Oral Answers to Questions

Justin Madders Excerpts

Tuesday 12th January 2021 Commons Chamber

[Helen Whately]

I can assure my hon. Friend that most secondary schools and colleges have already set up testing sites and have begun weekly testing, using lateral flow devices for staff currently in school. Staff could also participate in daily contact testing on site, and primary schools will shortly be receiving test kits for weekly staff testing and also for daily contact testing.

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

We can have all the testing in the world, but it will not be effective if people do not self-isolate after a positive result. We have repeatedly said that compliance with self-isolation rules is not good enough; with only one in eight people qualifying for the self-isolation payment, that is not surprising. Can the Minister ensure that everyone is properly supported to self-isolate from now on and explain why those who test positive after a lateral flow test cannot apply for a payment and do not even enter the national test and trace system?

[Helen Whately]

We absolutely recognise not only the importance of self-isolation, which is critical in breaking the chains of transmission, but that it is not always easy for people to do. We recognise, for instance, the cost of self-isolation, and that is why we introduced a payment of £500 for those who are on low incomes and unable to work from home while isolating. We will continue to make sure that people have the support they need to self-isolate.

Covid-19

Justin Madders Excerpts

Tuesday 12th January 2021 Commons Chamber

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

We have had another well-subscribed debate, and Members’ contributions have been short as a result but no less effective for it. On the Opposition Benches, we have heard from my hon. Friend the Member for Leeds East (Richard Burgon), who expressed concern that the current lockdown rules are inadequate and that the Government’s response is to blame the public for non-compliance. My hon. Friend the Member for Birkenhead (Mick Whitley) talked about the heroes who have kept this country going, and I join him in paying tribute to them. He said that they are the “very best of humanity” but are often among the lowest paid.

My hon. Friend the Member for West Ham (Ms Brown) gave a typically passionate speech. She described NHS staff as exhausted, stressed and traumatised, and she asked the right question: if the Nightingales are reopening, how can they be staffed when NHS staff are already at breaking point? She was outraged, as many of us are, at the paltry offering that our nation’s children have been told is enough to feed them for a week. My hon. Friend the Member for Newport East (Jessica Morden) paid tribute to the work of the Welsh Assembly and made the fair point that, when it has made decisions to lock down, financial support from Westminster has not always followed automatically.

My hon. Friend the Member for Hornsey and Wood Green (Catherine West) expressed regret that the Government did not formally review their actions after the first wave, because if they had, mistakes might not have been repeated. My hon. Friend the Member for Kingston upon Hull West and Hessle (Emma Hardy) was, as always, a powerful advocate for her city, and she spoke about how businesses and individuals have suffered during the last year. My hon. Friends the Members for Coventry North East (Colleen Fletcher) and for Brentford and Isleworth (Ruth Cadbury) drew attention to the widening health inequalities in the past decade that have now been exacerbated by the pandemic. My hon. Friend the Member for Weaver Vale (Mike Amesbury) spoke about the patchiness of vaccine supply in his constituency. As his neighbour, I recognise those concerns, as many Members do, and we hope to see great progress on that in the coming weeks.

Finally, in a powerful speech, my hon. Friend the Member for Mitcham and Morden (Siobhain McDonagh) reminded us that the link between covid cases and poverty is a stark one. She made a strong case for why more support is needed to enable people to self-isolate. In fact, just about every single Opposition Member raised that in one way or another. We have been making this case since the start of the pandemic, so why has it not happened?

We are in the darkest hour yet, but we still see the same failings again and again that have led us to this place. More people have been infected this year already than in the whole of October, when, let us not forget, things got so bad that we had to have another lockdown. Worse still, more people have died this month already than died in July, August and September put together. Every death is a tragedy. Every death leaves behind a grieving family, and while not every death is avoidable, not every one was inevitable.

The Government follow the same pattern every time, waiting until the last possible moment—until a decision becomes unavoidable. It is an ongoing cycle of bluster and denial, losing valuable time through delaying the inevitable and then running to catch up but never quite getting there. We can trace that pattern right back to even before the start of the pandemic, when warnings about preparations were ignored and the Prime Minister missed five Cobra meetings when our initial response to this threat was drawn up.

The Government have repeatedly been too slow to act. They were too slow to lock down the first time, and the second and the third. Ignoring the scientific advice from SAGE on a circuit breaker lockdown for six weeks was unforgivable. The Government certainly were not following the science then, nor were they when they said they would not change the Christmas relaxation rules because it was too late to do so, only to then do it three days later. They then told teachers, parents and children that it was safe to return to school one day, only to close them the next.

The Government ignored the World Health Organisation’s advice to test, test, test and stopped contact tracing altogether in March. As my hon. Friend the Member for Leicester East (Claudia Webbe) set out, the Government’s failings in social care are many, the most serious of which was allowing patients to be discharged into care homes without testing them for covid. We also had people being sent hundreds of miles just to get a covid test, all the while people were still coming into the UK without any checks at all. That still is not going to be corrected until the end of this week. The promise of all test results being returned within 24 hours has never materialised. Even now, the vast majority of tests take far longer than that to return.

They also delayed the roll-out of routine testing for care home staff but failed to anticipate the increase in testing capacity that would be needed when people returned to schools and workplaces, and they missed thousands of new cases because the spreadsheet was full. They set up a covid hotline that missed thousands of calls because of a failure to anticipate demand, again. On contact tracing, they developed the famous app and then could not get it to work. It was scrapped. They started again and finally delivered it four months’ late. Then, when it arrived, a notification to self-isolate from it did not count for claiming the self-isolation payment.

Worst of all, they handed massive sums of money to private companies with no record of contact tracing to deal with test and trace, repeatedly ignoring the evidence that locally led teams consistently delivered better results. The consequences of that were that thousands of people every day were not contacted quickly enough or were not contacted at all, meaning they continued to unwittingly spread the virus. They also did not require those private testing companies to report their results back to local public health bodies, meaning that opportunities for early action on local outbreaks were missed.

On PPE, where do we start? Stockpiles were allowed to run down. The Government allowed desperately needed PPE to be exported abroad, while our own health and social care staff were having to scrabble around or rely on homemade items. They signed £10 billion-worth of contracts on covid procurement without following the usual rules, including handing multimillion pound contracts to companies with no record of PPE production, some of whom supplied PPE that did not meet the required standards or, worse still, did not provide anything at all.

As we have said, they failed and are still failing to support people to self-isolate, bringing in a scheme of support that only one in eight people qualified for, with the unsurprising consequence that many people cannot afford to self-isolate. This is one of the first things we brought up at the start of the pandemic almost a year ago and it is unbelievable that it has still not been resolved.

Finally, the Government introduced a tier system that did not work and then another tier system that experts told them from the start would not work, so they had to introduce yet another tier system that did not work before finally creating extra tiers to the tier system that also did not work. They have over-promised and under-delivered every step of the way. There is a tragic failure to learn from mistakes. That must not be allowed to happen with the roll-out of the vaccine. It is, after all, our only way out of the situation.

It is, of course, a source of great national pride that we were the first country to approve a vaccine for distribution and that our own scientists were integral to the development of the second vaccine that was approved. So it would be a huge failing if we then did not become the first country to mass vaccinate our population. For the families forced to part, for the businesses facing bankruptcy and for the NHS staff exhausted by the relentless pressure that the virus has created, we all want the quickest possible route out of this.

The vaccines Minister said yesterday that the limiting factor to the vaccine roll-out at the moment is the volume of vaccines available, but has provided little detail on future supply. Where has it gone? AstraZeneca promised 30 million doses by September. That went down to 4 million by the end of year and clearly much less has actually been delivered on the ground. All the best laid plans will not matter if the supply is not there, so I hope the Minister can set out a detailed schedule of how many doses have been received to date, how many are expected each week and what the weekly projections are for delivery moving forward. Once we have got that sorted, let us go for 24-hour delivery. I can assure the House that there is an appetite for that.

