Rare Retinal Disease

Karin Smyth Excerpts

Thursday 23rd January 2025 Westminster Hall

[The Minister for Secondary Care (Karin Smyth)]

It is a pleasure to serve under your chairmanship, Dame Siobhan. I start by thanking the hon. Member for Strangford (Jim Shannon) for securing this debate on such an important issue and other Members for their contributions.

Both the shadow Secretary of State and I are covering for other colleagues this afternoon, so hon. Members can imagine my joy when actual experts walked into the Chamber. The hon. Members for Leicester South (Shockat Adam) and for Torbay (Steve Darling), as has been said, bring great personal and professional expertise to this debate, so it was joyful to see them come in. It was good to hear from my hon. Friend the Member for Doncaster East and the Isle of Axholme (Lee Pitcher); the experience he brings through his wife is really valuable. My hon. Friend the Member for Battersea (Marsha De Cordova) has been such a champion of this issue both in her personal experience and since she came to the House. I understand that it is her birthday today, so I hope she is having a good time. She has brought great expertise to this place.

I am going to do my best to answer the questions. I have been billed highly by the hon. Member for Strangford, and I am grateful for that. The Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Gorton and Denton (Andrew Gwynne), will write to hon. Members about anything that is outstanding.

I would like to take time to acknowledge the experiences of those living with rare inherited retinal diseases and their families, who I know will be paying attention to this debate. I pay tribute to all those who work tirelessly to raise awareness of rare conditions and bring about change. Although rare diseases are rare individually, their impacts are far-reaching. One in 17 people will be affected by a rare condition over their lifetime; that is around 3.5 million people in the United Kingdom. As the hon. Member for Strangford said, rare inherited retinal diseases affect around 25,000 people in the UK and collectively represent a leading cause of sight loss in working-age adults. We recognise the impact that these conditions have on patients, families and wider society and the need for innovative approaches to tackle these changes.

The Government are committed to improving the lives of people with rare conditions. The hon. Member for Torbay used that quote about providing opportunity, support and determination for people. The UK rare diseases framework outlines four priorities to achieve this aim: helping patients get a final diagnosis faster; increasing awareness of rare diseases among healthcare professionals; better co-ordination of care; and improving access to specialist care treatment and drugs. In England, our annual rare diseases action plan sets out the steps we are taking to meet those priorities. We continue to make progress and are working to finalise our next England action plan for publication this year.

It is vital that NHS patients with rare diseases are able to access innovative new treatments as they become available. That includes those with progressive retinal diseases, where early intervention is crucial to preserve sight. Under England’s action plans, NICE, the Medicines and Healthcare products Regulatory Agency and NHS England are working to understand and address the barriers to access for rare diseases treatment. The hon. Member for Strangford asked a number of questions about NICE’s approach that I hope I will cover. NICE does a difficult job well, in my view, and we think its approach is appropriate for the evaluation of treatments for rare diseases. NICE recommended 84% of medicines for rare diseases evaluated through its standard technology appraisal programme in 2023-24. That is comparable to its approval rate for medicines for more common conditions. Those treatments are now available for the treatment of NHS patients.

NICE also operates a separate, highly specialised technology programme for the evaluation of a handful of medicines for very rare diseases each year that recognises the challenges of bringing treatments for very rare diseases to market. NICE recommended the gene therapy Luxturna for a type of inherited retinal dystrophy through that route. One of the recipients of that groundbreaking therapy on the NHS has spoken of his gratitude for the positive effects of the treatment on not just his vision, but his confidence and independence.

NICE is also in the process of reviewing the criteria for routing topics to its highly specialised technologies programme, which the hon. Member for Strangford asked about. That review will ensure that future routing decisions are more transparent, consistent, efficient and predictable. As part of that process, NICE has launched a public consultation on its progress. I encourage the rare diseases community and hon. Members interested to continue to engage with that process.

Research offers a way to accelerate access to new and innovative treatments. Through the National Institute for Health and Care Research, the Government support rare diseases research. There are currently eight active research projects on rare retinal disease funded by the NIHR, with a combined value of over £6 million. The NIHR also invests in infrastructure to support and deliver research studies. The NIHR Moorfields Biomedical Research Centre, which is dedicated solely to vision research, has made significant strides in the field of rare retinal diseases. By harnessing genomic data, the BRC has developed effective treatments, including gene-replacement therapies for inherited retinal disorders. The NIHR is also working closely with commercial companies to bring new medicines and technology to patients.

To connect people living with rare diseases to innovative treatments and sources of support, we need to diagnose these conditions as early as possible. The UK is a world leader in genomic diagnosis. Patients in England have access to whole genome sequencing on the NHS. Advances in genomics mean that new causes of rare retinal diseases are being found every year. As part of Genomics England’s generation study, we are harnessing the power of genomic sequencing to screen for over 200 rare genetic conditions that can be treated in the NHS in early childhood to improve outcomes for babies and their families. That includes the rare retinal disease RPE65-associated Leber congenital amaurosis, which can be treated with Luxturna.

A central mission of this Government is to build a health and care system fit for the future. The 10-year health plan will ensure a better health service for everyone, regardless of condition or service area. The plan will focus on our three shifts for a modern NHS: moving from hospital to community, analogue to digital and sickness to prevention. All three offer opportunities to improve time to diagnosis and care for people living with rare retinal conditions. The shift from analogue to digital will enable innovative uses of data to improve diagnosis and measure treatment outcomes, while NHS ocular genetics services’ use of video consultations continues to widen patient access to specialist advice, in keeping with the shift from hospital to community. Although many rare diseases are not preventable, early diagnosis, as we have heard, can lead to timely interventions that improve health outcomes.

I will outline the treatment pathway for rare retinal diseases. I am thankful for the role played by high street optometrists, some of them here today, in helping to identify patients with sight-threatening conditions. There is good availability of NHS sight-testing services, with over 12 million free NHS sight tests provided to eligible groups annually, including children, individuals aged 60 and over, and those on income-related benefits. Optometrists are required to refer any patient showing signs of injury, disease or abnormality and integrated care boards have been asked to ensure that there are direct referral pathways in place between community optometry and secondary care. As the hon. Member for Leicester South said, the eyes are the gateway into other health conditions. Optometry has a very important role.

As one of the busiest outpatient specialties with one of the largest waiting lists, we know that ophthalmology is facing huge challenges and we are working hard on how we can help to build capacity. NHS England is looking at how digital connectivity could improve the triage of patients referred between primary and secondary care. That would allow for images to be shared, and specialist advice and guidance could help to keep patients in the community where possible.

We recognise the importance of access to emotional and practical support, especially where treatment may not be available. A diagnosis of sight loss will have a profound impact on any individual, who will be at increased risk of stress, anxiety and depression. NHS England’s patient support toolkit for eye care commissioners and providers aims to ensure that patients with ophthalmic conditions or sight loss are supported throughout their care journeys. The RNIB patient support pathway aims to strengthen that and ensure that support and guidance are available to patients from their first eye care appointment through to having a confirmed diagnosis, and then right the way through to living well with their condition. I know that the work of the all-party parliamentary group on eye health and visual impairment and of other hon. Members will help in giving those people a powerful voice.

