I rise to support the compromise measure on reconfigurations and to ask the Government to take forward the work on UK-wide statistics with vigour and gusto.

First, on reconfigurations, it is right and reasonable that the largest organisation in the country, which is funded by taxpayers through the taxes that every single citizen pays, should be accountable to Ministers who are in turn accountable to this House. Although that principle has been accepted in the Bill across the board and in general terms, the other place has decided that it should not apply in the specific circumstances of reconfigurations. It is vital that when a reconfiguration happens, not only the clinical voices but the voice of the local community should be heard. The two need to go together. The best way to make happen any reconfiguration that is needed on clinical grounds is to engage the local community and get it onside. If we are to save lives through a reconfiguration, we can win the argument, but only if we engage and make the argument. In my experience, too often a reconfiguration was put on the table, perhaps for good clinical reasons but without enough local engagement, and in practice the process just ran into the sand.

I welcome the six-month delay—I hope the Secretary of State will work quicker than six months most of the time, but it is a good backstop; I welcome the de minimis threshold, because relatively small reconfigurations happen all the time; and I welcome the removal of some of the bureaucracy in the amendment. To my hon. Friend the Minister, who has done a magnificent job on the Bill right from the start, before it even came to this House—I thank all his officials for their service—I say: let us take this compromise but say clearly to the other place, “Thus far and no further.” The principle of democratic responsibility for the NHS and for winning the argument with the public about its local design is at the heart of the Bill and it must stand.

In the final minute I have in which to speak, let me make a point about statistics. Those on the Treasury Bench have decided not to include in the Bill measures on the UK-wide measurement of health services and on the interoperability of data in the four nations of the UK, but I put on the record the importance—I hope the Minister reiterates this—of getting UK-wide measurements. In Wales, it was decided to discontinue the measurement of some aspects, especially in respect of A&E performance. A suspicion was raised—I am sure this could not possibly have been true—that those measurements were discontinued so that unfavourable comparisons with England could no longer be made. If that were true, it would be an outrage. I very much hope that it is not, but we should put it right anyway and measure NHS service delivery throughout the UK on the same basis, so that comparisons can be made, so that we can learn about and improve services across all four nations, and so that accountability can properly apply to the four different Governments who run the four parts of the one NHS, which operates across this United Kingdom.

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

I rise to speak to the Lords amendment on workforce—probably for the dozenth time during the Bill’s passage. I make no apologies for repetition because some things are worth repeating and the importance of our workforce can never be understated. Everything comes back to workforce: the grandest plans, strategy documents, reorganisations, integrations and configurations will all count for very little if the fundamental cog in the machine and the glue that holds the whole thing together—the workforce—is not a central part of those plans. The consistent failure to invest in the workforce and to provide a plan for it so that it is able to meet demand over a sustained period is at the root of many of the challenges that the NHS faces today. We should correct that.

On Friday night, a constituent contacted me as he suspected he had dislocated his hip and had been told that his situation did not warrant an ambulance. Eventually, he managed to get to A&E, but in the end he went home without receiving treatment because it was so busy that people were standing outside the department. That is just one example, but there are countless others like it—the frustrated constituents who can never speak to their GP; the many people left in agony because waiting lists are at record levels; those whose teeth rot away because they cannot get dental treatment; and those who receive no help for their mental health issues because they do not reach the threshold for intervention. Every one of those examples arises because, to a greater or lesser extent—I would say to a greater extent most of the time—there simply are not enough staff to meet the demand.

There is a pattern of disconnection in respect of the action required to meet the Government’s ambitions, let alone getting the NHS to meet its constitutional targets. Unless workforce is addressed in a meaningful way as part of all the plans and strategies issued, the Government are just fooling themselves that their plans are credible and deliverable. Even if the Government wish to fool themselves, they are not fooling anyone else. They are certainly not fooling us Members on the Opposition Benches or the 100 or so health and social care organisations that support what we are trying to achieve with the workforce amendment.

The most recent Department-commissioned NHS workforce strategy, the People Plan, did not include a forecast on staffing numbers. When asked about it, Baroness Harding, who authored the plan, said that the strategy did not include staff numbers not because

“the Government disagreed with the numbers”

but

“because we could not get approval to publish the document with any forecasts in it.”—[Official Report, House of Lords, 7 December 2021; Vol. 816, c. 1814.]

Perhaps that means the Government do have figures but just do not want us to see them. If that is right, perhaps the Minister could let us in on the secret when he responds. If that is not right, will he tell us what other organisation with more than a million staff manages to operate successfully without accurate figures on workforce projection?

In addition to the obvious arguments about why we need accurate information on workforce requirements, it is important that we collect such information for existing staff, because they need hope that help is on the way. We need to show that those claps on a Thursday night were not an empty gesture and that there is a determination to do something about the persistent rota gaps that mean staff are both exhausted and demoralised. Just look at some of the challenges we face: 93,000 vacancies; a £6 billion annual spend on agency staff; staff working extra unpaid hours; and some 40% off with work-related stress at some point or other. With all those things conspiring together, it is little wonder that retention is an issue, so we need to give staff hope that we have an answer—that we have a plan. As the Select Committee report on workforce burnout said:

“The way that the NHS does workforce planning is at best opaque and at worst responsible for the unacceptable pressure on the current workforce which existed even before the pandemic.”

With so many challenges currently facing the NHS, why do we want to make it worse by refusing to accept the evidence before our eyes? It is no coincidence that NHS satisfaction ratings are reported to be at a 25-year low at the same time as record numbers of NHS staff say they would not recommend working at their own trust. Those issues are not disconnected in any way, which is why we need to support the workforce amendment.

Health and Care Bill

Justin Madders Excerpts

Consideration of Lords amendments
Wednesday 30th March 2022 Commons Chamber

[Mike Wood (Dudley South) (Con)]

At its best, our national health service provides truly world-class care. That is down to the skill, passion and professionalism of its workforce. As hon. Members will know, I have personal reason to forever be grateful to the NHS, and particularly the staff at Russells Hall Hospital in Dudley. While new hospitals, equipment and technology are all crucial, they are nothing without the health and social care staff who are the beating heart of our health service.

However, I am concerned that Lords amendment 29 does little more than add to an already onerous level of bureaucracy in our NHS. Providing a report every two years instead of every five does not improve the record number of doctors and nurses. The Government are already committed to reviewing the long-term strategic trends in the health and social care workforce, and to developing a workforce strategy, and clause 35 of the Bill already commits to a workforce review every five years. That in itself will be quite an arduous task.

Huge steps have been taken in investing in the future of the NHS workforce, including by funding a 25% increase in places since 2016-17. That means 7,500 more medical schools training places in England over the past six years. The shadow Health Secretary is obviously right to say that the population has grown in recent decades, but I think it has grown by 8% since 2010, while the number of doctors working in our NHS is up by about one third. Clause 35 allows for medium and long-term workforce plans, and offers a sensible balance between the need for such work and the need to minimise unnecessary bureaucracy. That is why I will not support the amendment.

Turning to Lords amendment 30, while I recognise the arguments made by Opposition Members, I do not agree with them or believe that clause 40 should be removed from the Bill. I believe it contains sensible powers. We expect the Secretary of State to be responsible for our national health service—for the services provided in every part of the country. There was much opposition and controversy when provisions reducing that responsibility were introduced in previous legislation. If he is to exercise that responsibility, he must have the powers to do so.

Voters and Members of Parliament expect the Secretary of State to be able to take action where health services have been reduced. On 11 November, a few weeks before the by-election in North Shropshire, the leader of the Liberal Democrats, the right hon. Member for Kingston and Surbiton (Ed Davey), questioned the Prime Minister at Prime Minister’s questions about the closure of Oswestry ambulance service. If we are to question the Prime Minister or the Health Secretary on the closure of services such as ambulance stations or hospitals, then it is only right that the Secretary of State should, in extreme circumstances, have the power prevent those closures. Our voters expect that, and frankly so do the Opposition.

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

I wish to speak to Lords amendment 29 on the workforce. The most important thing I learned during my five years as a shadow Health Minister is that everything comes back to the workforce. We can have the grandest plans, strategy documents, reorganisations, integrations and configurations—all of which are probably in this Bill, in various forms—but it will all count for very little if the fundamental cog in the machine, the workforce, is not a central part of those plans. The consistent failure to invest in, and provide a plan for, the workforce, so that it can meet demand over a sustained period is at the root of the challenges that the NHS and social care face today. We now have a chance to correct that.