On the vaccination of NHS staff, the latest estimate is that there are now some 46,000 staff off ill with covid, so it is vital that all NHS staff receive their first dose as soon as possible. Will the Minister commit today not just to delivering them as soon as possible, but to ensuring that they all get their vaccines within the next two weeks? We very much welcome the vaccines data that will be published each day from Thursday, but will she also commit to publishing the daily total of health and social care staff vaccinated so we can see progress there, too. We absolutely need the NHS to be protected. In that regard, one way to relieve pressure is to ensure that discharges into the social care sector are managed. Can the Minister update us on when the 500 covid-secure care homes will finally be on stream?

I just want to say a few words on the current lockdown. As we have heard, there has been much debate, both in here and in the media, about whether the current measures in place are sufficient. Once again, we hear at second hand from media briefings that Ministers are considering introducing new measures. Can the Minister update us in here, today, on whether any further measures will be introduced? Advice in December called for the Government to reconsider the 1 metre-plus rule, and we hear that SAGE has urged the Prime Minister to go further and increase 2 metres to 3 metres. We cannot be too late on that as well, so can the Government set out today what their position is on the social distancing rules and whether they need to change?

We know that the Government have also been advised to reinforce the importance of face coverings, including in settings where they are not currently mandated, such as workplaces and outdoor spaces. There was a two-month delay in advice on face coverings moving from just being guidance to becoming law. We cannot wait another two months for a change again if that is needed.

We all know why we need to look at extra measures, but to reinforce just how important that is, I want to conclude with a message that I received this morning from a constituent, who is an ICU nurse. She told me:

“I work full time plus extra, as we’re so, so busy. It’s horrendous. I am exhausted. I am still awake after a night shift, as I can’t switch off. I had four patients last night, I should only have had two. Then on my days off, I’m having to home-school as my husband, who is a store manager, is having to go to work and do click and collect. He says there are huge queues. It’s an absolute joke. This is not a proper lockdown.”

We need to listen to her. Our own eyes should tell us that this lockdown is not as strict as the first one, yet we have a more transmissible variant of the virus in circulation. Let us not delay again making the difficult but necessary decisions. Let us not put more pressure on an NHS already at breaking point. Let us not make those same mistakes again.

Covid-19 Vaccination Roll-out

Justin Madders Excerpts

Monday 11th January 2021 Westminster Hall

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

It is a pleasure to see you in the Chair, Sir David. I want to start by thanking my hon. Friend the Member for Gower (Tonia Antoniazzi) for her comprehensive and compelling introduction to this subject. She raised a whole series of questions, dilemmas and judgments that follow on from the very clear objective that we all share: we want as many people as possible to be vaccinated as quickly as possible.

My hon. Friend the Member for Gower clearly set out that lots of people in the country have been discussing this issue, as we would expect, but this forum is the right place in a democracy for us to be discussing those ideas, exchanging views and doing so in a way that is respectful and tolerant of other opinions. She set out clearly, as did other Members, the consequences of missing school, particularly in terms of the widening attainment gap and the digital divide, and she explained why it really has to be a priority to get children back into school as soon as possible. It was so disappointing, if not sadly inevitable, that we had to make the decision to restrict attendance at school. It is also very regrettable that the decision was taken without a proper back-up plan to allow children to learn remotely. I agree with her that teachers inspire, build confidence and impart knowledge, and they do that best of all when they teach in person in the classroom.

We also heard from my hon. Friend the Member for Leeds North West (Alex Sobel), who talked about the overwhelming sense of fatigue that we all feel in dealing with this virus—I think we can all understand that. He described the vaccine as the way out of this situation and said that the wonders of human ingenuity have allowed the vaccines to be developed and made ready in such a short space of time. He gave a very good plug for our party’s campaign on the vaccination programme, and he raised the important point that it would be very helpful if employers gave paid time off for people to go and receive the vaccine.

My hon. Friend the Member for Leeds North West also raised an important question, which I hope the Minister answers, about whether hospice staff should be included in the priority group for vaccination. He talked about a 24/7 vaccination programme and told us that the Prime Minister had apparently said there is no appetite for it. After talking to Members present and to members of the public, I have to say that there is an appetite for that. Every minute, every hour and every day that we can vaccinate people is another step closer to the freedom that we all want to return to. Let us not miss any opportunity to get to that point as quickly as possible. As my hon. Friend the Member for Cardiff South and Penarth (Stephen Doughty) said, the 24/7 approach should apply not just to delivering the vaccine but to the production of it.

My hon. Friend was also right to talk about the importance of getting information out there, because everyone wants to know where we are up to with this. Certainly, my constituency office has had many phone calls and emails asking about the vaccination programme. He also spoke about the excellent work undertaken in Wales to roll out the vaccine. He made the fair point that this is not an easy choice—these are not easy options for anyone—but it is important that we take the best professional and scientific advice available when we take these decisions.

It is, of course, a source of great national pride that we were the first country to approve a vaccine for distribution and that our own scientists were integral to the development of the second vaccine, which is now beginning to be rolled out across the country. Having found ourselves in this good position, it would be very disappointing if we did not become the first country to mass vaccinate its population. For the grandparents who have not seen their grandchildren, for the businesses that have not traded properly for a year and are facing bankruptcy, and for the NHS staff exhausted by the relentless pressure that this virus has created, we all want the quickest route possible out of this.

To date, as we have discussed, the lockdown strategy has been our most effective weapon against the spread of the virus, but we all know that that has created another set of extremely tough challenges and that there are concerns that even that may not be enough to halt the spread of the new strain. Therefore, as has always been the case, mass vaccination is the key to ending the nightmare, which is why no stone should be left unturned and no component of the state left unutilised, and every member of society who wants to contribute should be engaged in some way so that we all play our part to get as many people vaccinated as possible, as soon as possible. We all share that ambition, but the Government have displayed a pattern in this pandemic of being too slow and of over-promising and under-delivering.

[Jim Shannon]

Does the hon. Gentleman share my concern—I suspect the Minister does—that the roll-out of the vaccine has been halted in parts of the United Kingdom because supplies are running out? Is there not a logistical issue to be addressed as well, to ensure that that does not happen?

[Justin Madders]

The hon. Gentleman predicts the journey I am about to embark on. I will talk about that very legitimate point, which hon. Members have raised. AstraZeneca promised 30 million doses by September, but that went down to 4 million by the end of the year and, clearly, much less has been delivered on the ground. All the best plans possible will not matter if the supply is not there. Various Members have raised this issue, so when he responds, I hope the Minister will set out the exact position in terms of supply. How many doses have been received to date from each manufacturer? How many are expected each week? What are the weekly projections for delivery?

I will give the Minister a local example. My vaccination centre in Ellesmere Port is due to open sometime this week, but nobody knows exactly when because nobody knows when the first delivery will arrive. One thing this country is not short of is logistics experts. The Vaccine Taskforce is supposed to have been addressing this for months, so those on the frontline should not have been put in the position of not knowing when the vaccine is going to arrive. No vaccine should be left on the shelves, in warehouses or stuck at a factory gate waiting to be delivered. Greater transparency would be much appreciated. As my hon. Friend the Member for Leeds North West said, we could do with a performance dashboard covering not just the total figures published each week, but the proportionate numbers in each category of the priority list, including NHS staff—at clinical commissioning group level as well as nationally—so that everyone can see what progress is being made. There are references to that in the document that was produced today.

Turning to the subject matter of the petition, we know from what SAGE has said that schools are making a significant contribution to the R rate and that, with infections running out of control, the closure of schools—except for vulnerable children and the children of key workers—was, sadly, inevitable. As we have said, however, there are multiple reasons why reopening them has to be a priority, not least the importance of getting children back into the classroom. Although we could not go against the JCVI priority list—indeed, it is likely that a change now would be counterproductive—we believe that, as with the change to the period between the first and second doses, serious consideration needs to be given to the order in which the vaccine should be distributed after the initial phase. Indeed, I think Sir Simon Stevens has said as much today.