As we work towards building a health care service fit for the future, it is vital that people living with rare diseases are not left behind. With the UK rare diseases framework coming to an end in 2026, we will look to build on the progress made over the past five years, which the shadow Secretary of State mentioned. We will work with colleagues in the devolved Administrations, as highlighted by the hon. Member for Strangford.

We have commissioned an evaluation of England’s rare diseases action plans through NIHR and will also be undertaking engagement this year to inform future policy decisions. The Government are deeply committed to working across the health and social care system and with the rare diseases community to improve the lives of those with rare conditions.

Once again, I thank the hon. Member for Strangford for raising this important matter. It is good to have high interest, expertise and experience in this place. We want to work with colleagues here and we thank the rare disease community for their valuable ongoing engagement with us to bring about meaningful change.

[Dame Siobhain McDonagh (in the Chair)]

Order. I will now put—[Interruption.]

New Hospital Programme

Karin Smyth Excerpts

Wednesday 22nd January 2025 Westminster Hall

[The Minister for Secondary Care (Karin Smyth)]

It is a pleasure to serve under your chairship, Dr Huq. I congratulate the hon. Member for Bexhill and Battle (Dr Mullan) on securing a debate on this important matter. I commend his timing in getting this debate two days after an announcement that nobody else knew about. If he were a Labour MP, there would be howls of “Fix!”

There has been a lot of back and forth, but I want to confirm that we pledged to support this programme, and we are supporting it. That is what Monday was about—let us be in no doubt about that. I was part of the largest capital programme in the NHS when I served as a non-executive director under the last Labour Government; this will be the next largest capital programme, delivered under this Labour Government.

As Lord Darzi noted in his investigation, the hospitals that we rely on are deteriorating after the NHS suffered years of under-investment. This Government inherited a programme to deliver new hospitals that was unfunded beyond March 2025 and was repeatedly delayed, with no credible delivery plan.

[Chris Vince]

I thank the Minister for the Secretary of State’s statement on Monday, in which £1.5 billion of Government funding was dedicated to Princess Alexandra hospital. At my local hospital in Harlow, it is not just an issue of funding: in fact, the land was not purchased and the business plan was not completed. The idea that the hospital would be completed by 2030 was a pipe dream, was it not?

[Karin Smyth]

I thank my hon. Friend; I am happy to take interventions, but I need to finish by half-past 4, so I am conscious of time. He is absolutely right, and I will come on to his point.

We need to be very clear and honest with people about what was ready and about the different stages of these programmes, which we are very keen to do. Staff and patients deserve better. That is why the Secretary of State asked officials to review the programme and put it on a firm footing with sustainable funding so that all the projects can be delivered.

I thank the hon. Member for Bexhill and Battle for his service to the NHS and his experience. I agree that it is appalling for staff. We all understand that he and I disagree in our political analysis, but he made some really well-informed points about models of care and future models of care, all of which we need to take into account in the delivery of this programme and other parts of the capital programme—and we will.

As the Secretary of State announced to the House on Monday, we now have a realistic plan to deliver the programme. I am pleased that we can be honest with people as we start a new chapter setting out a new commitment to deliver these hospitals, which are so important to all our constituents, that is realistic and backed with funding. We have worked closely with the Treasury to secure five-year waves of investment, backed by £15 billion of investment over consecutive waves, averaging £3 billion a year. This will ensure a balanced portfolio of schemes at different development stages being delivered now and into the future.

The new delivery plan sets out the order and the waves of investment in which each new hospital will be constructed. Hospitals included in a wave will begin construction, while forthcoming schemes will be undertaking pre-construction work to prepare planning permission and secure business cases. With this approach, we can ensure that schemes are ready to be built as soon as possible. A list of the schemes in each wave has been published on gov.uk and in the plan for implementation.

For reference, I will briefly outline the timeline for delivery. [Interruption.] Actually, I think we have seen all the waves, and the hon. Gentleman wants us to move on to Bexhill and East Sussex.

[Mr Mohindra]

For Watford general hospital, we have a window between 2032 and 2034. Given the certainty that the Minister is trying to give to the programme and to the rest of the country, what assurances and assumptions has she made for that two-year window? How can she assure me and my constituents that there will be no further delays?

[Karin Smyth]

I will pick up that point. Wave 3, which is what the hon. Member for Bexhill and Battle has secured this debate on, includes schemes that were always part of a post-2030 plan. We now have the confirmed dates. The East Sussex new hospital scheme for East Sussex healthcare trust includes, as the hon. Gentleman says, new buildings and refurbishments at Eastbourne district general hospital, Conquest hospital and Bexhill community hospital. The scheme is in wave 3 of the delivery plan, and construction will commence between 2037 and 2039. We understand that this is disappointing news to some people who were expecting and were told that their hospital would be built earlier, but we can assure them that there is now a credible and funded plan for delivery—no more false promises. Our priority now is to get on and deliver these new hospitals for the benefit of the staff and patients who so vitally need them.

We understand the importance of these schemes to local communities and the need to invest in health infrastructure. We will continue to engage with trusts—including Watford, which the hon. Member for South West Hertfordshire (Mr Mohindra) mentioned—over the next few years to establish whether there are any other activities that can be progressed during the spending review. We will be in discussions with all those trusts to understand mitigations in the meantime. That was the source of many questions that came up in the many meetings that I held with hon. Members yesterday. I understand that all these hospitals are critical—they would not be on the list if there were not a major problem with them—so we need to talk to the trusts about how we manage the process in the meantime.

I acknowledge that this will be a difficult time for the core teams and all the people who have been working on these schemes, many of which will be stood down. Their expertise and knowledge is extraordinarily valuable. I know that the programme teams will make efforts to ensure that expertise is retained where possible and used to develop the wider programme.

The trust is currently developing its strategic outline case, as per the business case process set out in His Majesty’s Treasury’s Green Book. Following the review and approval of the SOC, the next step will be the development, review and agreement of the outline and full business case. I understand that many areas, including Bexhill, have plans for housing to accommodate a growing population. My Department will work closely with integrated care boards and the Ministry of Housing, Communities and Local Government to ensure that those communities have the health provision that they need.

Beyond establishing a credible programme, we are taking steps to restore people’s trust through honesty and transparency. We will be setting out further information for each scheme shortly, to ensure a more open way of working and collaborative programme delivery.

Yesterday, I held meetings with Members of Parliament from all waves of the process to give them the opportunity to ask more detailed questions about their individual schemes, and to give them the clarity that their constituents deserve. Letters have also been issued to the trusts. That was a very successful way of working; I certainly learned a lot about the individual schemes. Members of Parliament of all parties came to talk about their schemes. I gave a commitment that I would continue to talk to colleagues about them. I absolutely offer the same to the hon. Member for Bexhill and Battle. I will work with Members’ trusts to understand the detail on the ground.