Let us look at some of the challenges. There are 93,000 NHS staff vacancies; £6 billion-plus has been spent on temporary staff to fill gaps; and more than half of staff are working unpaid extra hours each week, with 44% saying that they have felt ill with work-related issues—little wonder, given that retention remains a huge issue. We need a plan, and we need to give staff some semblance of hope that we are listening—that the claps on a Thursday were not just an empty gesture; that the tributes that we rightly pay here to their dedication are not meaningless platitudes; and that there is a determination to do something about the persistent rota gaps that mean that staff are both exhausted and demoralised.

The Health and Social Care Committee report on staff burnout says:

“It is clear that workforce planning has been led by the funding envelope available to health and social care rather than by demand and the capacity required to service that demand.”

That is rather the nub of it. Health and social care are both demand-led systems, yet the funding and therefore the workforce capacity are not linked to demand. Until that central issue is addressed, we will keep coming back to the many varied and unfortunate consequences of an overstretched and under-resourced workforce.

I suspect that the Minister—who I have a lot of time for, even though he is often wrong on these things—might privately think that a long-term workforce plan might be a good idea, not just to ensure that the NHS can plan properly and to move forward on a sustainable footing, but because that might help his Department when it goes into negotiations on the spending round with the Treasury, as it will be able to point to an independently verified assessment of workforce need. If the amendment has a weakness, it is that it does not ensure that any plan is actually feasible, because there is no requirement in it that any plan be fully funded. However, a plan that shows, for all the world to see, a clear funding gap would be helpful to the Minister, because it would allow him to go to the Treasury with a clear and objective demand. As he knows, I like to be helpful to him, so I hope that on this occasion he can support the amendment.

This debate is timely because it comes on a day when two surveys have been released that lay bare the crisis that we face. One survey shows that public satisfaction ratings with the NHS are reported to be at a 25-year low—a quarter of a century of surveys there—and another shows that the number of NHS staff who would recommend their trust as a place to work has plummeted. Those two facts are intertwined and symptomatic of the workforce crisis that the amendment is trying to address.

The question we must ask ourselves, if we choose not to support the Lords amendment, is whether the Government’s existing plans create sufficient accountability and rigour to deliver the transformative approach that the amendment would. In my view, it introduces a level of robustness to workforce planning that is currently missing. For the reasons I have set out, we owe it to the workforce, to patients and to those in receipt of social care to put workforce planning on the strong footing that the amendment would deliver.

[Madam Deputy Speaker (Dame Eleanor Laing)]

I am surprised that the hon. Member for Strangford (Jim Shannon) does not wish to speak. [Interruption.] Oh, he does. I hope he will be brief, so that the Minister will have time to answer the debate.

Access to NHS Dentistry

Justin Madders Excerpts

Thursday 10th February 2022 Westminster Hall

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

It is a pleasure to see you in the Chair, Mr Efford. Access to NHS dentistry has been raised with me throughout the pandemic, and judging by turnout for the debate, it is something that a lot of Members are keen to get their teeth into—[Interruption.] I promise to make no more dental puns.

I have met dentists and made representations to Ministers numerous times. The overwhelming feeling that I have had from such discussions is of a disjuncture between the two. Dentists and patients do not feel listened to, and Ministers are not offering the solutions needed to ensure that NHS dentistry is accessible for much of the population. While that is not being addressed, waiting times build, preventive dental action is not taken and health inequalities rise.

I pay tribute to all dentists and dental staff in my constituency, who have worked in a high-risk environment throughout the pandemic. I know that they are doing all they can to deliver those services. The correspondence I have had with them shows how passionate they are about ensuring good access to NHS dentistry.

As the Father of the House, the hon. Member for Worthing West (Sir Peter Bottomley), explained, a lot of the issues relate to the UDA system, which does not encourage dentists to take on new patients, especially those who require a lot of treatment. That scenario is increasingly common in the light of the difficulties that we have had over the past two years. The UDA system accommodates only 50% of the population. To my mind, that means that we start from a position of knowing that many people will be denied access to dental care. We need a functioning NHS dental system, and that will be possible only through contract reform recognising the realities of the difficulties that the sector faces, and if services are commissioned for a much higher proportion of the population.

I am told that the local commissioning figure sits at around 55% of the population, but of course that was pre-pandemic, so the number of people who have been able to access services is actually lower. Unless more of the population is covered, constituents will continue to struggle to access dentistry. One patient advised my local Healthwatch that they had contacted 45 practices in one day, and was told by all of them that there was no capacity as

“they only have a small NHS contract and are therefore not taking on patients at present”

but would be happy to take that person on as a private patient. The system actually encourages greater privatisation.

One constituent, who contacted me because of the pain she was experiencing from a hole in her tooth, described her attempts to register at a practice as a fight, which sums the situation up perfectly. We would not accept people having to ring around A&E departments to see if there was any space for NHS patients, so I do not see why we should accept it for dentists.

Since January 2021, there have been several increases in the UDA targets placed on dental practices. Between January and March 2022, it is expected that 85% of the UDA should be met. Last year, a practice in my constituency had to refund £45,000 because of activity that simply could not be delivered. I understand there is nervousness across the sector about the levels that will need to be refunded given that practices are expected to meet the 20% UDA increase at a time when we still have omicron-related staff sickness and appointment cancellations.

I recently asked whether any assessment had been made of the impact of short-notice cancellations on the ability of dental practices to meet their UDA target. The answer I received simply stated that that was considered within the 85% target and suggested that dental practices keep a short-notice cancellation list. However, the practices I am in contact with already do that and are proactive in trying to fill the slots. It seems, once again, that there is a disjuncture between what the Department says and what is happening on the ground.

Given that infection rates and community spread of covid-19 have been at their highest level in recent months, setting the target at 85% at this time seems questionable. There is little surprise that we are hearing of more dental practices leaving the NHS and operating on a purely private basis when there seems little financial incentive or, indeed, financial feasibility in continuing to deliver NHS services. We face the very real prospect of growing privatisation of dental services and people being priced out of receiving dental care. I have heard of price increases as high as 100% on previous NHS fees for those going private. Together with the cost of living, that is simply pricing people out.

Healthwatch Cheshire West confirmed that deregistration from dental practices is the primary cause of people needing to contact other NHS dentists and being unable to find one locally. The reality is that waiting lists locally sit in their thousands. One practice quoted a total waiting list of more than 3,000 people, demonstrating the significant challenge to be addressed.

In the last six months of 2021, I was contacted by 25 different constituents who faced that challenge. Many were writing on behalf of their whole families as well as themselves. One constituent, whose son was in pain after cracking his tooth, was told to keep ringing back each month to see if there was any capacity to reregister, another resorted to carrying out a temporary filling repair themselves at home and one lady, who had been shielding, was removed from the register due to inactivity. Many were shocked to find out how few rights or guarantees they have to remain registered at a practice. Healthwatch has suggested that clear information is needed so that patients are fully aware of the risk following inactivity or missed appointments. I agree that there needs to be greater information. However, there also need to be greater guarantees of access for individuals.

I will conclude by sharing the words of Cherie, a dentist who operates in my constituency.

“The only way to save NHS dentistry in England is to listen to dentists. It’s currently financially unviable for dentists in high need areas with large UDA contracts...this is only going to widen the oral health inequalities further.”

I urge the Minister to do just that: listen to dentists and act accordingly.

Ambulance Services in England

Justin Madders Excerpts

Thursday 10th February 2022 Commons Chamber

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

I am pleased to see the Minister for Health, the hon. Member for Charnwood (Edward Argar), in his place. He and I have debated many issues on health and social care over the last couple of years, and ambulance services have perhaps not had the attention that we would have liked. I know the Minister has had an extremely busy week, possibly because of the new trend for Ministers having multiple jobs, so I am grateful that he is here to deal with the points that will be raised.

It is an important and timely debate. We are regularly seeing images of long delays, with ambulances stacking up outside hospitals for long periods of time. Those images demonstrate wider difficulties throughout the whole system, but on an individual level they mean that patients are not getting the care they need as quickly as they should. The blame for that does not lie with the staff—the paramedics, the first responders and the call handlers—all of whom do a magnificent job in very demanding circumstances. We say thank you for their service, not just in the last couple of years but throughout their time in the NHS.