Of course, it is worth pointing out that the most clinically vulnerable adults who work in education will receive the vaccine shortly anyway, and we believe that the priority should be to increase the number of people who have received the first dose, so that debates over prioritisation become obsolete. However, if that is not possible, we believe that it is more than reasonable to look not only at the risk posed by particular workplaces but at the wider societal benefits of vaccinating particular groups of workers.

I hope that we have sufficient supplies and delivery networks so that we do not end up in a position where particular groups of workers are pitted against one another, but clearly there is a strong case for priority to be given to those working in education settings. At this point, may I thank everyone who works in education for their contribution? I know how hard many of them worked over the Christmas period to prepare for the mass testing regimes, and we could all hear their exasperation when they were asked to revert to remote working at 24 hours’ notice. I am afraid that some of that exasperation actually turned to anger when the Education Secretary delivered his warning that Ofsted could become involved if online learning was not up to scratch. If ever there was a sentence that summed up how he is not listening to the education world, that was it.

When I talk about education, I mean education in the widest sense. As various Members have said today, that includes all those who come into close contact with others as part of their job in an educational setting. For example, if we look at those in special educational needs settings, we see that they are often in much closer contact with others than most people. It is not just teachers whom we must consider but classroom assistants, cleaners, cooks and probably just about everyone who works in a school. We are not only talking about schools; as my hon. Friend the Member for Leeds North West said, nurseries and other childcare settings should be looked at. However, for reasons that are not entirely clear, they remain open at this time. I think we can all see how, in those settings, it can be very difficult to avoid close contact with others.

[Tonia Antoniazzi]

Just to reiterate, everyone in an educational setting should be prioritised for vaccination. Also, what about student teachers? Does my hon. Friend agree that they need to be prioritised too?

[Justin Madders]

Yes. I think we have to look at the actual work that they do and the risk on the ground, but clearly student teachers would be part of that process.

There are strong arguments for those in other essential services to be given additional priority. There has been much talk of the police and their role in enforcing covid rules; if 20,000 police officers had not been cut in the past decade, the police might not be in such a difficult place to do that. We should remember that when the police go about their duties, they engage with the public and so, by definition, they put themselves at risk of infection.

Similar arguments could be made for those involved in the vaccination process—not just NHS staff but those who are volunteering. In relation to that, can the Minister update us on how many retired NHS staff have now passed all the requirements in this regard, so that they can assist in the vaccination process? We have all heard the stories about the fire safety training modules that have to be taken; although such requirements are worthy in their own right, it cannot be mission-critical at the moment for those tests to be undertaken. I can put it no better than the retired consultant who contacted me and said:

“This is actually more than I was required to do when I was a full-time NHS consultant. It is grossly excessive, unnecessary and burdensome.”

On the vaccination of NHS staff, we know the unprecedented pressures they are facing at the moment; the latest estimate is that there are some 46,000 NHS staff off sick with covid, and that is before we even consider those who are required to self-isolate. The need for a full complement of NHS staff to be available to work cannot be clearer, so we want to see all NHS staff receiving their first dose of the vaccine as soon as possible. There is also a concern about whether those people who are not directly employed by the NHS and instead may be self-employed are being picked up by the system.

In conclusion, we know that at the moment the vaccine programme rightly prioritises the most vulnerable and is designed to protect life. However, as that group of people receives that protection, it is right that we consider where priorities lie next. The nation’s key workers have literally kept the country going in the last 12 months—those in education and in transport, council workers, and many, many others who have gone to work day in and day out, knowing that they risk contracting a deadly virus. They do not deserve to be thanked with a pay freeze. At the very least, they deserve serious consideration for prioritisation in the next phase of the roll-out. Proper recognition of their contribution and of the wider societal benefits of their work demand no less.

Breast Cancer Screening

Justin Madders Excerpts

Wednesday 16th December 2020 Westminster Hall

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

It is a pleasure to see you in the Chair this afternoon, Sir Edward. I thank the hon. Member for High Peak (Robert Largan) for securing this important debate and for his introductory speech. It is clear that he feels very passionately about improving access to breast cancer screening for his constituents. He was right that tremendous progress has been made in tackling this awful disease in recent years, but there is still an awful long way to go, as we have heard today.

The hon. Gentleman mentioned the importance of screening, as most Members did. I was very sorry to hear that the mobile screening service in his constituency has been temporarily halted. I hope it is a temporary halt and the Minister is able to give us some good news when she responds. It is particularly disappointing because the hon. Member spoke very highly of that service in the last debate we had on this matter, only last month. He certainly set out very clearly why moving to the system that we have at the moment is presenting a particular challenge to his constituents. He also gave some very personal testimony about the consequences of a delay in screening, showing why, of course, access is important.

We have heard some other excellent contributions this afternoon. The hon. Member for West Bromwich East (Nicola Richards) cited her local area’s statistics to point out that the figure for screening appointments in her constituency was lower than the national average; clearly, such a situation is something that all Members can play a role in remedying. She was right to say that the key to all this is being proactive and encouraging people to seek screening and early diagnosis. She gave a very personal example of how that approach had made a real difference to someone very close to her.

The hon. Member for Westmorland and Lonsdale (Tim Farron) extrapolated from his local statistics to state that about one in six people who would ordinarily have received treatment this year are not receiving it. He mentioned his work as the chair of the all-party parliamentary group on radiotherapy and I commend him for his consistent work in that particular forum. He referred, quite rightly, to the 15% drop in the use of radiotherapy treatment, which is of particular concern. He said that he does not believe that there were good medical reasons for that reduction, so there is a challenge for the Minister to go back to trusts to see whether there are reasons beyond medical reasons why these treatments are not taking place. He described the situation as a crisis on the scale of covid and said that it needs a Government response on that scale to tackle the issues that we have discussed today.

Those sentiments were also expressed by the hon. Member for Strangford (Jim Shannon), who gave a typically passionate and well-informed speech. I am sure that we all agreed with him when he said that he would like to read out a different set of statistics in a debate on this issue next year. Like all the hon. Members who have spoken today, he very clearly set out the importance of screening. He also raised a number of other issues, which I will touch on in my remarks.

This is the second Westminster Hall debate on breast cancer in as many months, which reflects the importance of this subject. On both occasions, it has been evident from the testimonies of Members how many people have had their own lives touched by breast cancer. Debates such as this one are important because, as many Members have mentioned, the various statistics out there show that there are very few people whose lives are not touched by this issue in some way. As we have heard from many Members, one in seven women in the UK will develop breast cancer during their lifetime—on average, that is 55,000 women, as well as 370 men, every year. Around 600,000 people in the UK are living with or beyond breast cancer, and, sadly, around 35,000 people have incurable secondary breast cancer.

As the hon. Members for High Peak and for Strangford both said, almost 1,000 women die from breast cancer in the UK every month, almost all of them from secondary breast cancer. The hon. Member for Strangford put things very well when he reminded us that these statistics are about real people and real homes, which may never recover from such a tragic loss. We must never forget the human tragedy behind these figures when we read them out in debates such as this one.

This very important issue affects so many people, but there are also many people who are united in their desire to do all they can to beat this disease. I pay tribute to all the dedicated campaigners, ambassadors and charities, who all do their bit to make life a little bit easier for those suffering with cancer. We must, of course, pay tribute to the NHS staff for everything that they do, not just this year—the most difficult of years—but every year, in the fight against cancer. I also thank Breast Cancer Now for its continuing support for all politicians from all parties in the House and, most importantly, the support it gives to those living with or affected by breast cancer, because, as we have heard, more women, thankfully, are now surviving breast cancer than ever before.

As many Members have already said, the key to that is screening, because we know that the earlier a cancer is diagnosed, the more likely it is that treatment will be successful. We also know that currently around 95% of women diagnosed will survive for more than one year and more than 80% for more than five years.