[Ben Maguire (North Cornwall) (LD)]

I warmly welcome the news, on which I congratulate the Minister, that the women and children’s hospital at Treliske and the emergency care hospital at Derriford are in wave 1. However, some of my North Cornwall constituents rely on the crumbling North Devon district hospital, which is potentially 15 years from a rebuild. We are talking about mitigations, so please will the Minister meet me to discuss how we can expand care at the community hospitals in Bodmin, Launceston and Bude, which are all at least one hour from their closest district hospitals?

[Karin Smyth]

I thank the hon. Gentleman for his intervention. We had a good discussion yesterday about North Devon; I understand the rurality of that location, as it is fairly close to my Bristol constituency. Obviously, however we manage it, there are a lot of schemes represented by a lot of MPs. I am open to suggestions about how we go forward. I hope hon. Members feel that we have tried to give as much information as we can to them and the trusts in the announcement and the meetings yesterday. That is the spirit in which we will continue.

[Danny Beales (Uxbridge and South Ruislip) (Lab)]

I welcome the spirit of openness and transparency that the new leadership of the programme has demonstrated. Previously, and frustratingly, residents in Hillingdon were—to be frank—led up the garden path. We were left with all but an IOU note for £750 million for a new hospital. The revenue funding for the new hospital ran out this year. We were pleased to see it renewed, and to be in wave 1; a significant capital investment of more than £1 billion has been committed to.

This is complicated: it is hard to deliver projects at this scale. With the best will in the world, if another £20 billion were to appear, despite the Conservative party opposing any methods that would raise money, the construction sector would struggle to build all these hospitals at once. Is it not the case that it is challenging to deliver this project at scale? Will the spirit of openness and transparency continue?

[Karin Smyth]

I thank my hon. Friend for his continued campaigning on behalf of the residents of Hillingdon; I used to be one of them. Talking to people is really important, and we have learned a lot from it. In case I have not outlined this enough, let me be clear that all our constituents who are on the programme are in severe need. The programme has looked at clinical need and deliverability. We understand how difficult these choices are, so I thank my hon. Friend for that intervention.

[Helena Dollimore]

I welcome the Labour Government’s confirmation of funding, which will help the Conquest hospital in Hastings, part of the East Sussex Healthcare trust, and other hospitals that my constituents use. It comes alongside the Chancellor’s announcement of a big package of support in the Budget, with record investment in our NHS to provide more appointments to clear the backlog left by the Conservatives.

[Karin Smyth]

I thank my hon. Friend for her intervention, which highlights the point that the hon. Member for Bexhill and Battle raised about other capital plans and programmes to help his constituents and others over the coming years.

In conclusion, I thank the hon. Gentleman for raising this issue.

[Clive Jones]

rose—

[Dr Mullan]

rose—

[Karin Smyth]

If the hon. Member for Bexhill and Battle, whose timing is superb, wants to make an extra point, I will give him the courtesy of a chance to come back in.

[Dr Mullan]

In the last hour, I have had a communication from the trust explaining that, with the delay, the extra cost may be in the hundreds of millions. I would be grateful to take up the Minister’s offer of some time, as well as to talk to MPs who use those services, to see how we can help the trust to access that funding.

[Karin Smyth]

I thank the hon. Gentleman for that intervention. We learned a lot yesterday from the expert team from the new hospital programme; I thank them for their incredible work in getting to this point. Those colleagues who could make the meetings yesterday found that the team’s knowledge about every single programme was phenomenal. I have yet to ask the team a question about any scheme to which they do not know the answer—I give hon. Members that confident assurance. The team includes colleagues from both NHS England and the Department.

When I went to an assurance meeting a few weeks ago, I learned that the relationship between the central control of the programme and the trusts, how we get the schemes delivered for everyone’s constituents, and the value of parliamentarians talking to me—everyone has stopped me in the corridors to raise these issues—are all very valuable. That is a good function of parliamentarians. That is the spirit in which we want to continue.

Our commitment is to deliver these hospitals, including the Eastbourne district general, Conquest hospital and Bexhill community hospital schemes, and I am pleased to say that we have an affordable, deliverable plan to do so. It will be difficult, but I look forward to working with the hon. Member for Bexhill and Battle and other colleagues.

[Mr Mohindra]

It is very gracious of the Minister to allow me to intervene again. In the interests of full transparency, can she assure us that if the development of the new hospitals gets delayed, all MPs will be informed, not just those in the relevant constituency? Work on Watford general is meant to begin between 2032 and 2034. Will the Government communicate any further delays as quickly as possible? That will certainly be critical to our constituents.

[Karin Smyth]

We absolutely will. This is one of the advantages of the waves: we recognise, and everybody knows, that there are sometimes unavoidable delays to schemes, perhaps to do with the sites, but the advantage of the pre-construction work and our knowledge of the sites is that most of that should be built into the programme and the timing. But life happens.

One of the central issues for the programme is capacity in the construction arena, as well as across the country, in terms of developing primary estate to get these things done. The advantage of the waves is that they give us flexibility if things move, as they inevitably will—that is life. We very much want to keep up relationships with local trusts and inform them. That will be difficult, as my hon. Friend the Member for Uxbridge and South Ruislip (Danny Beales) says, but that is the spirit in which we want to continue. I give him and other colleagues that absolute commitment.

Question put and agreed to.

Welfare of Doctors

Karin Smyth Excerpts

Tuesday 21st January 2025 Westminster Hall

[The Minister for Secondary Care (Karin Smyth)]

I will of course adhere to your instruction, Sir John.

I am grateful to my hon. Friend the Member for Bury St Edmunds and Stowmarket (Peter Prinsley) for bringing this important topic to the House. I know it is close to his heart, as a working doctor. I thank him for his continued dedication to the NHS, as a surgeon and an MP, and I thank his family, too, for their dedication to it. We welcome the knowledge and expertise that he has already brought us, and he has done so again powerfully today. What a lovely memento he has of his own father’s service.

I thank my hon. Friend for highlighting the incredible role that resident doctors play in our NHS. We absolutely recognise the challenges that they face as they progress through postgraduate training. We are committed to giving them the support that they need to develop and thrive in the NHS. My hon. Friend spoke passionately about the welfare of doctors. Let me acknowledge, as I know he would, the tireless professionalism and dedication that all health professionals show across the NHS daily.

The NHS is broken, but we have a plan to fix it. In his investigation into the state of the NHS last year, Lord Darzi identified that this Government have inherited an NHS that is in serious trouble, with record waiting lists, people struggling to see their GP, and quality of care often lagging behind other countries. He found that too many staff are disengaged, that levels of sickness absence are worryingly high, and that many people working in the system are still exhausted from the pandemic and its aftermath, which has resulted in

“a marked reduction in discretionary effort across all staff groups.”