Despite their efforts, we are in a crisis. Last week ambulance waiting figures outside hospitals reached their highest level in five years. The latest NHS figures show that record numbers of patients in England—over 150,000 of them—have waited in the back of an ambulance for at least half an hour so far this winter, because emergency departments are too busy to admit them. That is the equivalent of one in every five patients—that is the scale of the challenge that we are facing. Those figures sound extraordinary because they are. They are 14% higher than the previous highest total for the number of patients forced to wait during the same period, with the previous high being in the winter of 2019-20.

As awful as those headline figures sound, the figures for the number of ambulances waiting more than 60 minutes are even worse: they are up 82% compared with the last two winters. These are exceptional and concerning statistics.

--- Later in debate ---

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

[Justin Madders]

In my constituency, the British Heart Foundation has told me that it is concerned about reports from the North West Ambulance Service that patient flow in and out of emergency departments is currently very slow, with ambulances being held for long periods, which has the knock-on effect, of course, of causing higher category 1 and category 2 stacks. Worryingly, we have heard reports of delays of up to four hours in these queues.

I am sure these figures, as shocking as they are, will not surprise hon. Members who, like me, have probably had many emails of concern and complaint from worried constituents. Behind these statistics are tens of thousands of seriously unwell people in dire need of help. As the chief executive of the Patients Association said:

“Going to A&E can be frightening. To then be stuck in an ambulance unable to get immediate medical help once you get there must add to the trauma of an emergency visit.”

I think we can all understand where they are coming from. The Royal College of Nursing’s director for England also points out:

“Having to wait outside in an ambulance because A&E is already dangerously overcrowded is distressing, not just for patients but also for staff, who can’t provide proper care.”

It must be so frustrating for those staff, knowing there are other urgent calls they could be going to, that they cannot leave their current patient because the hospital is already at capacity.

I agree with those comments. Not only does having an ambulance stuck outside A&E as it waits to offload a patient mean that it is unable to answer 999 calls, which leads to slower response times, but it means we lose ambulance hours. We lost 8,133 ambulance hours in the last week of January due to crews having to wait outside busy A&Es. That is an incredible statistic.

As NHS Providers points out:

“safety risk is being borne increasingly by ambulance services.”

We know that people are dying in the back of ambulances or soon after their admission to hospital because of these long waits. We heard from ambulance chiefs in November that 160,000 patients come to harm each year because ambulances are backed up outside hospitals.

The shocking report from the Association of Ambulance Chief Executives, which is based on NHS figures, did not report how many patients die each year because of ambulances stuck outside hospitals, but it did say:

“We know that some patients have sadly died whilst waiting outside ED”—

emergency departments—

“or shortly after eventual admission to ED following a wait. Others have died while waiting for an ambulance response in the community.”

The report acknowledges that, whether or not those deaths were inevitable

“this is not the level of care or experience we would wish for anyone in their last moments.”

The report also highlights that around 12,000 patients suffered serious harm because of delays, sometimes with a risk of permanent disability. In the same month, more than 40,000 people in England who called 999 with a category 2 condition such as a stroke or heart attack waited more than one hour and 40 minutes for an ambulance. Of course, the NHS target is to reach them within 18 minutes.

Just last week, NHS figures revealed that thousands of people are dying because ambulances are taking too long to answer emergency calls. The official statistics show that only three of England’s 32 ambulance services are reaching a majority of immediately life threatening call-outs within eight minutes. In fact, the latest available NHS England data for December 2021 shows that the average ambulance response time for category 2 emergencies —suspected heart attack and stroke patients—is 53 minutes and 21 seconds: three times the 18-minute target. Those are incredibly worrying figures.

The British Heart Foundation also reports that there were 5,800 excess deaths from heart and circulatory diseases in England during the first year of the pandemic alone. Although it acknowledges that these excess deaths were driven by a multitude of factors across the entire patient pathway, it also says it is very plausible that some of the deaths could have been prevented if these people had been able to access urgent and emergency care in a timely manner. If we are to avoid more preventable deaths and disability from heart conditions, it is vital that the most critically ill patients can access the care that they need when they need it.

Perhaps the Minister will be able to say what action has been taken to address the dangerous impact on emergency heart attack and stroke care and the victims whose lives are being put at risk, what conclusions the Department has reached as to why so many trusts are failing to reach the targets that have been set for them, and what steps are being taken to reduce waiting times for responses to 999 call-outs and ambulance waits. We know that these delays matter. If 90% of 999 calls were answered in time, 3,000 more heart attack victims could be saved each year.

I have reeled off a lot of statistics. Now I want to give a couple of constituency examples to show what this means for people who have experienced long waits. Thankfully neither case ended in tragedy, but these were clearly difficult and distressing times for those involved.

One constituent told me that she had waited more than 10 hours for an ambulance, having first called 111 at about 10.15 am, when she was advised to call 999. When she called 999, it took a few minutes for the call to be answered. The call handler confirmed that an ambulance would be coming, before asking if it was OK for her to hang up and go on to the next call. About an hour later, having seen no sign of the ambulance, my constituent called 111 again and was told to call 999, but was then told that the ambulance waiting time was about eight hours. At 2.30 pm she was forced to call 999 again, as her husband’s condition was becoming noticeably worse. By that stage he could not move or talk because he was in so much pain. The call handler took the details again, but advised my constituent only to call if the condition worsened further.

Another three hours passed, with my constituent’s husband in absolute agony. When she decided to call again at 5.30 pm, she waited more than five minutes for the call to be answered. The call handler asked if the patient was breathing, and said that an ambulance could only be sent if a patient was not breathing, as it was a busy day, although he did also confirm that the request for an ambulance had been prioritised after her call at 2.30 pm—which, by that stage, was three hours earlier.

The ambulance eventually arrived at 8.45 pm, 10 and a half hours after the initial call. Unsurprisingly, my constituent told me that the paramedics were lovely and could see immediately that her husband needed to go to hospital. When he arrived there, he was scanned and treated, and operated on within 24 hours. It was clear that he needed urgent medical treatment; in fact, he probably needed more treatment than he would have needed had he been seen at the right time. However, in the long run, no serious harm has come to him.

That is just one example of a person who waited longer than they should have. It was not an isolated incident; we know that this is happening week in, week out throughout the country. Another constituent told me that he called an ambulance after his wife collapsed at home. They are both pensioners. My constituent called 999 at 11.45 am, and was told that an ambulance would not be able to attend for at least nine hours. He cancelled the call.

The Minister will no doubt be aware of the tragic case of Bina Patel, which has received considerable media coverage, and has been raised by my right hon. Friend the Member for Ashton-under-Lyne (Angela Rayner). Anyone who has heard the calls that were made requesting an ambulance, and the clearly urgent nature of those calls, cannot fail to be concerned about what is happening in our ambulance services. As I have tried to emphasise, these are not one-off incidents; they are part of a wider pattern, and symptomatic of a system unable to cope with the demands placed on it.

Targets are not being met and people are being put at risk or worse, but NHS England’s response is a proposed new standard contract which contains a “watering down” of several waiting-time targets, with standards lower than those that were in place before the pandemic. The proposals include scrapping the “zero tolerance” 30-minute standard for delays in handover from ambulance to A&E and setting it at 60 minutes, and introducing the additional targets that 95% of handovers must take place within 30 minutes and 65% within 15 minutes. I do wonder how performance can be improved if targets are loosened. The pandemic should not be used as a cover for this, as performance across the system was getting worse before the pandemic. Indeed, it is nearly seven years since the normal targets were met. By scrapping standards for delays in handover, the Government are trying to normalise those longer waiting times. My hon. Friend the Member for Ilford North (Wes Streeting) asked the Secretary of State earlier this month whether he really thought it should take an hour just to be transferred from an ambulance into a hospital. It should not take that long. Does anyone really think it is acceptable for people ringing 999 to be told they must make their own way to hospital?

I am sure the Minister is aware of reports in the Health Service Journal last month that several trusts, most notably the North East Ambulance Service NHS Foundation Trust, advised people calling 999 with symptoms of a heart attack or stroke to take a taxi or a lift with family or friends rather than waiting for an ambulance. I am sure the Minister will want to comment that that is not what we want to be hearing from our ambulance services.

The British Heart Foundation told me that it recently reviewed two calls to its heart helpline that highlighted instances where patients with suspected heart attacks called 999 and paramedics did attend, but then asked both to have their family drive them to hospital for further tests because the ambulance services in their area were under so much pressure. Neither person actually went to A&E, which is most unfortunate: one did not want to bother their family and the other thought that, if the ambulance was not taking them, their situation must not be urgent enough, which of course was not the case.