In the debate on this issue last month, I touched on the impact of coronavirus on early diagnosis, as most Members have today. Cancer Research UK estimates that around 3 million people are waiting for breast, bowel or cervical screening, and Macmillan estimates that there are currently around 50,000 missing diagnoses from this year compared to last year. This is the biggest crisis that cancer has faced in decades.

Breast Cancer Now estimates a significant backlog of nearly 1 million women requiring screening has built up during this year. Among the women still waiting for their screening, we know from the statistics that there will be around 8,600 who do have breast cancer, but it remains undetected. As Members have set out, the reasons for that backlog are numerous. Social distancing and infection control means that many cancer services can operate only at about 60% of their capacity. As the hon. Member for Westmorland and Lonsdale pointed out, that means the situation might get worse rather than better. Services were already under severe strain during the first few months of this year, and we know about the unprecedented steps that the NHS has had to take to deal with the large influx of covid-19 patients, which has led to an effective pausing of breast screening in England.

Of course, not only the screening programme was affected. Breast Cancer Now has also reported that the number of people referred to see a specialist with suspected cancer declined dramatically during the peak of the coronavirus outbreak in April. It estimates that across the UK there are likely to be nearly 107,000 fewer breast cancer referrals. Some of those women could be living with undetected breast cancer, and with every month that passes more women will be missing that early diagnosis that we have all heard today is the key to preventing death.

Although screening programmes have now restarted, we have heard that that has happened more quickly in some parts of the country. Breast cancer charities have raised concerns about the current strategy that has been adopted to clear the backlog, with the plan to send women open invitations to call and make an appointment from September this year to the end of March. As the hon. Member for West Bromwich East said, research has shown that the number of women who make appointments is sometimes lower than the number of women who actually attend for a timed appointment.

Breast Cancer Now fears the strategy could worsen the persistent decline that we have seen in the uptake of screening in recent years. It has also raised concerns, as did the hon. Member for West Bromwich East, about the impact on groups, among which uptake is already low, such as those who live in deprived areas and those from black and minority ethnic groups. This is particularly important at a time when surveys have shown that people are reluctant to come forward with symptoms due to concerns about catching coronavirus and giving it to the family, and putting pressure on an already very busy NHS. When the Minister responds, will she tell us a little more about what steps the Government can take to ensure that the women who have received open invitations for screening are able to take those up in the coming months?

It is very welcome that October’s NHS breast cancer waiting times showed an increase in referrals for people with potential symptoms of breast cancer to see a specialist. However, the crucial targets for women to be seen within two weeks was missed. There are immense pressures on our health service at the moment, but before the pandemic the breast imaging and diagnostic work was already overstretched and under severe pressure because of increased demand on their services—and that of course has been compounded, as many Members have referred to, by the shortages and vacancies in the workforce.

As the hon. Member for High Peak mentioned, Public Health England has previously reported a vacancy rate of 15% for mammography staff. About half of all mammographers are aged 50 or over and therefore likely to retire in the next 10 to 15 years. That is very concerning, given the importance of mammograms in detecting breast cancer.

Of equal concern is what Breast Cancer Now tells us: only 18% of breast screening units are adequately resourced with radiography staff in line with breast screening uptake demand in their area, and one in four trusts and health boards across the UK has at least one vacant consultant breast radiologist post. Sadly, that situation is unlikely to improve any time soon as vacancies are set to increase with about a quarter of breast radiologists forecast to retire over the next five years.

A recent analysis of NHS trust risk registers showed that 83% of trusts surveyed reported a workforce risk, including not having enough staff to manage cancer care, showing the NHS entering the pandemic with huge holes in the workforce.

The Government commissioned reviews that have highlighted some concerns. We heard from the hon. Member for High Peak and various other Members about the independent review of adult screening programmes in England, which found that such programmes are constrained by the size and nature of their workforce and by the equipment and facilities available to them. As we heard, Professor Sir Mike Richards’s review, which was commissioned by Sir Simon Stevens, found that significant investment in facilities, equipment and workforce was needed. That means replacing outdated testing machines and expanding the imaging workforce by about 2,000 additional radiologists and 4,000 radiographers, as well as support staff.

In September, a Public Accounts Committee report called on the Government urgently to prioritise publication of the long-term workforce plan. Unfortunately, that exposed the lack of long-term thinking in the current approach to the NHS workforce. Such thinking is vital if we are to see the NHS perform at the level we all want it to. We need to see a full five-year people plan, with costed actions within it.

The pandemic has shown, as other Members said, just how valuable and appreciated NHS staff are, but it has also highlighted the unaddressed long-term issues of excessive workload, burn-out and the inequalities experienced by staff. The rhetoric on support for our NHS staff needs to be matched by action. As we have heard today, that commitment is vital to ensuring that breast cancer services can safely continue to give all those affected by breast cancer the very best chances of survival. I hope that we will hear from the Minister about how that ambition, which we all share, will be delivered.

Ockenden Review

Justin Madders Excerpts

Thursday 10th December 2020 Commons Chamber

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

I thank the Minister for advance sight of her statement and the personal commitment she has shown on this issue. I too thank Donna Ockenden and her team for their work to date.

Sadly, the report is not the first of its nature, and it is unlikely to be the last. We need to get ourselves into a place, sooner rather than later, where these systemic, almost cultural, failings become a thing of the past. The families have suffered unimaginable pain, and it must not be exacerbated by closed and defensive responses to the tragedies they have experienced.

Today’s statement comes only a fortnight after another damning report on maternity safety—Bill Kirkup’s report “The Life and Death of Elizabeth Dixon”. This is the latest in a long line of reports that show that, across large parts of the NHS, there is still a long way to go before we have the openness and transparency that patients deserve. That is not to do down the hundreds of thousands of staff who do a fantastic job day in, day out, but the report points to the wider problem—it is not a new problem—that when things go wrong, there is too little candour, too much defensiveness and a lack of leadership at the top of trusts; the leadership do not take personal responsibility and put right what has gone wrong.

Once again, we have got to this point only because of the persistence and resilience of the grieving families who have suffered such personal tragedy and refused to accept that what they were told was the end of the matter. I want to put on the record my appreciation of the courage and strength that they have shown throughout, but we really should not expect light to be shone on these issues only because individual families do not accept what they are told.

Senior leadership within trusts has to be much more candid and challenging with itself when faced with these concerns.  These families just want answers and an assurance that nobody else will have to go through what they did, but, too often, they do not get them. The fact that we are now looking at more than 800 cases over a 40-year period, when the original investigation was tasked to look at just 23, must surely tell us that, for a very long time, those grieving families were not being listened to and the necessary lessons were not being learned. That in itself is as much a failure as the individual incidents. With so many more families coming forward and having to relive some of the most difficult experiences in their lives, it is vital that support is offered to them to deal with the consequences of that, so can the Minister assure us that appropriate support is available to all those who need it?

So that we will all be clear now, the Ockenden review will be far larger and take far longer than was originally intended. Can the Minister assure the House that the review has the resources necessary to complete the final report as soon as possible? I understand that the trust has not waited until today to take action, but, inevitably, further recommendations will emerge from the final report. There are also actions for the whole NHS, and a number of specific actions that can be taken across the board now, which the Minister indicated are in fact urgent. I would be grateful if she indicated whether she intends to set a deadline for implementation of the system-wide recommendations and whether she will provide regular updates to the House on their progress.

Strong leadership, challenging poor workplace culture and ring-fencing maternity funding are all key to improving safety. On tackling the poor workplace culture that exists in some trusts, it is clear that there is still a long way to go. It is concerning to see a report this morning that the review into bullying at West Suffolk Hospital, which was originally due to be published last April, is now not due until next spring. It is also clear that there is a pressing need to reinstate the NHS maternity safety training fund. That money was vital for safety and makes a big difference to care, so can the Minister commit to reinstating that training fund?