The Government completely agree with that assessment. We are on a mission to fix our broken NHS by driving fundamental reform to bring our analogue health service to the digital age. Through our 10-year health plan, we will cut waiting lists, reduce waiting times and get the health service delivering for patients and staff once again. Those ambitions will be possible only thanks to the hard-working staff, so it is essential that doctors and others are properly valued, supported and looked after at work.

Employers across the NHS play a pivotal role in looking after doctors. Strong and effective leadership is fundamental to building a healthy organisational culture and too many NHS organisations are falling short in that regard. I have been shocked to hear stories, some of which we have heard again today, about the lack of support received by resident doctors, whether on shift patterns and rota changes, access to rest breaks while on duty, or really basic things that we should expect from any employer, such as hydration and the provision of decent food. We have heard about people sleeping in cars and not being able to go to a close relative’s wedding or to be the best person at their best friend’s wedding. It is unbelievable, really, and it cannot continue. It has to improve. We expect better from trusts and employers and we will make sure that that happens.

We brought an end to the industrial action by resident doctors that was impacting the NHS’s ability to deliver a good-quality service and having such a corrosive effect on the morale of the workforce. As part of that deal, resident doctors and dentists in training received an average uplift of just over 4% into the 2023-24 pay scales, on top of the average 8.8% uplift they received for 2023-24. The Government have committed to improve the current exception reporting process, and to work in partnership with the BMA and other health organisations to review the current system of training, as my hon. Friend the Member for Bury St Edmunds and Stowmarket highlighted, and rotational placements. That is in addition to the work being undertaken by NHS England to improve working lives.

We want to work with the unions on the key issues that doctors face on the frontline, and improve their working lives. That applies to all NHS staff. For example, we are working at the moment with the BMA resident doctors committee to improve the exception reporting process. We know that is important to residents, and we agreed to address it as part of their pay deal.

It is vital that we look after the health and wellbeing of the whole NHS workforce. High-quality care and support for patients cannot be effectively provided without a compassionate and inclusive working environment. My hon. Friend listed a number of actions, some of which are more easily addressed than others. We would expect many of them to be included as part of a supportive culture in trusts. I accept that some are more challenging and involve discussions with NHS England, the Government and trusts, but I do not think that many are beyond local trusts and systems, working with the profession, to resolve.

The mental health of doctors and all NHS staff is incredibly important. We saw the strain and trauma placed on staff during the pandemic. They do so much for patients, and we owe it to them to ensure that they are properly supported in return. The NHS offers occupational health and wellbeing services for staff when they need them, but provision can be patchy. There is a drive to improve the quality of those services across the NHS. Not only can that reduce sickness absence and improve retention, but proactive and preventive occupational health can lead to improvements in productivity and, in the long run, save taxpayers money.

Access to specialist mental health support is important. I know that services such as the practitioner health programme, which we have heard about this afternoon, are highly valued by many doctors. NHS England is currently reviewing the mental health and wellbeing support available across the NHS, and looking at how it can be made more equitable and sustainable. There is no doubt that we need to continue to improve the mental health support available to NHS staff, and I look forward to seeing the outcome of that review. NHS England is also moving forward with a joint initiative with NHS charities to invest £10 million in health and wellbeing initiatives for staff. That will provide grants for better facilities and invest in improved wellbeing support.

I want to make a point about violence, which I do not think my hon. Friend particularly highlighted in his speech. Sadly, the threat of violence in the workplace is another thing that NHS staff are dealing with, as we saw in last week’s horrific assault in Oldham—I extend my wishes to the nurse and her family for a speedy recovery, as I know we all do. I reiterate that the Government take a zero-tolerance approach to that type of behaviour. Doctors, nurses and all healthcare workers are the backbone of our NHS and should be able to care for patients without any fear of violence or abuse.

At a national level, NHS England is focused on improving workplace experience, with the NHS people promise and the NHS retention programme addressing the issues that matter to staff, whether that be improving opportunities for flexible working, tackling racism and discrimination, preventing and reducing violence in the workplace, or improving facilities so that staff have the basic opportunity to rest and recover. Resident doctors face many challenges as they progress through postgraduate medical training, as my hon. Friend outlined. Expanding access to less than full-time training, rationalising and reforming statutory and mandatory training, and increasing choice and flexibility in rota management are just some of the things we are looking to do to improve their working lives.

We are also working with NHS England to support the GP workforce, including with measures to boost recruitment, to address the reasons why doctors are leaving the profession and to encourage them to return to practise. The NHS is working to address training bottlenecks, so that there are enough GPs for the future and patients can get the care they need. We have provided £82 million of additional funding for 2024-25 to address GP unemployment and support the recruitment of more than 1,000 new GPs.

In conclusion, through the 10-year plan, we are engaging widely with staff, patients and the public and listening to their views on how we need to reform and modernise the NHS. That applies equally to the NHS as an employer. Our ambition is for the NHS to become a modern, innovative and supportive employer. That is a necessity if we are to continue to attract and retain skilled and experienced professionals, give them the support they deserve as they care for the nation, and build a robust and resilient NHS. I look forward to working with NHS England. My hon. Friend the Member for Bury St Edmunds and Stowmarket will bring great expertise to this work in the House, as will Members more broadly, to make it a reality.

Question put and agreed to.

Medicines and Healthcare Products Regulatory Agency

Karin Smyth Excerpts

Thursday 16th January 2025 Commons Chamber

[The Minister for Secondary Care (Karin Smyth)]

I congratulate the right hon. Member for Tatton (Esther McVey) on securing this debate and thank her and all those who have spoken for their contributions. We have heard some powerful stories of failure as well as some useful experiences. I have to thank my hon. Friend the Member for Stroud (Dr Opher), the hon. Member for Dewsbury and Batley (Iqbal Mohamed) and the shadow Minister for sharing their expertise. I have heard many of these stories before in my 10 years in this place. Sadly, I have also had a constituent who shared her experiences with me, for which I am grateful. Frankly, those experiences shocked me and my staff.

I congratulate my hon. Friends the Members for Camborne and Redruth (Perran Moon), for Washington and Gateshead South (Mrs Hodgson), for Poole (Neil Duncan-Jordan), for Bolton South and Walkden (Yasmin Qureshi) and many others who have brought their experiences to this place, shining a light on the issues. It is right for us to debate this matter. Six months into the job and I am still learning, Madam Deputy Speaker, so I am grateful for being able to take part in this debate.

I can assure my hon. Friend the Member for Blackley and Middleton South (Graham Stringer) that I cannot answer everything, and I am glad that he recognised that. The right hon. Member for Tatton has focused my mind, for which I am very grateful. If I do not do justice to the points that have been raised, I will write to Members about specific things. I am meeting representatives from the MHRA and will be very clear about our expectations. It is absolutely the role of Parliament to be the ultimate monitor of its work.