In short, those two patients did not access the care they needed because of the message being sent out about the burden they were placing on the system. That is completely wrong and certainly not the message we should be giving people who are clearly in urgent need of treatment.

A recovery plan has been announced this week, which, if we are honest, does not really address the issues of the wider NHS and social care pressures. It does not have any real plan for this particular area. The recovery plan, such as it is, is one part of the much wider system overhaul that is needed.

The Secretary of State said this week that approximately 10 million people represent missing referrals who did not come forward for treatment during the pandemic. I am afraid they may well end up becoming urgent referrals because they have not been through treatment and been spotted and helped at an earlier stage. I do not know whether the Government have given any thought to whether those 10 million missing referrals will lead to increased pressure on emergency services and A&E attendances.

What about those people whose care was not managed to target? The British Heart Foundation estimates that up to 1,865,000 people with high blood pressure were not managed to target last year, which could mean more than 11,000 additional heart attacks and more than 16,000 additional strokes across England over the next three years if those patients do not get support. Of course, that will again increase pressure on urgent and emergency care services in the longer term.

I appreciate there is quite a lot of ground to cover here, but when the Minister responds I would be interested to hear his analysis of the situation, whether he believes the examples I have given are part of a wider pattern of concern or isolated incidents, and what he believes must be done to put the ambulance service on a sustainable, safe footing for the long term. Are those images that we have seen of ambulances queuing up outside hospitals a temporary feature of a very difficult winter, problems with the ambulance service in particular, or symptoms of a wider health and social care system that is under incredible pressure?

[Mr Deputy Speaker (Mr Nigel Evans)]

Back-to-back appearances at the Dispatch Box by Ed Argar.

[The Minister for Health (Edward Argar)]

Reflecting the rest of the week, Mr Deputy Speaker.

I am grateful to the hon. Member for Ellesmere Port and Neston (Justin Madders) for securing this important debate. In the same spirit, this is rather nice; it is like déjà vu: he used to shadow me at that Dispatch Box and in Committee. It is a pleasure to respond to his debate on this occasion.

However, I must say that responding to the hon. Gentleman is a pleasure slightly tempered by caution on my part, because I know the depths of his expertise on this subject after his many years shadowing the Minister for Health—I think he shadowed my predecessors as well. He has great depth of knowledge in this space. He is and has been a notable advocate for our ambulance service and what it needs, and he looks forensically into those issues. I also know that he is a diligent reader of The BMJ, the Health Service Journal and various other excellent trade and specialist publications. It is a genuine pleasure to respond to him on this extremely important issue. It is a shame that the way in which the House allocates debates means that this is the last debate of the day, so there are few Members in the Chamber for it, because it is important. However, those we have in the Chamber are quality, and I look both at the shadow Minister—sorry, the former shadow Minister—and the hon. Member for City of Chester (Christian Matheson).

As the hon. Member for Ellesmere Port and Neston highlighted, ambulance services have faced extraordinary pressures during the pandemic. I am sure that the House will join me and the shadow Minister—the former shadow Minister; by force of habit, I keep calling him the shadow Minister. The hon. Gentleman and I have not always agreed, but we have been as one in paying tribute to all those who work in our ambulance services up and down the country. They have done an amazing job over the past two years, during the pandemic, to the very best of their ability. Of course, they do that amazing job day in, day out; irrespective of pandemics, they always do everything they can to support those who need them.

The hon. Gentleman rightly highlights that the pandemic has placed significant demands on the service. In January 2022, it answered more than 800,000 calls. That is an increase of 11% on January 2020 and is one of the factors placing significant pressures on ambulance services, the wider NHS and the A&E departments to which they will take people when they feel that there is a clinical need. Although 999 calls tend to highlight the demand related to more serious medical conditions, many ambulance services are also responsible for 111 calls, which, in December last year, saw an increase of 15.5% compared with December 2019.

I use those statistics to illustrate the demand pressures, but I understand that behind those numbers, in every case, lies a human story—someone in need of care, someone worried and anxious, with friends and family anxious for them—so before I seek to go into the reasons, statistics and our plans and support, I want to say that I am sorry for patients who have suffered the impact of those service pressures. I want to be very clear that patients should expect and receive the highest standards of service and care.

The hon. Gentleman highlighted some specific examples, including the case of Bina Patel. He is right that the right hon. Member for Ashton-under-Lyne (Angela Rayner) has raised that with me. I have asked for full information because I want to get back to her with as full an answer as I can, and I hope that he can convey that to her, if he speaks to her before I do. I am fully aware of her correspondence raising this on behalf of the family.

Let me turn to ambulance response times and the reasons sitting behind some of the pressures. The ambulance service is facing a range of challenges that are impacting on its performance. The hon. Gentleman will be familiar with many of them, including the impact, still, of infection prevention and control measures not only in the ambulance service but particularly in A&E departments and wider acute clinical settings. Higher instances of delays in the handover of ambulance patients into A&E as a result of some of those factors, which I will turn to, are therefore leading to ambulances waiting for longer in queues and not being as swiftly out and about on the road and able to respond to calls. So there are knock-on effects there.

One of the key challenges, which the hon. Gentleman will be very familiar with, remains the question of flow through an A&E and through a hospital. I am referring to the flow of patients out of ambulances into the A&E, who are then able to be treated in the A&E and discharged, hopefully, or who are then, in some cases, able to be admitted to a bed in a hospital ward. To do that, we have to see discharges continue of patients who no longer meet the criteria to reside because they have recovered sufficiently, and the national discharge taskforce has done a huge amount of work on addressing that challenge.

In recent months, we have seen the combined pressures of winter—the hon. Gentleman and I are familiar with those on an annual basis—and the impact of the omicron variant on the number of hospitalisations, which have not been as high as many feared and predicted, thankfully, but which have still had a significant impact on hospital beds. The combination of those factors, coupled with a high level of workforce sickness absence rates, including through positive covid tests—particularly over recent months with omicron—has created pressures that we would not expect to be systemic or built into the system. That partly reflects longer term pressures, and I will move on to what we are doing to address those, but a large element of it is down to the specific circumstances of the past winter.

The hon. Gentleman touched on the support in place to improve services, and asked what we are going to do about it, and what is being done to address these issues. He is true to form from when he shadowed me, as he will always set out the challenge and ask me what I am going to do or am doing about it, rightly holding the Government to account. Because of the pressures I mentioned we have put in place strong support to improve ambulance response times, including a £55 million investment in staffing capacity to manage winter pressures to the end of March. All trusts are receiving part of that funding, which will increase call handling and operational response capacity, boosting staff numbers by around 700.

NHS England has strengthened its health and wellbeing support for ambulance trusts, recognising the pressure of the job on those working in the ambulance services, with £1.75 million being invested to support the wellbeing of frontline ambulance staff during the current pressures. NHS England and Improvement is undertaking targeted support for the most challenged hospitals, to improve their patient handover processes, helping ambulances to get swiftly back out on the road. That is focused on the most challenged hospital sites where delays are predominantly concentrated, with the 29 acute trusts operating those sites being responsible for more than 60% of the 60 million-plus handover delays nationally. That is targeted support for trusts that have particular challenges, either from the current situation or where there are underlying issues that we need to resolve.

There is capital investment of £4.4 million to keep an additional 154 ambulances on the road this winter, and a £75 million investment in NHS 111 to boost staff numbers by just over 1,000, boosting call taking and clinical advice capacity that will better help patients at home, and better help triage those who genuinely need an ambulance and those who can be treated safely in a different context. There is continuous central monitoring and support for ambulance trusts from NHS England’s national ambulance co-ordination centre, and we have also made significant long-term investments in the ambulance workforce. The number of NHS ambulance staff and support staff has increased by 38% since July 2010.

More broadly, alongside the ambitious plan set out by the Government earlier this week, showing how we will invest the significant additional resources in outcomes for patients, just over a year ago we invested £450 million in A and E departments, to help mitigate the impact through increased capacity of infection prevention and control measures. I have regular direct meetings about discharge rates, and what we can do further to improve the flow of patients through hospital trusts within NHS England, with members of the taskforce on that.

I am pleased to reassure the hon. Gentleman that those measures have had an impact, and we are seeing improvements in response times from the peak of the pressures in December. Performance data for January, published today, shows significant improvement against all response time categories. Performance for category 1 calls—the most serious calls, classified as life-threatening—has largely been maintained at around nine minutes on average over the past several months, and improved to eight minutes and 31 seconds in the latest figures. That is despite a 19% increase in the number of incidents in that category compared with December 2019. Average responses to category 2 calls improved by more than 15 minutes compared with December, and the 90th centile responses to category 3 calls by more than two hours.