Can the Minister also advise what action is being taken to ensure that we have enough staff in all maternity units, and will the Government commit to legislating for safe staffing levels? More widely, can she set out what is being done to tackle the estimated 3,000 midwife vacancies that we currently have? We cannot ignore the fact that some of the problems created by this culture will be exacerbated and will continue if we do not solve the staffing and resourcing crisis in the NHS, and these issues will continue to compromise patient safety.

Finally, it is understandable if families who are currently receiving care at the trust are anxious. Can the Minister provide them with some reassurance today that they will be safe and well looked after?

[Ms Dorries]

I thank the hon. Member for Ellesmere Port and Neston (Justin Madders) for his, as always, constructive and reasonable tone in his response. Yes, I can assure him that the resources are in place, and have been guaranteed to be in place. As for the deadline, it is 2021. I cannot give an exact month. It was really important to me—I believe that Donna Ockenden has mentioned this in her report a number of times— that the first 250 cases were evaluated so that we could take the learning from those cases and introduce it as quickly as possible. In that way, we could identify what had gone wrong so that we could prevent it from happening again in the future. That is why we have produced the report in two stages. We know the findings of this interim report and the recommendations that have been identified by Donna and her team can be put in place. The second stage of the report will appear before the end of next year—certainly in 2021. I will, as the hon. Gentleman requests, and personally if he requires it, update the House on what is happening with the report.

With regard to the maternity safety training fund, we secured £9.4 million in the spending review. It cannot be underestimated, in this time of covid, what a huge achievement that was. The money will not go into the old format of the maternity safety training fund, because we do not believe that that worked as well as it should have done. Much of that money was used to backfill the staff, who then, unfortunately, did not attend training. We did not get the best results—the biggest bang for the buck.

What we, as a Department, are doing now is directing that £9.4 million to where it is needed most and to where it can be spent in the most effective manner to produce results in maternity safety. That work is ongoing now in the Department, and I hope to be able to update the House and the hon. Gentleman very soon on how that money is being spent and what results we expect to see in return for the expenditure.

I did not anticipate the hon. Gentleman’s question about midwives. I do not have the exact number, because the figure rises every day. None the less, we are recruiting new nurses—I think the figure was 12,000 when I last gave a statement to the House—some of whom will be recruited to become midwives. So, yes, work is under way on the workforce and on nurse recruitment.

DHSC Answers to Written Questions

Justin Madders Excerpts

Thursday 19th November 2020 Commons Chamber

[Edward Argar]

I am grateful to my hon. Friend. As he will be aware, other Departments, while they have heavy workloads, are not leading the response to the pandemic. In response to his final point, he will not be surprised that I do not characterise it in that way. Instead, I would characterise it as the Department of Health being in the lead in saving lives and protecting the NHS in this country.

My hon. Friend asked two other substantive questions. I think his language was a little intemperate in respect of the serious efforts that officials undertake every day to try to provide accurate and timely answers. There is no suggestion that they seek to stonewall or to avoid responding. They do their best, but it is difficult and the situation changes day by day. Where answers are deemed to be inadequate, hon. Members often revert to me directly or table their questions again, and we endeavour to fulfil our obligation to provide accurate answers.

On my hon. Friend’s question about recovery, we have set a trajectory for each month in order to recover performance over the coming months. Of course, that depends to a degree on the workload of officials in responding to the pandemic, as well as in providing answers, but I do not see it as an either/or; we intend to recover performance in parallel with tackling the pandemic.

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

I thank the Minister for his response and for the hard work he and his Department put in. However, as he acknowledges, the performance here, like in so many other areas, is just not good enough. We know it is tough, but there comes a point when it begins to look like departmental scrutiny is being used as a cover for evading giving answers.

This morning, I looked at the Department’s response times to my own written questions over the past six months. I have had to wait over one month for an answer 29 times, over two months 11 times and over three months four times. I was actually thinking of putting in a question asking for the average response times to questions, but then I thought I would just be waiting a long time for that answer as well. I have even had to wait five months for the answer to what I thought was a pretty simple question asking what tests for covid-19 had been used. One hundred and sixty-eight days later, I received the utterly unrevealing answer:

“A large number of different tests have been used throughout the programme.”

I was lucky; my hon. Friend the Member for Sheffield, Brightside and Hillsborough (Gill Furniss) waited 18 weeks for an answer to a question on tests, only to be told:

“The information is not held in the format requested.”

Why did it take so long just to say that? Do Ministers even read the answers that they sign off?

This is not just about the time; the quality of the answers that we get back also needs improving. On dozens of occasions, I have been told that the Department does not hold the data, or no real attempt is made to answer the question that was asked. I accept that sometimes that information may not be easily acquired, but too often it looks as though the Department wants to keep us in the dark. I remind the House that the ministerial code requires Ministers to be

“as open as possible with Parliament”,

even when that may be inconvenient to them. In the spirit of openness, will the Minister also look at restarting NHS England and NHS Digital publications?

In conclusion, we all understand that the Department is dealing with many pressing issues, but scrutiny is important. Accountability matters, and if the pandemic is used too often as an excuse for standards to slip, that is how we go from questions not being answered to major policy changes being announced by media leaks, until we end up with the shameful spectacle of spivs and cronies pocketing millions from PPE contracts. Government must do better.

[Edward Argar]

I was going to say that, as ever, I was grateful to the hon. Gentleman for his tone, right up to almost the end of his remarks. On his substantive points, when it comes to accountability to this House, he will know from our regular double acts at this Dispatch Box and in Committee that I and fellow Ministers do not shy away from our accountability to this House in all its forms.

On volume, as I have said, during the same period last year we received 4,000 written questions; this year, the figure has been 8,000. That cannot be addressed by increasing administrative resource alone, because the technical expertise of policy experts is required to provide accuracy in the answers that the hon. Gentleman and other hon. Members seek. The same policy officials are dealing, day to day, with all aspects of the response to the pandemic.

The hon. Gentleman talked about accuracy, and he is right about the importance of accurate and timely answers. Given that we have answered 8,000 parliamentary questions between March and, I believe, October, some may, sadly, not live up to his expectations. I know that he will hold me and other Ministers to account when that is the case.

In answer to another of the hon. Gentleman’s question, yes, I and other Ministers read not only the answers and the questions, but the background to those questions. If we do not, we will quite rightly end up at the Dispatch Box, being asked those questions again and being challenged on the Floor of the House. In view of that, and in view of our obligations to the public and under the ministerial code, it is absolutely right that we take the answering of written parliamentary questions very seriously.

On the hon. Gentleman’s final point about NHS Digital and the publication of data and so on, I am happy to take that away and look at it for him.

Oral Answers to Questions

Justin Madders Excerpts

Tuesday 17th November 2020 Commons Chamber

[Edward Argar]

I am delighted that my hon. Friend’s constituents will benefit from £3 million to increase capacity at Russells Hall Hospital in Dudley as part of the investment to upgrade A&Es ahead of winter. Future NHS capital spending will, of course, be determined at the upcoming spending review, but once our settlement has been confirmed with the Treasury, we will consider carefully how projects are prioritised within it. In the meantime, I encourage the Dudley Group NHS Foundation Trust to discuss its proposals with NHS England and NHS Improvement. I would be happy to meet my hon. Friend to discuss this, because I know how hard he campaigns on this issue, and I would be delighted to take him up on the offer of a visit when I am able to.

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

The NHS will only survive the winter if its workforce are valued and supported. The evidence from the British Medical Association to the Health and Social Care Committee this morning was stark. So does the Minister understand how demoralising it is for staff to hear reports that they may face yet another two-year pay freeze? I asked those on the Government Benches to rule this out last week. I got no answer, so I ask them again today: will they rule out a pay freeze for NHS staff?

[Edward Argar]

I am grateful to the hon. Gentleman. He is quite right to highlight the amazing work that our NHS and social care workforce have done throughout this pandemic, as they do every year, and I pay tribute to them for that. As he will know, the NHS agrees with its staff multi-year pay deals set by independent recommendations, and we continue with that process.