The MHRA plays a vital role in fulfilling the Government’s health mission: balancing its responsibilities to maintain product safety and championing innovation. I will, if I may, be clear about the role of an enabler. It is about enabling innovative products to reach patients without compromising patient safety and without unnecessary delay.

It is thanks to vaccines and medicines such as antibiotics and modern surgical procedures that we are living longer, healthier, and more active lives. No medical product is completely free of risk; the main objective of the safety monitoring process is to identify any new risks that may emerge. When that happens, the MHRA must take its responsibility seriously, rigorously and transparently when balancing population risks and benefits of each medical product, taking prompt and decisive action whenever that is needed.

On supporting safety, the MHRA recognises the need constantly to seek to improve its safety monitoring systems to deliver better results for people. Recent improvements include implementing the new Safety Connect IT system, following recommendations from the Cumberlege Review. This IT system will improve the efficiency of reporting and processing of yellow card reports, much of which we have heard about today, supporting the prompt identification and assessment of new safety concerns.

In addition, the MHRA makes use of real-world data via the clinical practice research datalink, which collects anonymised patient data from a network of GP practices, across the UK, encompassing data from 60 million patients, including 18 million currently registered patients.

The MHRA has recently launched a pilot, in partnership with Genomics England, to create a rich source of genetic information to investigate the role of genetic pre-disposition in the development of serious adverse drug reactions. The aim is to establish a yellow card biobank to reduce the number of harmful side effects caused by medicines—a step towards personalised prescribing.

The Cumberlege review also highlighted the need to improve the regulation of implantable medical devices. In November last year, the Government introduced new regulations to strengthen the requirements for manufacturers to proactively monitor and report on medical devices once they are on the market, which was noted by my hon. Friend the Member for Washington and Gateshead South.

We plan to lay further reforms before Parliament this year, including unique device identifiers and implant cards to improve the traceability of implanted devices, as well as increasing the classification of devices to ensure that they receive the highest scrutiny throughout their lifetime. Finally, the MHRA has made some progress in response to the wider set of recommendations set out in Baroness Cumberlege’s report. It listened carefully to the people who gave evidence and to the review’s findings, and is committed to bring about those changes. It is our job to ensure that that happens.

The yellow card scheme provides the backbone of our safety monitoring system. The scheme relies on voluntarily reporting from patients, parents, caregivers and healthcare professionals. The MHRA also collects reports of suspected safety concerns involving defective, falsified or fake healthcare products. Last year, it assessed more than 118,000 reports, and identified 134 safety signals, but I take onboard the comments made today. When safety signals lead to confirmed risks, the MHRA can introduce specific risk minimisation measures, such as introducing particular warnings about the risk of side effects in the product information, restricting the use of the medicine or medical device, or suspending or removing the medicine or device from the market. The MHRA will continue to proactively encourage the reporting of adverse effects through improvements such as those within the new Safety Connect system, and will ensure that there are better connections between clinical systems, working with the wider healthcare system.

The MHRA recognises that there have been delays in some of the regulatory services that it provides, including licence applications for innovative and generic medicines, variations to licences, and inspections of manufacturing and laboratory premises. Since September 2024, all new applications for marketing authorisations of established medicines are being assessed within expected timescales. That element is therefore improving, but we will keep a close eye on it.

I reiterate my thanks to the right hon. Member for Tatton. This has been an informative and, bizarrely, a wide-ranging but focused debate. Trust is really important. Patients have to be at the heart of our work, and that of the MHRA. Patient safety is the foremost priority. The MHRA is continuing to work on improving engagement and involving patients in decision making throughout the life cycle of the products that it regulates. It will continue to work to facilitate patient access to new medicines and medical devices, in collaboration with health system partners across the UK. The regulator maintains its focus on continuous improvement, and has implemented new ways of working to maximise productivity in ways that put patients and public health outcomes first. I take the point made by the shadow Minister, the hon. Member for Hinckley and Bosworth (Dr Evans), that communication around that is key.

The MHRA has turned around performance on clinical trials and is on track to deliver all regulatory services within statutory timelines by the end of March 2025. Later this year, as part of its programme of reform, we will introduce new point of care manufacturing legislation that will make the MHRA the first regulator in the world to introduce a tailored framework for innovative manufacturing methods, taking the manufacture and supply of medicines to patients. It is truly an exciting development, and I pay tribute to those involved.

The process for recruiting the new chief executive is well under way. We welcome Professor Anthony Harnden. His strategic focus is on helping the organisation to protect patient safety through robust surveillance systems, embracing risk-proportionate regulation and fostering an inclusive workplace where people flourish. Without putting him on the spot, we should think about organising a parliamentary event of some sort to bring people together to discuss matters with the MHRA and build that trust. I am pleased to support its work. It is internationally recognised as a regulator. We want to do better. The Government will ensure that the MHRA is better.

Endometriosis: Women in the Workplace

Karin Smyth Excerpts

Wednesday 15th January 2025 Commons Chamber

[The Minister for Secondary Care (Karin Smyth)]

I congratulate my hon. Friend the Member for Sheffield Brightside and Hillsborough (Gill Furniss) on securing this important debate on the impact of endometriosis on women in the workplace. In opposition I supported the work of the APPG. I echo the praise for the campaigning work of Endometriosis UK and the support that you, Madam Deputy Speaker, and others in the Chamber have given to the APPG. I also remember the work of our friend David Amess. I echo the recognition of the recent report by the Women and Equalities Committee on reproductive health conditions. My Department is working across Government on our response, which will be published in due course.

I welcome the progress made on raising awareness—we are moving very fast on this—and on providing better support for women’s health conditions, including endometriosis. Nevertheless, this Government recognise that women with endometriosis have been failed for far too long, and we acknowledge the impact that it has on women’s lives, relationships and participation in education and the workforce. There is still much more work to be done. We are committed to improving support for any women and girls whose periods or women’s conditions disrupt their normal life, work or education.

In addition to receiving support in the workplace, all women should have access to healthcare support to help diagnose and manage this condition. We are making progress to ensure that those with endometriosis receive a timely diagnosis and effective treatment.

[Sir Alec Shelbrooke]

There has been a lot of cross-party work on this issue. I led a debate—the last one before the general election was called, I think—on endometriosis education. It is not prescribed that schools should educate about what a bad period is—I still meet women born in this century who do not know. If someone does not know what a disease is, how do they know that they have it? I urge the Minister to ensure that those messages are pushed in the Department for Education, as we need to ensure that people know what diseases they could have.

[Karin Smyth]

I thank the right hon. Gentleman for that point, which I will talk about later.