We recognise that that is welcome progress, as I am sure the hon. Gentleman would agree, but there is much further to go to recover fully from the pandemic’s impact on response times and to sustain that improvement. We welcome the service’s hard work and dedication and pay tribute to it for making those changes and delivering the significant improvements on which I am updating the hon. Gentleman.

[Justin Madders]

As always, the Minister is being courteous and comprehensive in his response. Will he comment on the concern expressed earlier about patients being told, when visited by the service, that they needed to go to hospital but should find their own way there? That is extremely worrying, and we should be clear that it is not what we expect to happen.

[Edward Argar]

I am grateful to the hon. Gentleman—I keep feeling tempted to say shadow Minister; he is a shadow Minister but he is no longer my shadow—for that point. He is right that when people ring 999 they should be given the appropriate clinical advice on whether they need to go to hospital, and if they do, an ambulance should be sent. I suspect that in individual cases a call handler may have made a tough clinical decision about the fastest way to get someone to hospital given the availability of ambulances, but the hon. Gentleman is right that if someone rings 999 and their condition is clinically deemed to require an ambulance and swift transfer to hospital, they should be able to expect an ambulance to come, assist them and take them to hospital.

At a time when the NHS is facing unprecedented demand, ambulance services are absorbing some of the increase in pressure. They are treating more people over the phone and finding other ways to reduce pressure in a clinically safe way. With clinical support in control rooms, the ambulance service is closing around 11% of 999 calls with clinical advice over the phone. That is far more than the 6.5% achieved in January 2020 and saves valuable ambulance resources for response to genuinely more urgent clinical needs.

Let me say a little about North West Ambulance Service, if that is helpful to the hon. Gentleman—I know that he and the hon. Member for City of Chester take a close interest in their local ambulance service. Our support and investment has benefited the North West Ambulance Service. The hon. Member for Ellesmere Port and Neston’s local trust received £6.2 million of funding, which it has used to increase its workforce for operational and contact centre teams. The trust is also engaged with regional NHS England and Improvement and commissioning teams to develop a six-point winter plan that seeks to address six key areas throughout the winter period. As it starts to get a little warmer and the daffodils start to come out, it is tempting for people to think that winter has passed, but winter pressures in the NHS can continue into late February and occasionally a bit beyond. I wanted to add that caveat.

Three systems-led initiatives focus on the reduction of hospital handover times, the improvement of pathways for patients with mental health presentations and ensuring that alternatives to emergency departments—including access to primary care and other non-emergency-department pathways—are available to North West Ambulance Service in a timely and responsive manner.

Hospital handover delays continue to challenge the North West Ambulance Service footprint. Through its Every Minute Matters collaboration, which began three years ago, the trust has been working with other hospital trusts on improvements by working with senior leadership teams in hospital trusts to ensure there is a shared understanding of the risks of handover delays and a lack of ambulance resources to respond to patients in the community, to revisit action cards for operational commanders and, crucially, to recognise and thank staff for their continued reporting of delays and willingness to highlight problems to their managers or to the trust.

The trust’s strategic winter plan has been activated and includes details of the measures in place to handle winter pressures and mitigate the effects of increased demand and a loss of capacity. The plan is comprehensive and covers a wide range of topics and details on the preparation for various scenarios. It includes several continuous improvement initiatives for support during the winter period.

In summary, North West Ambulance Service is increasing its double-crewed ambulance capacity in line with winter funding arrangements, reducing conveyance to emergency departments and reducing the number of lost operational hours caused by day-to-day operational challenges. The trust has already seen significant improvements in the number of patients managed effectively through telephone advice, which helps free up ambulances to be deployed to where they are most needed. The trust has recruited additional paramedics and emergency medical technicians and upskilled its ambulance care assistants to blue light driving standard, thereby enabling the trust to deploy 269 additional frontline staff by the end of December.

I close by reiterating the Government’s commitment to support the ambulance service. We retain regular contact with ambulance services, trusts and those delivering on the frontline to help to ensure that patients and the ambulance service receive the care and support that they need. I am grateful to the hon. Member for Ellesmere Port and Neston for bringing this matter to the House.

Question put and agreed to.

Children’s Mental Health

Justin Madders Excerpts

Tuesday 8th February 2022 Commons Chamber

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

We should not be surprised that there has been a 77% rise in the number of children needing treatment for severe mental health issues since 2019. We have lived through extraordinary times, and the fallout from that will be with us for years to come. However, in respect of mental health services, as with much of the rest of the NHS and social care, we have been woefully unprepared for the challenges with which the last few years have presented us.

I had a conversation with someone who had been a clinical psychologist in CAMHS for more than 20 years, and who listed some of the reasons why we find ourselves in this position now. She told me that during the last decade, staffing had been hugely squeezed. Whenever someone left, their post was frozen and the money was used to meet savings targets; staffing levels consequently shrank considerably, adversely affecting service provision. She said that nearly all the staff were very hard-working, working far longer hours than they were paid for and well-motivated, but staff sickness levels became very high over the years because of the pressure on the staff, exacerbating the problems.

One respect in which the service suffered was the increase in waiting times for all referrals other than emergency risk assessments from three months to a year. At some points the waiting time did fall, but most young people were then put on another waiting list for therapy, so, overall, waits were still far too long. A year is such a long time in a young person’s life. The person I spoke to told me her particular concern about teenagers who were highly anxious and depressed to the extent of being unable to attend school and superficially self-harming: because they were not suicidal, they could not be assessed any more quickly. Imagine being in that situation—at times the feeling of helplessness must seem overwhelming. Concerningly, there were some young people who attempted suicide while on the CAMHS waiting list and were then risk-assessed when they got to hospital, which of course was too late. Of course, those are the children who actually got on the waiting list; last year, a third of young people were turned away altogether despite being referred by a professional.

It sounds very much as if rationing is in place. A child would not be turned away with a physical illness, but because mental health issues often do not manifest in an obvious way until there is a crisis, children can be shuffled around the system for months, if not years. That is not parity of esteem, and it is no way to treat vulnerable young people, but some of my constituents feel that that is what is happening to their children and that CAMHS needs to be continually chased before action is taken. Even when action is taken, it may be a referral to treatment but not what is needed, so another referral is made and the whole process starts again.

One constituent, who has had to give up their job to look after their daughter because she has been so let down, said:

“I think one of the biggest problems is no single person is responsible for her care so you never know who to speak to and who is doing what.”

That is heartbreaking to hear. I am afraid that it is symptomatic of a system that is stretched beyond breaking point.

Public Health

Justin Madders Excerpts

Tuesday 14th December 2021 Commons Chamber

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

Having had the dubious pleasure of spending an inordinate amount of time in various Committee Rooms over the past 18 months to scrutinise regulations introduced by the Government as part of their response to the pandemic, I must confess that I have had withdrawal symptoms following the reshuffle, so I am pleased to have the opportunity to speak on these regulations today.

I am sorry to say that, on too many occasions, regulations were debated well after they came into force, so it is positive that at last we seem to be getting into the habit of having debates and votes before regulations become law. I would not want that to be seen as a ringing endorsement of the Government’s approach to parliamentary scrutiny, as two of these sets of regulations were published only at 3 pm yesterday, less than 24 hours before this debate began. I know things move quickly, but some of these regulations have been the subject of consultation for many months. There is no excuse for their being dropped in at the last minute.

The decision to reveal the precise detail of these regulations at the last minute has probably generated more opposition than is warranted. I have had many representations from constituents about the entry to venues regulations on the basis that they represent a compulsory vaccine passport. Let us be clear that they do not. A negative test taken in the 48 hours before entry can be used as an alternative, which addresses many of the legitimate concerns that have been raised with me about civil liberties and discrimination. I am pleased that my party’s persistence in pushing for a negative test as an alternative has been accepted, because it gives me enough confidence to support these regulations.

[Matt Western (Warwick and Leamington) (Lab)]

Across the House, many of us have been calling for greater transparency from the Government. The more we hear from the chief medical officer, the more concerning it is. If the Government had been more transparent up front, I am sure there would be greater support across the House.

[Justin Madders]

Indeed. If we look at what has happened in Wales, there has been a similar system for some time, which seems to be working reasonably well. People have been required to produce tests when travelling abroad and several venues in England have been doing that on a voluntary basis. It is not the slide into dystopia that some people fear, but the situation has not been aided by the Government not being as up front as they should about what the regulations mean. Many people already routinely take lateral flow tests before they go out.