Breast Cancer Diagnosis and Services: Covid-19

Justin Madders Excerpts

Thursday 12th November 2020 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr McCabe. I start by thanking the hon. Member for North Warwickshire (Craig Tracey) for securing this important and timely debate and for his excellent introductory speech. He made a number of important points, some of which I hope to return to, and I hope he gets a positive response to his very helpful suggestion on the gathering of data. I also thank all the other hon. Members for their contributions today, and I will go through some of the highlights of those.

My hon. Friend the Member for Barnsley East (Stephanie Peacock) spoke about the need for a cancer recovery plan, which I think we all agree on, and addressed the important point about widening health inequalities and the startling differences in the availability of screening depending on where people live. I agree with her that improvements to the cancer outcomes datasets are an important part of beginning to understand how those disparities work out.

We heard from my hon. Friend the Member for Easington (Grahame Morris); I pay tribute to the work he does on the all-party parliamentary groups in this area. He mentioned the Catch Up With Cancer campaign and drew attention to the backlog, which, of course, many hon. Members have raised today. He also raised the availability of radiotherapy, which, in his own words, he bangs the drum on consistently in this place, and we pay tribute to his persistence.

The hon. Member for High Peak (Robert Largan) made an important point about the availability of mobile screening units and the hon. Member for Strangford (Jim Shannon) , who always speaks with such knowledge on this subject, made some important points about clinical trials and charities, which I hope to be able to return to if time allows.

It was a pleasure to see the hon. Member for Southend West (Sir David Amess) find his spiritual home at last; it is the equivalent of Gary Neville turning out to play for Liverpool, but he is welcome all the same. We have a vacancy in the shadow health team for a Parliamentary Private Secretary at the moment and, if he shows the promise that he demonstrated in his speech today, I think we may be able to find a role for him on this side of the House.

The hon. Gentleman made, as my hon. Friend the Member for Dulwich and West Norwood (Helen Hayes) did, an important point about some of the people who are not here today, including the hon. Member for Chatham and Aylesford (Tracey Crouch), who we heard this morning in business questions speaking about her frustration at not being able to participate in this debate. I am sure it would have been enhanced by her presence, given her current battle, alongside the former Member—still our friend—for Dewsbury, Paula Sherriff. I am sure the whole House sends both of them our very best wishes.

I want to speak about the impact the pandemic has had on the early diagnosis of cancer in general, as many Members have referred to already. We know how important early diagnosis is to improving chances of survival and in successful treatment. As we heard, Cancer Research UK estimates around 3 million people are waiting for breast, bowel or cervical screening, and there were over 1.2 million patients waiting for a key diagnostic test by the end of August this year. As my hon. Friend the Member for Easington mentioned, we know from Macmillan’s latest report that there are currently around 50,000 missing diagnoses; that compares to a similar timeframe for this time last year, and means 50,000 fewer people have potentially not been diagnosed with cancer.

We know significant amounts of capacity had to be created during this pandemic, and that meant the cancelling of planned operations, large numbers of patients being discharged back into the community, and staff and patients having to be protected from the transmission of covid-19. What those changes also meant is that, thankfully, intensive care did not have to be rationed so that only covid-19 patients were treated. However, it also caused the shutdown or reduction in many other non-covid services, which, combined with drastic changes in patient behaviour, has led to us facing this huge backlog today. We know that stricter infection control measures—which are absolutely necessary—mean that the backlog of care will probably take much longer to clear than we would like.

My hon. Friend the Member for Dulwich and West Norwood and other hon. Members referred to the Breast Cancer Now report, and how the number of people referred to see a specialist declined dramatically from April. There is an estimate that across the UK, there have been 107,000 fewer breast cancer referrals, and a backlog of almost 1 million women requiring screening has built up during this time. Some of those women may well have been living with undetected breast cancer, and some may still be. Every month that that situation continues, more women could be missing out on the best chance of getting an early diagnosis and the best chance of beating the disease. It is vital—and something that we have been pushing for for a long time—that we get a clear sense of how we are going to tackle that backlog, because it is so important.

The hon. Members for Wakefield (Imran Ahmad Khan) and for Crewe and Nantwich (Dr Mullan) mentioned the importance of mammograms. As we know, they are a key tool in early detection. There is a plan to send open invitations for screening from September to March of next year. That has caused some concern among cancer charities, because some of the research shows that the number of women who make appointments is significantly lower than those who actually attend timed appointments. There is a fear, sadly, that this could actually worsen the persistent decline we have seen in recent years of the uptake of breast cancer screening. We are particularly concerned about the impact that will have on some groups where uptake is already low, such as those living in deprived communities and some BAME groups. We heard a little bit about the impact on BAME groups from my hon. Friend the Member for Dulwich and West Norwood, and both she and the hon. Member for Winchester (Steve Brine) very powerfully put into words the additional mental toll that this disease has during this time, on top of everything else that people ordinarily face when they have received such a diagnosis.

Several hon. Members mentioned the impact of covid-19 on secondary breast cancer patients. It is still, sadly, the case that around 11,500 people—women, mainly—die from breast cancer each year. Most of those are to do with secondary breast cancer, and as we have heard, it is not something that there is a cure for at the moment. It is estimated that around 35,000 people in the UK are living with secondary breast cancer. As the general population ages and people live longer, numbers will continue to increase, so it is really important that we get a better understanding and response to secondary breast cancer. We also need to look at this issue from the patient’s perspective.

I want to mention my hon. Friend the Member for Oldham East and Saddleworth (Debbie Abrahams), who wanted to speak in today’s debate but could not. She wanted to pay tribute to one of her constituents, Jo Taylor, and to METUP UK, which focuses on making positive changes for everyone with metastatic breast cancer. Its “busy living with mets” campaign calls for increased awareness of secondary breast cancer, because catching it earlier leads to better outcomes. It is also campaigning for better access to drugs, clinical trials, radiotherapies and surgical pathways.

As the hon. Member for North Warwickshire mentioned in his opening comments, the national cancer patient experience survey tells us that the experiences of patients with secondary cancer differ greatly. It has identified gaps through the taskforce in the support and services offered to people, including variation in access to clinical nurse specialists, patchy provision of information, patients’ psycho-social needs not being met, and a lack of prompt and timely access to palliative care services.

As we have heard from several hon. Members, clinical nurse specialists play a critical role in co-ordinating care, providing information and helping people to manage their diagnosis and treatment better. In fact, Breast Cancer Now reports that the support of a clinical nurse specialist is the single most important contributing factor to people’s positive experience of care. That is particularly important for secondary cancer patients, who are often on lifelong treatments and have complex needs as a result. Its importance was acknowledged in the long-term plan, with a commitment that by 2021—it is only six weeks away now—all patients, including those with secondary cancers, will have access to a clinical nurse specialist or support worker.

It is very important that we get to a point where everyone is able to take advantage of the expertise that a clinical nurse specialist provides. Prior to the pandemic, the workforce was already overstretched and under pressure due to increased demand and persistent shortages across the workforce. A report by the Public Accounts Committee was highly critical of the Government’s approach to the workforce, finding that the long-term plan was not supported by a detailed workforce plan. Of course, the removal of the NHS bursary in 2017

“signally failed to achieve its ambition to increase student nursing numbers.”

Before I conclude, I want to echo what the hon. Member for Strangford said about the importance of charities in this sector. We know there is a great deal of concern in the sector. I know that some support was announced by the Government back in April, but it falls well short of what was suggested by the associations involved, and only a few have been able to benefit from it. I hope the Government will listen to the sector and look again at what additional financial support can be provided, because we know that clinical trials provide a vital opportunity for patients to access new treatments, which are always in development. We know it is particularly important for patients with secondary breast cancer. We hope that is something the Minister can take on board today, and I look forward to hearing her response.