On the Employment Rights Bill, our plan to make work pay sets out a significant and ambitious agenda to ensure that workplace rights are fit for a modern economy, empowering working people and contributing to economic growth. On 10 October, the Government fulfilled their manifesto commitment to introduce legislation within 100 days of entering office, by introducing the Employment Rights Bill. As part of the Bill, we are taking the first steps towards requiring employers to publish action plans alongside their gender pay gap figures. The relevant clause sets out that regulations may require employers to develop and publish action plans relating to gender equality, which include measures to address the gender pay gap and support employees going through the menopause. It deliberately does not provide an exhaustive list of matters related to gender equality, giving us the scope to be led by the actions themselves. This reflects the fact that many of the actions employers take will be beneficial for people in a lot of different circumstances; for example, improved provision of flexible working can be valuable for an employee balancing childcare as well as someone managing a health condition such as endometriosis.

In the same way, ensuring that employers support staff going through the menopause will necessitate them taking steps that are positive for supporting women’s health in the workplace more broadly. For example, menopause best practice includes greater discussion around women’s health and awareness of potential workplace adjustments—things that have a much wider potential benefit. As my hon. Friend said, we need to start to reduce the stigma and taboos and remove them from the debate.

Through the Employment Rights Bill, the Government are also making statutory sick pay payable from the first day of sickness absence. This will particularly benefit those who suffer from conditions such as endometriosis, who may need to take time off to manage a flare up. We are also removing the lower earnings limit and extending statutory sick pay to up to 1.3 million additional low-paid employees, particularly benefiting women, young people and those in part-time work.

The Minister for Equalities, my hon. Friend the Member for Llanelli (Dame Nia Griffith), leads for the Government on the Bill from the equalities team, and I can assure my hon. Friend the Member for Sheffield Brightside and Hillsborough that we are working with her and talking about this issue throughout the Government. For example, I regularly join Women and Equalities questions here in the Chamber to make sure we work closely together, and I will continue to work closely with colleagues on these issues.

The new measures we are seeking to introduce build on existing Government support for employers, which recognises their key role in increasing employment opportunities and supporting disabled people and those with health conditions to thrive as part of the workforce. The Government’s current offer to employers includes a digital information service that provides tailored guidance to businesses to support employees to remain in work. That includes guidance on health disclosures and having conversations about health, as well as guidance on legal obligations including statutory sick pay and reasonable adjustments. The service is available across Britain and can currently be accessed from a range of trusted locations, including both the Health and Safety Executive and ACAS websites. We are also taking steps to better understand the challenges faced by women with endometriosis in the workplace and to improve workplace support for those with the condition.

The Government health and wellbeing fund has awarded almost £2 million to 16 voluntary, community and social enterprise organisations leading projects focused on supporting women who experience reproductive health issues to remain in or return to the workplace, including a project on endometriosis delivered by Endometriosis UK.

An Office for National Statistics study is investigating the impact of endometriosis on women’s labour market outcomes. This important study will be a vital step to improving our understanding and will inform future actions policy work. The first publication in this research project, on the characteristics of women diagnosed with endometriosis in England between 2011 and 2021, was published in December.

In addition to providing workplace support for endometriosis, the Government are committed to improving healthcare support and ensuring that women with endometriosis can receive timely diagnosis and treatment. We recognise that patients have been let down for too long while they wait for the care they need. Nearly 600,000 women are on gynaecology waiting lists. It is unacceptable that patients are waiting too long to get the care they need. I thank my hon. Friend the Member for Sheffield Brightside and Hillsborough for her sympathy with the task of reducing those lists, but that is our priority. Cutting waiting lists, including for gynaecology, is a key part of our health mission and a top priority for this Government. We have committed to achieving the NHS constitutional standard that 92% of patients should wait no longer than 18 weeks from referral to treatment by the end of this Parliament, and that absolutely includes those waiting for gynaecology treatment.

My noble Friend Baroness Merron, the Minister responsible for patient safety, women’s health and mental health, and I recently met with the Government’s women’s health ambassador, Professor Dame Lesley Regan, and NHS England to discuss progress on women’s health and current issues including gynaecology waiting lists. Following that meeting I am pleased that our recently published plan for reforming elective care sets out commitments to support the delivery of innovative models in gynaecology offering patients care closer to home and piloting gynaecology pathways in community diagnostic centres for patients with post-menopausal bleeding.

Enabling access to adequate healthcare support begins with providing high-quality education and information on menstrual health, as the right hon. Member for Wetherby and Easingwold (Sir Alec Shelbrooke) highlighted, so that women and girls know when and how to seek help for symptoms such as heavy or painful periods. The compulsory aspects of the curriculum on relationships, sex and health education means all pupils are taught about several areas of women’s health, including menstruation, contraception, fertility, pregnancy and menopause.

My right hon. Friend the Secretary of State for Education has committed to providing teachers with clear guidance that focuses on the wellbeing of children. Her Department will look carefully at all relevant evidence and engage with stakeholders, including young people and parents, ahead of publishing a consultation response and the revised guidance later this year. I am pleased that Dame Lesley Regan, in her role as women’s health ambassador, has been feeding women’s health perspectives into this work.

My Department has worked with NHS England to improve and create new content on endometriosis symptoms, diagnosis and treatment options on the NHS website and YouTube channel. NHS England has also published a decision support tool for managing heavy periods to support women’s understanding of their symptoms and appropriate treatment options to discuss with clinicians. Education and clinical guidelines support healthcare professionals to provide care for women with endometriosis.

The General Medical Council has introduced the medical licensing assessment for most incoming doctors, including all medical students graduating in the academic year 2024-25 and onwards. The content for the assessment includes several topics relating to women’s health, including menstrual problems and endometriosis, and will encourage a better understanding of common women’s health problems in all doctors as they start their careers in the UK, which we all want to see. Endometriosis is also already in the core curriculum for trainee GPs, obstetricians and gynaecologists.

Last year, the National Institute for Health and Care Excellence published updated guidelines on the diagnosis and treatment of endometriosis, and the new and updated recommendations on referral and investigation should help women receive a diagnosis more quickly. Through the National Institute for Health and Care Research, the Department has also commissioned a number of studies focused on endometriosis diagnosis and treatment and patient experience.

In closing, I thank my hon. Friend the Member for Sheffield Brightside and Hillsborough for tabling this debate and for her continued long-standing advocacy for women’s health. Let me affirm the Government’s commitment to supporting the many women who live with endometriosis in the workplace and beyond. This Government are committed to prioritising women’s health as we build an NHS fit for the future. My noble friend Baroness Merron is carefully considering how we take forward the women’s health strategy by aligning it to the Government’s missions and forthcoming 10-year health plan, and women’s equality will be at the heart of our missions. It is vital that we work with women to better understand their experiences and address their concerns, which have been ignored for far too long.

Question put and agreed to.

7.27 pm

House adjourned.

Oral Answers to Questions

Karin Smyth Excerpts

Tuesday 7th January 2025 Commons Chamber

[Graeme Downie (Dunfermline and Dollar) (Lab)]

1. What steps he is taking to improve mental health services for children.

[The Minister for Secondary Care (Karin Smyth)]

The delivery of mental health services for children in Scotland is the responsibility of the Scottish Government. I hope that they will make the best use of the boost from the recent Budget to invest in mental health services. In England, we will support children and young people earlier by providing access to a specialist mental health professional in every school and rolling out Young Futures hubs in every community. We will also cut waiting times by recruiting 8,500 more workers across children and adult mental health services.