However, there are some outstanding questions and concerns. There is no doubt that some constituents feel that the regulations are the start of a slippery slope and that we will soon have to show vaccination papers to get in anywhere. I will be clear: I do not support such a move. Given that the Government cannot even bring themselves to mandate wearing face coverings in pubs, I would be surprised if they moved in that direction, but I want confirmation when the Minister winds up that the Government are not planning any extensions to where the regulations will operate. We also need a clearer explanation of where the line is drawn and to which venues the regulations apply. Do places such as this, which fall into the definition of a public hall indoors with 500 or more people who stand up and move around, come within the ambit of the regulations? My reading suggests that they do. If we want to gain the public’s confidence, we should show that the rules apply to us equally.

Another concern that has rightly been raised is whether a charge will be introduced at some point to obtain lateral flow tests. That would obviously undermine tests as an alternative to showing vaccine status. Charging people to obtain tests would be an absolute disaster from a public health perspective. That goes way beyond the remit of the regulations, but I hope we can get confirmation from the Minister that there are no plans to charge for tests.

The Government need to do rather better at setting out what they consider the cost of the regulations to be to businesses. Again, I note there has been no impact assessment for the entry regulations. Who will pick up the cost of enforcing them? There is nothing I can see about supporting businesses to check people, let alone providing resources to local authorities, which are meant to enforce the regulations.

What will be the position if there is a national shortage of tests? We are told that there are tens of millions of them but, as we know, there are challenges in getting them out to the people who need them. In those circumstances, will the regulations be suspended, or will people be pushed down the vaccination route?

That said, the evidential burden for a negative test seems particularly broad. I think that will assist in reducing the burden on businesses, but it also increases the risk of fraudulent tests doing the rounds. That would undermine the whole point of the regulations. We do not want the worst of all worlds: an expensive bureaucratic system that does not actually help reduce transmission because it is not properly enforced.

Regarding the vaccination of NHS staff, there is plenty of evidence to suggest that a small but significant proportion of covid admissions is the result of people acquiring the infection in hospital. I have seen figures to suggest that it has been as high as 15% to 20% of all covid admissions, although once staff started to receive the vaccination, the figure dropped dramatically. There is therefore evidence to show that the regulations will have an impact on covid admissions and the wider pressure on the NHS. I know it is difficult, but on balance, the regulations should be supported.

However, that should not be the end of the story. We have had a workforce crisis for years. Covid has accelerated cases of burnout and only a few weeks ago, the Government passed up the opportunity to grasp the nettle by refusing to implement a long-term workforce strategy. That is why we need an awful lot more work on the regulations.

The Government have an uphill struggle to earn people’s trust and explain why they consider the proposals necessary, to convince the public that what is before us will be the limit of restrictions and that we will not be talking about extensions or changes at some point in the future. Judging by the comments of many Conservative Members, the Government have failed to persuade a number of their Back Benchers, so it is little wonder that we are all being bombarded by emails from our constituents expressing concern. That exposes the wider truth that the Government have vacated the space where leadership should be. They are compromised by their own failure to follow the rules, riddled with internal disagreements about the route ahead and unable to provide the authority to persuade a sceptical public that the measures are needed.

Covid-19 Update

Justin Madders Excerpts

Monday 13th December 2021 Commons Chamber

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

My constituent Lexi is seven years old and has heart and lung conditions that mean she is clinically extremely vulnerable and has been home-schooled since the start of the pandemic. Her parents are understandably desperate for her to get vaccinated and to get back into school. I understand that it is the JCVI’s decision as to when that will take place, but can the Secretary of State give us some idea of what information the JCVI is waiting for, when it is likely to make a decision and whether he is doing everything in his power to hurry it up to make the decision that Lexi’s parents so desperately need?

[Sajid Javid]

I understand the situation that the hon. Gentleman describes, and there will be others across the country in a similar situation, so we understand the importance of this issue. The JCVI, as he says, is looking at this, which I confirmed earlier, but I say to the hon. Gentleman that before we can deploy any vaccine in any particular age group, it needs to be approved by our independent regulator, the Medicines and Healthcare products Regulatory Agency, as safe and effective. At this point in time, we do not have that approval. The MHRA is actively looking at this, but those two things are crucial before Ministers can make a decision.

Health and Care Bill

Justin Madders Excerpts

Report stage
Tuesday 23rd November 2021 Commons Chamber

[Edward Argar]

I am grateful for the manner in which the hon. Lady puts her points. She is right; we have debated this previously. We have been publicly clear that we do not believe that the exemption or exception should be extended to the ombudsman. She is right that there are campaigns saying we should have no exceptions or that we should widen the exceptions. We believe we have struck the right balance with this measure, while respecting the fact that a coroner is a judicial office holder and has a very specific function to perform, as set out in legislation in—this is where my memory may fail me—the Coroners and Justice Act 2009, which recognises their particular and special status. I suspect that she and I may have to agree to disagree on whether the appropriate balance is struck, but that sets out why we have done what we have done.

How best to achieve an effective safe space is complex and the current drafting has been arrived at through years of detailed policy work, including pre-legislative scrutiny before the Health Service Safety Investigations Bill was introduced in the other place in autumn 2019. The issue was also debated at length in Committee, and I look forward to hearing contributions from Members on that, particularly the hon. Member for Central Ayrshire.

Turning to the two minor and technical Government amendments to the health service safety investigations body provisions, amendment 24 is a technical amendment to clarify the definition of “investigation” that applies to part 4 of the Bill. Investigations carried out by HSSIB by agreement under clause 114, which relate to Wales and Northern Ireland, were never intended to be part of the main investigation function of HSSIB and therefore will not be covered by the safe space or other investigatory power provisions provided for in the Bill. The amendment ensures that the drafting of the Bill fully reflects that original policy position. I hope that hon. Members on both sides of the Chamber will be content to pass this technical amendment.

Finally, I turn to Government amendment 88 to schedule 13. Schedule 13 contains a regulation-making power which allows the Treasury to vary the way any relevant tax has effect in relation to associated transfer schemes. Regulations made under this power will be used to ensure that no unintended tax consequences arise. The amendment ensures that value added tax is included in the taxes which the Treasury can, by regulations, vary when considering the transfer schemes in this Bill. Without this amendment, it is possible that complications with VAT bills may arise when transfer schemes are made and transactions take place. It is for those reasons that I ask hon. Members to support this amendment.

I am conscious that other hon. and right hon. Members may wish to speak to their amendments. I look forward to addressing those that I have not directly addressed thus far when I wind up debate on this group of amendments. With that, I conclude.

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

I thank the Minister for his introduction. It seems like only yesterday that we were having a similar exchange across the Dispatch Box.

I will begin with our new clauses 28 and 29 and amendment 10. This discussion about workforce could well be the most important of all today. Just this weekend, Chris Hopson from NHS Providers was trying to get the Government to acknowledge the seriousness of the problem when he tweeted:

“93k NHS staff vacancies. £6bn spend on temporary staff to fill gaps. 55% of staff working unpaid extra hours each week. 44% saying they’ve felt ill with work related stress. NHS desperately needs long term workforce planning. Govt must make this happen this week.”

Everything comes back to workforce and the failure to invest in it consistently over a sustained period. Today we have a chance to correct that.

While we favour our new clause 29, it is obvious that amendment 10 has captured the attention of many and may well be put to a vote. In many ways, as the Minister said, it closely mirrors what we have put forward, so I will be making my general points on both the new clauses and the amendment. In supporting amendment 10, I pay tribute to the right hon. Member for South West Surrey (Jeremy Hunt), the Chair of the Health and Social Care Committee. Given his previous role, he is well placed to have an informed view on what needs to be done, and he has done that with this amendment without undue hype or drama. The support he has obtained more widely from stakeholders outside the House is impressive; indeed, the way he has united just about the entire sector shows not only his powers of persuasion, but the importance of the issue. He has come close to uniting the entire sector in the past, but that was usually in opposition to something he was proposing, rather than in support. There may be many other areas where we have disagreed in the past, but that does not diminish our support for his call.

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

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

[Justin Madders]

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

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

[Alex Sobel (Leeds North West) (Lab/Co-op)]

A doctor in my constituency, Dr Tom James, told me that he and his colleagues in the hospital were demoralised, exhausted and at the end of their tether, particularly after the covid crisis, in a building that was falling apart around them. He said there was no more goodwill, and the Government needed to grab hold of this crisis and resolve it. Are new clause 29 and amendment 10 not a minimum, rather than a maximum, for what we should be looking to achieve?