Covid-19

Justin Madders Excerpts

Wednesday 11th November 2020 Commons Chamber

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

It is now 293 days since the Secretary of State first came to this House and spoke about the emerging threat of covid-19. Since then, thousands of lives have been lost, both directly and indirectly, and billions of pounds have been spent. There has been great personal sacrifice, and we have all heard so many stories of individual courage and dedication that have been an inspiration, but there is no doubt that people are now weary. Not one corner of this isle or one aspect of our lives has been immune to the impact of this virus, so the news this week that there may be a way out of this nightmare has given people hope, and we all need hope at this difficult time.

However, that hope should not obscure the truth that we are in the midst of a second wave, so we must be sure to maintain vigilance. As we heard from the Minister, as of yesterday there were 20,000 new infections; more than 13,000 people are in hospital in England, with more patients in hospital in the north of England than there were at the peak of the first wave; and sadly, there were another 532 deaths yesterday, the highest number in one day for approximately six months. That is another 532 families who have lost a loved one, and among the huge numbers we talk about, we should never lose sight of the fact that each one of those numbers is a person. With the news today that we have now passed 50,000 deaths since the start of the pandemic, we know that the scale of human loss has been immense.

Those figures remind us that we still have a long way to go. Hope for the future is important, but it is not guaranteed, and neither is the end likely to be reached before we enter the difficult winter months, during which it is sadly likely that more people will catch the virus and more will die. It is right that plans are now being made for the roll-out of the vaccine, but that should not mean we take our eye off the ball when it comes to the immediate and pressing challenges that this virus presents. I know that time is at a premium today, so I will not detain the House for too long, but I want to say a few words about some of those immediate challenges.

Every challenge in the NHS is faced, first and foremost, by its workforce, so I will start by paying tribute—as the Minister did—to everyone in the NHS: the doctors, the nurses, the many allied health professionals, the porters, and everyone who has gone above and beyond over these past nine months to keep the NHS going. We know that working in the NHS is never easy, but the pressure, the workload and the trauma this year are of a scale and intensity we have never seen before. Not only must we show our gratitude to those who have given their all, we must demonstrate that we are listening to them by addressing their well-documented and legitimate concerns. That has to be more than a clap or a badge: there has to be tangible recognition that there are only so many times people can go to the well before they become physically and mentally exhausted. It is clear that burn-out is a real risk, as 14 health unions and royal colleges have warned in their letter to the Prime Minister earlier this week. They say that asking staff to carry on at this level of intensity is “increasingly unrealistic”. We have to listen to that warning.

Addressing workforce fatigue is not just the right thing to do: it is the only thing to do if we want the NHS to continue to be the jewel in this nation’s crown. I hope that the rumours of another two-year pay freeze for NHS staff are just that—rumours—because if that were true, it would send the most appalling message about the value this Government place on the NHS workforce. When the Minister winds up the debate, I will be delighted if she could put that particular rumour to bed.

Of course, NHS staff should be properly rewarded for the work they do, but they also need to be properly supported when doing the job. We cannot have a repeat of the obscenity of doctors and nurses bringing in home-made PPE while UK manufacturers are selling it overseas. I know that general practice is particularly concerned about the availability of PPE this coming winter, and while many of these debates have rightly focused on the hospital-based issues that covid presents, we should not underestimate the demand there has been on GPs this year. We know it is always the case that, when general practice struggles, the impact is felt elsewhere in the NHS. It is not yet clear what role GPs will play in the roll-out of any vaccine, but any additional demands placed on them in that respect must be matched by additional support.

We welcome the news that at last, many months after we first suggested it, there will be routine testing of frontline NHS staff. The Healthcare Safety Investigation Branch report on the transmission of covid in hospital settings, which came out last month, stressed the importance of increasing pillar 1 testing capacity, and it is a matter of deep regret that we are only just starting to see that now. Let us hope that that pledge does not face the same problems with availability that we had in the social care sector.

[Carla Lockhart (Upper Bann) (DUP)]

I had hoped to speak in this debate but, unfortunately, there are limited flights to Belfast. Does the hon. Member agree that there needs to be additional testing in the care home sector, particularly for family members who could be designated as care workers? I know that the Minister brought forward a pilot scheme. Does the shadow Minister agree that that should be rolled out right across the United Kingdom and that loved ones should get access to their family members in the care home setting?

[Justin Madders]

I thank the hon. Member for her intervention. The recent developments in rapid testing give us the ideal opportunity to allow relatives of those in care homes to get in and see them and give them the support that they have been so sadly lacking in recent months. None of us could fail to be moved by the many representations we have had from family members who have been unable to see their loved ones for many months.

On the health and social care workforce, we know, sadly, that over 600 staff have lost their lives so far to covid-19. They have paid the ultimate price just for doing their job. It is important that lessons are learnt about how we stop transmission, and it is right that the Government opened up their life assurance scheme to all health and social care staff, but over half of all families who have lost someone to the virus have still not received their payment, so we need the Government to be much more proactive in making sure that everyone who is entitled to that payment receives it.

Let us support the staff, but let us not forget the impact on patients as well. We know that the NHS could cope with the first wave only because so many planned operations were cancelled. We know that the need to operate in a covid-secure environment presents additional challenges to the NHS in reaching previous levels of activity. We know that before the pandemic started, waiting lists were already climbing to record levels. Covid-19 has accelerated that increase so that by August this year, over 100,000 patients were waiting over a year just to start treatment. Cancer Research UK estimates that around 3 million people are waiting for breast, bowel or cervical screening, and there were over 1.2 million patients waiting for a key diagnostic test at the end of August. We need to hear what the plans will be to address these spiralling waiting lists, and we need a cast-iron guarantee that no patient will be discharged from hospital into a care home if they have tested positive for covid-19.

I turn to what awaits us in a few weeks’ time, because we all hope that the current lockdown will end on 2 December as planned, and as promised, I believe, by the Prime Minister. If it does end on that date, it seems likely that we will still have some system of tiered restrictions moving forward. That is another area where we need to see improvements, because the Government’s approach to restrictions to date has at times been contradictory, muddled and rushed. I accept that the Government have had on occasions to move quickly, sometimes because of a rapidly changing picture—but sometimes, regrettably, because of leaks to the press too. Of course, we would not expect things in this kind of situation to be perfect, but they can be better than they have been.

The time that this lockdown buys us should be used not just to fix test and trace, to prepare for a roll-out of the vaccine and to fine-tune the mass testing pilots, but to set out a clear and consistent framework for determining and implementing future restrictions. The Minister and his colleagues have spent many Monday afternoons in Committee Rooms with me and others going through increasingly convoluted and amended statutory instruments dealing with each new restriction, often published only hours before they became law and always debated weeks after they came into force. We cannot go back to that style of governing. Public trust is eroded when decisions are not made in a transparent and timely manner, so when the Government decide what their exit strategy to the lockdown will be, they also need to consider what the process will be for making and communicating those decisions. It is critical that individuals and businesses get sufficient advance warning in future to enable them to prepare properly for whatever comes next. This point is as much about process as it is about substance, but the process matters, because restrictions need to be tested in this place; if they do not stand up to scrutiny here, we cannot expect them to stand up to scrutiny out there.

I want to say a few words about test, trace and isolate. The Serco side of the system is underperforming badly, and the decision to place responsibility for mass testing into the hands of local directors of public health is a welcome one. It recognises, perhaps belatedly, where the real expertise lies. The latest figures for the national test and trace system are frankly shocking, with 26% of test results received within 24 hours. We should not forget that the Prime Minister said we would have all results turned around in that timescale by the end of June, yet the figures have been getting worse in recent weeks, not better. We know how important it is for results to be turned around quickly if we are ever to get test and trace playing the part it was meant to play in controlling the spread of the virus. Ministers can boast about record capacity, but capacity is meaningless if the results are not coming back quickly enough to be effective.