[Graeme Downie]

The long-term impact of the covid-19 pandemic on young people is often forgotten, with isolation leading to missed opportunities, lost life experiences and still unknown impacts on mental health. Child and adolescent mental health services referrals in Fife and across Scotland have skyrocketed, and despite a record Budget settlement from the UK Government, the SNP Scottish Government have told NHS Fife not even to bother asking for more funding to tackle this massive problem. I and colleagues will write to the Scottish Government about that. Will the Minister join me in urging the Scottish Government to reverse course and ensure that young people have the support that they deserve and need?

[Karin Smyth]

My hon. Friend makes an excellent point on behalf of young people. It is disappointing that the Scottish Government do not seem to be allocating the funding as they could. He raises a powerful case, and I know that he will work hard with the Government in Edinburgh to make the situation better for his constituents.

[Damian Hinds (East Hampshire) (Con)]

Is the mental health support in schools that the Minister just mentioned the same as or different from the plan for mental health support teams in schools that was already being rolled out by the previous Government?

[Karin Smyth]

Our plan is to have universal coverage in every school. That was not achieved by the previous Government, and we hope to ensure that it happens.

[Charlie Dewhirst (Bridlington and The Wolds) (Con)]

2. What assessment he has made of the potential impact of the increase to employer national insurance contributions on social care.

--- Later in debate ---

[Josh Fenton-Glynn (Calder Valley) (Lab)]

7. Whether he has made an assessment of the effectiveness of improvements made to the Care Quality Commission.

[The Minister for Secondary Care (Karin Smyth)]

In response to the report by Dr Penny Dash, we have made it clear that the CQC is not fit for purpose and requires significant reform. We have increased our oversight of the CQC to ensure implementation of the recommendations in Dr Dash’s review, and we will continue to monitor the CQC’s progress through this period of improvement. We are also supporting the swift and efficient recruitment of CQC leadership roles, including the new chief executive Julian Hartley, who started in December.

[Josh Fenton-Glynn]

It is inarguable that the CQC needs improvement. Many who run care services in local authorities have little confidence in its performance. Does my hon. Friend agree that we could go some way to improving how it is viewed by looking at the use of single-word assessments, which create undue stress for social services leads? They were raised by the Dash review as insufficient to support local authorities to improve, promoting box-ticking over real improvement and giving little information to members of the public on the quality of social services provision.

[Karin Smyth]

My hon. Friend is right that confidence is the key word in the huge agenda that the CQC has to deliver. Dr Dash and Professor Mike Richards highlighted serious failings that need to be re-addressed. As one of our predecessors said, priorities are our language. Currently, a review of one or two-word ratings is not a priority, but it will be kept under review.

[Mr Gregory Campbell (East Londonderry) (DUP)]

Is the Minister indicating today that there will be a new start in the Care Quality Commission, and that things will change for both staff and the recipients of care?

[Karin Smyth]

The hon. Gentleman makes an excellent point, particularly with regard to staff, who need support to continue their important work. A new start with new leadership is what they need, as well as implementation of the recommendations.

[Tom Gordon (Harrogate and Knaresborough) (LD)]

8. What steps his Department is taking to improve access to mental health services.

--- Later in debate ---

[Emily Thornberry (Islington South and Finsbury) (Lab)]

13. How many and what proportion of NHS employees have received enhanced maternity leave entitlements under Agenda for Change contracts.

[The Minister for Secondary Care (Karin Smyth)]

I thank my new Dame Friend for her question. The Department does not collect data on the number of people who have specifically received enhanced maternity leave entitlements. Access to an enhanced maternity leave benefit forms part of the total reward package for Agenda for Change staff, which we believe is critical for retaining our much-valued and needed NHS workforce.

[Emily Thornberry]

Thank you very much, Mr Speaker. Doctors throughout the NHS, no matter who employs them, have blanket maternity agreements, but nurses do not. When I visited the River Place health centre, I found that nurses employed by Whittington Health were working alongside nurses employed by the GP practice who got completely different maternity leave and pay. As we turn out our hospitals into the community and do much more work in that way, such anomalies will get worse. It is not fair and I wonder what my hon. Friend is going to do about it.

[Karin Smyth]

My right hon. Friend highlights a problem throughout the system, not just in her area. Self-employed contractors to NHS GP surgeries are not bound by national terms and conditions; they can develop their terms and conditions as they see fit. They have the flexibility to set terms and conditions to aid recruitment and retention. We anticipate that good employers will set wage rates and terms and conditions that reflect the skills and experience of their staff. That is better for staff and for patients, and I know that she will continue to highlight that with her local employer. It is certainly something that we need to keep an eye on as we develop services further.

[Pippa Heylings (South Cambridgeshire) (LD)]

14. What steps he is taking to extend Start for Life services to South Cambridgeshire constituency.

--- Later in debate ---

[Mohammad Yasin (Bedford) (Lab)]

T8. The East of England ambulance service NHS trust remains at the highest escalation level—level 4—as call handlers in Bedford remain under immense pressure after responding to 39,000 calls between Christmas and new year. Despite the unprecedented demand, the trust is considering closing the Bedford emergency operation centre, putting nearly 200 jobs at risk. Given that resources are already stretched to the limit in Bedford, does the Secretary of State agree that we must keep experienced staff who have helped to save countless lives in the region?

[The Minister for Secondary Care (Karin Smyth)]

My hon. Friend is right to highlight the particular problems in his constituency. Decisions on the configuration of call centres are a matter for local trusts in consultation with staff and representatives, and I encourage him to continue to engage with the trust in the interests of his constituents.

[Greg Smith (Mid Buckinghamshire) (Con)]

Will the additional money announced for hospices before Christmas cover the full cost of the increase in employer’s national insurance contributions or not?

NHS Backlog

Karin Smyth Excerpts

Monday 6th January 2025 Commons Chamber

[The Minister for Secondary Care (Karin Smyth)]

I wish you, Madam Deputy Speaker, and all hon. Members a happy new year. I thank the hon. Member for North Shropshire (Helen Morgan) for securing this debate. I am delighted to be able to respond. It has been a passionate and well-informed debate, and I am genuinely grateful for the opportunity to build on what the Secretary of State said in his oral statement today, because we have a great deal to say about our plans to build more capacity and give patients more power over their care.

Colleagues across the House have set out how 14 years of failure have damaged their constituents, letting down the people we represent and breaking the NHS. That was starkly illustrated by my hon. Friend the Member for Bury St Edmunds and Stowmarket (Peter Prinsley), who should have been doing something else this morning but was not. That is a loss to his patients. It was also highlighted by the hon. Members for Epsom and Ewell (Helen Maguire) and for Wokingham (Clive Jones). The Lib Dem spokesperson, the hon. Member for Chichester (Jess Brown-Fuller), outlined how it impacts on her own father as well as her constituents.