[Justin Madders]

New clause 29 and amendment 10 are the starting point, not the whole answer. They are a framework for getting this right in the future and offering the workforce, which, as the Minister said, has given so much in recent times, some hope that there will be better times along the way. I will refer later to the report by the Health and Social Care Committee on workforce burnout, which brought home just how demoralised the workforce have become and why they need to be given some positive news today.

[Rachael Maskell]

Anyone who on Sunday was on the March with Midwives will understand the real crisis now facing that profession—a particularly acute once since it is also about women’s health. Is there not a need to ensure that plans are not just on paper, but expedited, so that we are sure of seeing real delivery of those much-needed staff?

[Justin Madders]

Like just about every profession and sector in the NHS, midwives are under tremendous pressure and are understaffed. We need a clear plan, and a plan that is delivered. Of course, having a plan is not the whole answer, which is why it is important that we hear regular reports back from the Secretary of State on progress. That is why we hope amendment 10 will be supported.

[Emma Hardy]

One reason I want to emphasise the importance of new clause 28 is that we are anticipating a greater demand for mental health services, and therefore a greater demand for mental health professionals working in the NHS. Only by having regular reviews will we be able to anticipate what that demand will be and prepare accordingly.

[Justin Madders]

My hon. Friend is correct; we could not have anticipated what has happened in the past 12 to 18 months, but we can see what it means moving forward. Regular reviews of demand are critical, and we know that training these highly qualified and skilled staff takes time, which is why a longer-term view and approach are required.

[Richard Fuller]

I want to pick up on the increasing demand for mental health services. Does the hon. Gentleman accept that in general, it is utterly impossible to meet the expectation of increasing demand for health services without vast improvements in the efficiency with which people working in the health and care sector deliver that service? Is it not a shortcoming of both the Government and the Opposition that there is not an intense focus on solving that problem of labour cost productivity? Without that, we will not be able to meet current needs and we certainly will not meet future needs.

[Justin Madders]

We are always looking at ways to improve productivity, but we know that on the current figures there are 100,000 staff vacancies in the NHS. No amount of productivity gains will cover for that.

[Munira Wilson (Twickenham) (LD)]

The hon. Member for North East Bedfordshire (Richard Fuller) talks about efficiency, but the figures show that in 2019-20, some £6.2 billion was spent on bank and agency staff. If we are talking about efficiency and using all the extra money the Government are saying they will put in to catch-up, we need to provide value for money for the taxpayer. Therefore, long-term planning to recruit the right skills is critical.

[Justin Madders]

I thank the hon. Member for her intervention. The point about agencies and locum spend is not a new one. It will be interesting to see the figures for the last 12 to 18 months when the Minister has finally ratified them, because I suspect they will be even higher than those we have heard recently.

[Dr Whitford]

Having spent over three decades in the NHS, I know that this is not just about senior staff and what are called frontline staff. It is said, “We’ll protect frontline staff, but we’ll cut administrative staff or backroom staff.” However, if I am not in a clinic with the right results with the right patient at the right time, I am a waste of space. In actual fact, we need to look at the whole team. There is a sweet spot where I am working flat out but I have a team who are helping me. If we cut any of those, then we lose efficiency, and as the hon. Member for Twickenham (Munira Wilson) said, costs are going up, so we are becoming not more productive, but less productive.

[Justin Madders]

I thank the hon. Member for her intervention. Indeed, this actually covers some of the debate we had in Committee. There has been a rhetoric coming out of Government in recent months that managers are somehow a cost burden and that administrative staff do not actually help deliver the services. Of course, as the hon. Member has just pointed out, they are a vital source of support for those on the frontline.

[Dr Murrison]

The hon. Member is being generous in giving way. Would he avoid the temptation to suggest that productivity is in some way simply a demand for hard-pressed people in health and social care to work harder? It is not that at all. It is just doing what they want to do, which is to work smarter and thus get more out of the system, which I think is what the hon. Member for Central Ayrshire (Dr Whitford) has just said.

[Justin Madders]

I accept what the right hon. Member has said. There has been a gap in investment in IT and other things that make people’s jobs easier and more efficient, and that has been a characteristic of NHS spending over the last decade.

With your permission, Madam Deputy Speaker, I will try to make some progress, but it is important, as we have talked about the staff, that we pay tribute to all those who make the NHS what it is today. On Nursing Support Worker Day, I pay tribute to all those who work in wards, clinics and community settings to support our nurses and provide that essential hands-on care to patients.

Our care system does indeed face a crisis—over waiting times, over recovery—but as with all other crises, the root cause is inadequate funding. The most visible and significant symptom is an inadequate workforce, plus the scandal of social care provision. There is no plan at the moment; it is just a plan for a plan. When we talk about a workforce crisis, that cannot be in any way a reflection on the huge value and contribution of the workforce we have now.

There are particular positive aspects to amendment 10 to which I would like to draw attention. Explicit recognition of the need to consult with the workforce through trade unions is very welcome. The planning covers health and social care, which is also absolutely essential. Given the scope of the review, the timescale is about right—every two years is demanding, but not too onerous—but a regular update each year might be preferable. However, the main point, which I have made already, is to compel a regular report and review of demand. The central role is that the Secretary of State has a duty to get planning done, and we hope that will be a crucial lever for the change we need to see.

If the amendment has a weakness, it is probably the one we have touched on already, which is that it does not ensure that the plan is feasible or delivered. A plan that shows the gap is not a plan unless it has a credible funding solution alongside it. Even if that is not explicit in the amendment, we assume that funding would follow any such assessment and plan that is set out. Our suggestion would be that any such financial projections in a plan are subject to the same level of independent expert verification as we see with the Office for Budget Responsibility. Since all the various think-tanks are going to do an assessment anyway, we may as well have a built-in process for verification.

[Rachael Maskell]

Does my hon. Friend agree with me that many of the recruitment challenges often sit in outsourced services in the private sector, and as a result it is really difficult to find the complement of staff required because people want to work in the NHS? That needs to be taken into consideration in any workplace plan.

[Justin Madders]

I thank my hon. Friend for her intervention and I will later talk a little about outsourcing and the role it has to play. We believe that plans should be built from the bottom up, not from the top, and that implies the involvement of ICBs, NHS trusts and foundation trusts. ICBs and their strategic arms, integrated care providers, will not be functional for some time. That is a shame, but it does not mean we should not proceed with the amendment.

The scale of the workforce challenge is well established: high rates of vacancy, inadequate levels of retention, and much more. It goes far deeper than numbers and structures, to issues of workforce terms and conditions, particularly in social care. It must also cover cultural issues, as there is a clear indication that all is not well in the NHS in terms of diversity. There is also whistleblowing, and aspects of how staff are nurtured and supported. At its very best, the NHS is very good, but unfortunately that is not the story across the board. It should be good in every part.

On that theme, let me mention the continuing disgrace in the way that some members of the NHS workforce are treated. I find it unacceptable that cleaners, porters, catering and IT staff are still being outsourced by trusts that are trying to make tax savings or outsource services to the lowest bidder. Perhaps the Minister can look into the current dispute at South Warwickshire in that regard, as we do not think that is a template to follow. Workforce planning is not a problem that can be solved quickly, although increased funding in social care could help that. For the NHS, the long term is indeed a long time—for example, the time needed to develop and train GPs and consultants. More money is not the only answer; technology and reform of the way we work must all be part of the mix. However, the labour-intensive nature of care will not fundamentally change, so we must look at workforce numbers as the priority. It is often said that failing to plan is the same as planning to fail. Some colleagues believe that a failure to plan is exactly that—a route to ending the NHS as we know it by showing that it fails. However, the Bill suggests an acceptance that a plan is needed, and work is under way. Hopefully that work is not being handed out to more consultants, of whom we see enough already.

Labour will support the amendment tabled by the Chair of the Health and Social Care Committee, which we hope will be pushed to a vote. I hope I have not been too effusive in my comments about him—I have a reputation to maintain after all—but I will refer to the excellent report done by his Committee on workforce burnout, which in many ways is the cornerstone of what we are debating. In its conclusion, the Committee said:

“The emergency that workforce burnout has become will not be solved without a total overhaul of the way the NHS does workforce planning. After the pandemic, which revealed so many critical staff shortages, the least we can do for staff is to show there is a long term solution to those shortages, ultimately the biggest driver of burnout. We may not be able to solve the issues around burnout overnight but we can at least give staff confidence that a long term solution is in place.