Let me turn to the contact tracing system itself. In the most recent weeks for which figures are available, 40% of close contacts were not reached and asked to self-isolate, amounting to more than 130,000 people in one week. That is a failure. When every one of us in here has those difficult and distressing conversations with our constituents about the restrictions that we currently face, we need to reflect on that failure and question not only why these unproven private providers have been given the task in the first place, but why they continue to be responsible for a system that they are clearly not delivering on. Every scientific adviser said that relaxing lockdown measures would work only if we had an effective test and trace system in place, yet on just about every measure the system is going backwards. How much longer will Ministers tolerate this failure? However, whoever is doing the contact tracing, that is only half the story. Without people adhering to the rules of self-isolation thereafter, the success of the entire system is in doubt.

Yesterday Baroness Harding gave evidence to the joint inquiry of the Science and Technology Committee, and Health and Social Care Committee, where she made the important point that the reason that people were not self-isolating was that they could not afford the loss of income, not because of a refusal to comply. She also made the rather remarkable claim that the surge in cases that we have seen in the last couple of months was not anticipated, which I thought was an incredible admission.

The Committees also heard from Professor Sir John Bell, who said that the self-isolation system was “massively ineffective” and spoke about using the increased testing capacity perhaps to cut short the self-isolation period for negative cases. No doubt the Government are actively considering that, but we are still left with the need to do more to encourage people who test positive to self-isolate.

In September a report for the Scientific Advisory Group for Emergencies concluded that self-isolation rates would be improved if additional financial support were available, ensuring that those required to self-isolate—let us not forget that these are people who are doing the right thing—are not penalised and do not experience financial hardship when doing so. This survey found that only 18% of people with symptoms self-isolated, and that figure went down to just 11% of those told to self-isolate by Test and Trace after coming into contact with a confirmed case. I know that these are preliminary figures and that other studies have suggested slightly higher levels of compliance, but no study that I have seen has shown levels anywhere near close enough to where they need to be for us to have an effective system.

The entitlement to a self-isolation payment is tied to being in receipt of certain benefits, which means that a significant number of people do not qualify, although those not in receipt of those benefits and those who do not receive contractual sick pay can also receive statutory sick pay or employment and support allowance. But that is frankly not good enough. SSP is far below the rate set for a self-isolation payment. The Secretary of State famously said that he could not live on such an amount, so we should not be surprised when we see low rates of compliance, because asking those who are not eligible for a self-isolation payment to accept a significant drop in their pay for a fortnight inevitably causes hardship and discourages compliance. I urge the Government seriously to consider doing more to encourage people to self-isolate.

It is a massive oversight that those notified through the app are not entitled to the payment. I understand that the Government are actively looking at this, but given that it is over six months since we started hearing talk about the world-beating app, it is staggering that we are only now looking at how properly to tie it in with support for self-isolation. Action on that issue cannot come soon enough.

There has been newspaper speculation that the actual period of self-isolation might be cut, with a suggestion that it could end at 10 days following a negative test. A report in The Guardian on Monday says that a compromise was “cooked up” to placate Dominic Cummings. Frankly, he ought to be the last person in government to be determining the self-isolation rules, given that he has found it impossible to follow them himself. Any change to this period should be based on medical advice, so I do hope that we get clarity from the Government during the wind-ups that any decisions on shortening the self-isolation period will be based on advice from the chief medical officer, rather than any Dom, Dick or Harry who happens to be in the Prime Minister’s office.

I hope that those on the Government Benches have been listening today and considered the issues and the suggestions that I have made, as none of us wants to be back here in another month or two debating another lockdown because the time this lockdown has bought was wasted. We do not want to be here talking about how the second wave saw us with one of the highest death rates in the world again, and we do not want to be here in a few months’ time seeing cases rising again because demand was not anticipated. We all want to hear that cases are falling, that hospital admissions are reducing, and that other NHS patients are getting their treatments quicker. Human endeavour has given us the opportunity to get to that place. While reaching that destination is not entirely within the Government’s gift, it would be inexcusable if we failed to get there because of incompetence or neglect on the Government’s part. The people would never forgive that, and nor should they.

Exiting the European Union (Agriculture)

Justin Madders Excerpts

Tuesday 10th November 2020 Commons Chamber

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

I thank the Minister for his brief but informative introduction —I would like to say it was entertaining, but that might be pushing the boat out a bit, because it is a very technical piece of legislation, as he outlined. The instrument is primarily being made to reflect the Northern Ireland protocol in the field of food safety and hygiene.

As we know, the instrument amends or revokes 16 of the 17 EU exit statutory instruments that were hurried through in the weeks ahead of the original 29 March 2019 Brexit deadline. As the Minister said, the intention is to avoid disruption to food controls, which is critical for the approximately 220,000 businesses active in the agrifood sector. As such, we will not be opposing the regulations today. We have a number of questions, however, because we have been clear that any future changes to regulatory controls after the UK leaves the EU should provide at least the same, or even an improved, level of consumer protection. That applies to food hygiene and safety standards as much as anything else.

As the Minister briefly outlined, there was a public consultation. The explanatory memorandum sets out that that was completed by the Food Standards Agency in respect of the amendments made to this instrument, which is welcome. I note, however, that the initial consultation, which was carried out in September and October 2018, received 50 responses from interested parties across a wide range of sectors. The consultation that we are talking about today, which was carried out in August and September of this year, received only seven responses. That is a concerning drop-off, even though many other issues have clearly been occupying people’s attention this year. Will he confirm that the recent consultation was as widely publicised and drawn to the attention of stakeholders as the previous one? Does he have a view on why there was such a drop-off in responses?

Although we can view the consultation document itself, a summary of the responses has not yet been published, so is not available for proper scrutiny. That is especially concerning as the explanatory memorandum states that 29% of replies had “mixed comments” and that further analysis of them will be undertaken. The phrase “mixed comments” could, of course, be classic civil service speak for major concerns being flagged, or equally, those concerns could have been addressed in the regulations. We do not know because we have not seen them. Although 29% amounts to only two responses in this consultation, that does not make them any less valid, given the small number of responses that we had.

The Minister knows that I am keen on transparency and full disclosure, so I hope that he will be able to shed some light on the nature of those mixed comments, the concerns that were raised, and what further analysis of the instrument was undertaken following that response. Given the low level of response, I wonder whether he can be confident that the consultation process was sufficiently robust.

Will the Minister update us on the progress of the provisional framework on food and feed safety and hygiene that will create a joint risk analysis process across the UK from the end of the transition period? I note that the chief executive of the Food Standards Agency gave a written response to some questions raised by the Common Frameworks Scrutiny Committee last week, which indicated that the provisional framework will continue to be reviewed into early December.

As that is a matter of public safety, it is imperative that any changes are communicated clearly and in a timely manner to ensure that the industry can remain in line with current legislation. Can the Minister assure us that it will be possible to do that within those timescales? What assessment has been undertaken of the readiness and capability of the FSA and Food Standards Scotland to take on those responsibilities from day one?

Finally, the explanatory memorandum states that guidance is not required for this instrument as it generally maintains existing regulations and does not introduce new requirements. Given that this regulation was spread across 17 instruments previously, it presumably covered 17 different sets of guidelines. This concern was raised by the Local Government Association in the initial consultation, which suggested that the FSA or other organisations, such as relevant professional bodies, may wish to consider how clear guidance and assurance for councils on the new regulations could be provided.

The Proprietary Association of Great Britain has also expressed concerns about the FSA’s assertion that there would only be minimal, one-off familiarisation costs to local authorities and port health authorities, stating that cuts to local authority funding are such that some authorities do not have any full-time food and feed officers and that the time required for officers to read and understand the proposed regulations will impact on the already limited time that trading standards, environmental health and port health authority officers have to undertake enforcement activity. We know local authorities are already under intense pressure due to the covid-19 response, so will the Minister confirm whether he has spoken with colleagues in the Ministry of Housing, Communities and Local Government about whether councils do have sufficient capacity to carry out their duties in this important area? On that note, I will end my speech.