The way that the NHS does workforce planning is at best opaque and at worst responsible for the unacceptable pressure on the current workforce which existed even before the pandemic.

It is clear that workforce planning has been led by the funding envelope available to health and social care rather than by demand and the capacity required to service that demand. Furthermore, there is no accurate, public projection of what health and social care require in the workforce for the next five to ten years in each specialism. Without that level of detail, the shortages in the health and care workforce will endure, to the detriment of both the service provision and the staff who currently work in the sector. Annual, independent workforce projections would provide the NHS, social care and Government with the clarity required for long-term workforce planning.”

That conclusion shows what we are trying to achieve today. That is the nub of it: if not now, when? When will the Government finally accept the obvious that has been staring them in the face for years?

New clause 29 would require the Secretary of State to lay before Parliament a fully funded health and care workforce strategy to ensure that the numbers, skill and mix of healthcare staff are sufficient for the safe and effective delivery of services. It builds on other amendments, and seeks further assurances by putting patient safety and safe staffing levels at the heart of workforce planning, by setting out how the Government will be required to act to assess and rectify shortages. It seeks to ensure that the workforce will be on a sustainable footing in future. Patient safety should be our primary concern. We have the evidence base: when there are not enough registered nurses, mortality rates change and health outcomes are worse. I accept that the level of detail in the new clause is significant, but we consider that necessary to underscore the importance of setting out how this will be delivered.

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[Mr Richard Holden (North West Durham) (Con)]

I thank the hon. Member for giving way, and I apologise to the Minister for not being here at the very start; I was on a train back from a ministerial visit in my constituency. I would just like to pay tribute to some of the campaigners who are in the Public Gallery at the moment, particularly those from Karma Nirvana, the Iranian and Kurdish Women’s Rights Organisation, the Middle Eastern Women and Society Organisation, and the Royal College of Obstetricians and Gynaecologists. Does the hon. Member agree that it is those campaigners and charities who have worked on this issue for a very long time who have really brought it to the fore—they have just been supported by some Members of this House—and that it is they who deserve the credit?

[Justin Madders]

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

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

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

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

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

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

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

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

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

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

[Jeremy Hunt]

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

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

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

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[Mr Deputy Speaker (Mr Nigel Evans)]

Fantastic. I am grateful to the Minister for his brevity; he can see how many people are trying to catch my eye.

[Justin Madders]

Thank you, Madam Deputy Speaker—[Interruption.] It has been a long day, Mr Deputy Speaker, but we will get there.

I will speak to the amendments tabled in my name and those of my right hon. and hon. Friends. As the Minister said, this group of amendments covers a large range of important areas, so I will be brief.

New clause 27 flags up the issues around waiting times. Passing any amendment requiring a report is, of course, not a total solution, but it might be a source of focus. As Labour has said many times since 2010, winter pressures, waiting times and the flight into private healthcare to get earlier treatment have exacerbated the issues.

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

Many of my constituents find it increasingly difficult to book an appointment with an NHS GP or dentist, forcing them either to go private or to suffer without treatment. Does the shadow Minister agree that, after a decade of failure and misguided policies, the Government must take urgent remedial action? However, the term “waiting time”, to which he has just referred, is not mentioned once in the Bill.

[Justin Madders]

My hon. Friend is right that one of the criticisms we have levelled against the Bill is that it does not address the issues and challenges facing the NHS. I will take no further interventions, because I am conscious that many Members have contributions to make.

I will move swiftly on to our two amendments dealing with inequality and to new clause 64 in the name of my hon. Friend the Member for Oldham East and Saddleworth (Debbie Abrahams). To show that this is an NHS and social care Bill, not just an NHS Bill, local authorities need to be more involved and more emphasis must be placed on wellbeing and better outcomes. We support the NHS triple aim—improving health, quality of care and cost control are, of course, important functions. Nevertheless, we live in a country where significant inequalities remain, and narrowing those gaps should be a national priority.

Research from the IPPR last month highlighted the 10-year gap in life expectancy between a person living in the poorest community and a person in the best off. That gap doubles when we talk about healthy life expectancy. Tackling that disparity must be a priority in the Bill. The Secretary of State for Health and Social Care said in his first speech that said he wanted to tackle the “disease of disparity”, so why is that missing?

Turning to clause 39—one of my favourites—why it remains in the Bill is a mystery given that the previous Secretary of State, the right hon. Member for West Suffolk (Matt Hancock), who requested these powers, is no longer in the role. Perhaps he will give us his insight into that later on. It is the absolute antithesis of the Lansley view that politicians should be distanced from NHS operational issues and makes a mockery of the overall thrust of this Bill, which is about encouraging local decision making. It is no exaggeration to say that, taken literally, clause 39 and its accompanying schedule 6 require the Secretary of State to be told if there are, or even if there might be, proposals to vary service—even moving a clinic from one location to another nearby.

As has been pointed out by wise heads, the power is not one that many Secretaries of State should want to get involved in. A Secretary of State who used it could be accused of favouring certain areas or decisions for political purposes. The well-articulated fear is that it will be used to block necessary but unpopular changes and that expediency will rule. Such decisions should be left to the clinicians or maybe the health economists but not politicians. Labour opposes this new power and would gently say to the Minister, “Be careful what you wish for.”

Finally, the issues around discharge to assess are complex. As we worked our way through in Committee, we heard evidence from many stakeholders, and it is fair to say that views on the matter were polarised. We are led to believe, and have some confirmation, that this development is working well for some acute settings, helping ease the perennial and disruptive issues around delayed transfers of care, but in other places we hear voices calling for much greater caution and for tougher safeguards or even, as amendment 60 requests, to stop it altogether. While we have sympathy with amendment 60, it would only pose more problems for the NHS if it was passed, so we have opted in our amendment 73 just to tighten up on safeguards.

Of course the real solutions are far more complex and would require higher investment both in the NHS and in social care. It should be mandatory that all aspects of ongoing care have been properly discussed and agreed with the patient and carers prior to discharge. An assessment should include carers with special attention if a child carer is involved, and there is a concern that unpaid carers will not be identified and consulted at the point of discharge.

The system for step-down care outside acute hospitals must be adequate, and there must be sufficient high-quality and funded places in care settings of all kinds. We are literally a whole generation away from having that kind of system, even if the funding started to become available today. On a related point, new clause 63 from the hon. Member for St Albans (Daisy Cooper) also deserves support.

I will leave my comments there, as I know many hon. Members want to speak.

[Mrs Theresa May (Maidenhead) (Con)]

I rise to speak in support of amendments 93 to 98, whose purpose is very simple.

The Health and Social Care Act 2012 established parity of esteem between physical and mental health in their treatment in the national health service. The Bill is silent on the issue. I know that Ministers have given assurances, in a variety of ways, that it is not the Government’s intention to move away from that parity of esteem, but if that is the case, the answer is simple: accept the amendments. The Government do not even have to write them; they have been written for them. There would then be absolutely no doubt about the continued commitment to ensuring parity of esteem between physical and mental health.

Mental health was clearly in the long-term plan for the national health service that I was pleased to see introduced. It was there because of the need to accept, as Members across the House do, that for too long mental health has not been given the attention that it deserves. People who were suffering with mental health problems were not getting the services that they need.

It will take time to ensure that we can provide for all, but sadly the issue has been exacerbated by the pandemic. In March 2021, there were 26% more referrals for mental health services than in March 2019, before the pandemic. The Centre for Mental Health reckons that 10 million additional people will need mental health care as a result of the pandemic. I am particularly concerned about the impact on young people; I am sure that Members across the House are seeing young people in their constituencies whose mental health may have been suffering anyway, but has suffered even more as a result of the pandemic.

More people now require mental health services. The Government talk a lot about dealing with the backlog that is a result of the pandemic, but it is only ever spoken about with reference to surgery or operations. The great danger is that in their focus on dealing with that backlog, which we all accept is necessary, the Government will push the issue of mental health services to one side.

The amendments stand in the name of my hon. Friend the Member for Broxbourne (Sir Charles Walker), in my name and in the names of Members across the House—there is cross-party concern. I say to the Minister once again: it is very simple. If the Government wish to maintain parity of esteem between physical and mental health and ensure that people with mental health problems are given the services and care that they need, they must put uncertainty to one side, accept the amendments and make it clear that physical and mental health will be treated with parity of esteem in our national health service.