Years of neglect, lack of funding and unresolved industrial action meant that this Government inherited an appalling backlog of people waiting for treatment—the 7.5 million-strong waiting list. I gently remind the hon. Member for Farnham and Bordon (Gregory Stafford) and the Opposition spokesperson, the hon. Member for Sleaford and North Hykeham (Dr Johnson), that that waiting list stood at 4 million people before the start of the pandemic. The Darzi investigation described how these waits were becoming the new normal, with patients waiting far too long for treatment. As a result, public satisfaction with one of our most beloved institutions is at an all-time low. That was eloquently put by my hon. Friend the Member for Carlisle (Ms Minns), who highlighted the figures from 2010 and now, as they affect her constituents.

On average, 58% of people do not receive treatment within 18 weeks of referral. The NHS constitutional standard sets out that 92% of patients should receive treatment within this timeframe, but that has not been met consistently for almost a decade. In other words, there are people today younger than me who would have no memory of the NHS working efficiently and delivering a timely service.

Colleagues are right to point out the impact on our constituents, with people putting their lives on hold while they wait for a diagnosis, for a new hip or for eye surgery. If the human tragedy were not enough, the economic and social effects of waiting times are almost incalculable. That is why today the Prime Minister set out our plans to tackle hospital backlogs and finally meet the NHS standard of 92% of patients in England waiting no longer than 18 weeks for elective treatment. I confirm for my hon. Friend the Member for Bury North (Mr Frith) that that is an average. I also wish his grandmother well—that is unfortunate for her time of life, and I hope she is getting good care.

Our elective reform plan sets out a bold package of productivity measures and reforms to deliver fundamental change for patients by building a health service defined by patient choice and patient control. I agree with the hon. Members for Runnymede and Weybridge (Dr Spencer) and for Farnham and Bordon about local accountability. My own comments on the 2022 Act, which I think the Government at the time should have done more on, are well-made. I regularly encourage all hon. Members to engage proactively with their ICBs. It is incumbent on ICBs to engage with elected representatives on behalf of all our constituents. I certainly have always done with mine, and I commend everybody else to do the same.

Under our plan, NHS care will be increasingly personalised and digital. We will focus on improving experiences and convenience, empowering people with choice and control over when and where they will be treated. Different models of care will be more widely and consistently adopted, following on from the work by the hon. Member for Farnham and Bordon on Getting It Right First Time, which I also commend. We will roll out artificial intelligence and other technology to boost capacity and deliver excellent care consistently across the country.

I will not have time to go into the details of all the drivers of the backlog, but we recognise the pressures on primary and community care and social care. That is why last month we were able to put forward proper proposals for a new GP contract, with extra money to slash red tape and bring back the family doctor—the biggest funding boost to primary care that we have seen. I have been really impressed by some of the fantastic work going on in women’s health hubs. We continue to welcome the cross-party support for our proposals on social care, and I hope we build that cross-party support for Baroness Casey’s work. Social care was highlighted by my hon. Friends the Members for Ashford (Sojan Joseph) and for Calder Valley (Josh Fenton-Glynn), among others.

On the key drivers, in diagnostics we will reduce the waits for scanners by extending the work of community diagnostic centres to seven days a week. Patients will be able to receive same-day tests and consultations, direct referrals from primary and community care, new consulting rooms and at least 10 straight-to-test pathways by March 2026. Pathway improvements will get us only so far, though. We are also setting clear expectations that funding must be used responsibly to provide the best value for money for both patients and the taxpayer. That is why, under our plans, money will follow the patient and the organisations that do the best will get the most reward, so that incentives drive improvement.

I will just say gently to the Opposition spokesperson that many places do offer online access—I get texts regularly from my hospital, because I, too, am a patient. However, it is not universal, and that was the Conservatives’ failure in government. We want to take the best of the NHS to the rest of the NHS.

On cancer, the 62 and 31-day cancer waiting time standards were last met in 2015 and 2020 respectively. Cancer is a priority for this Government: cancer patients are waiting too long for a diagnosis and for treatment, and we are determined to change that. We will get the NHS diagnosing cancer earlier and treating it faster so that more patients survive. I assure the Lib Dem spokesperson, the hon. Member for Chichester, that we remain committed to all three targets. We know that swift diagnosis is key to improving outcomes and ensuring that patients get a diagnosis and treatment quickly, which is why expanding CDCs is a core plank of achieving those standards. We recognise that a cancer-specific approach is needed to meet the challenges in cancer care, which is why, after the 10-year plan, we will follow up with a dedicated national cancer plan, which will help us to go further for cancer patients.

This Government are tackling challenges beyond routine elective care, such as the crisis in emergency care. Last month, a quarter of the 2.3 million people who attended A&E waited for more than four hours; in November, the average ambulance response time stood at 42 minutes, which is more than double the NHS constitutional standard. These figures do not come close to the safe operational standards set out in the constitution. It will take time to turn things around, but our action to quickly end the junior doctors strike means that, for the first time in three years, NHS leaders are focused on winter preparedness and not planning for strikes. NHS England has set out a national approach to winter planning and is managing extra demand, with upgraded 24-hour live data centres, strengthening same-day emergency care and offering more services for older people.

As we have heard, mental health waiting lists are far too long. We want to build on our mission and ensure that we recruit 8,500 additional mental health workers to reduce delays. We will also provide access to specialist mental health professionals at every school in England, roll out young futures hubs in every community and modernise the Mental Health Act 1983. As the hon. Member for Guildford (Zöe Franklin) highlighted, young children and young families are being particularly badly affected. The Chancellor backed our plans in the Budget with an extra £5.6 million over the next two years to open new mental health crisis centres and help reduce pressure on A&E services.

[Adam Jogee (Newcastle-under-Lyme) (Lab)]

Will the Minister give way?

[Karin Smyth]

I would like to, but I am afraid I need to adhere to the time limit.

In closing, on Second Reading of the National Health Service Act 1946, Nye Bevan warned us against following abstract principles that work on paper but not in the real world. This Government are interested only in what works, and we know we must do things differently, because the backlog began to build before the pandemic. NHS constitutional standards have not been met for more than a decade. Whatever the last Government were doing, it was not working. That is why our elective reform plans will do things differently, giving patients more choice and more control over their treatment, making greater use of technology—including the NHS app—to give patients the convenience of a seven-day diagnostic service.

In response to the hon. Member for North Herefordshire (Ellie Chowns), we will use private sector capacity to help—supporting patients is what matters. As the party that founded the NHS, we will always be committed to a publicly funded NHS that is free at the point of use. We are going hell for leather to get waiting lists down, rebuild our NHS and ensure that it is there for us when we need it once again. None of this will happen overnight, but we are not asking to be judged by our promises; we will be judged by our results, and we are determined to succeed.

[Madam Deputy Speaker (Judith Cummins)]

I call Helen Morgan to wind up quickly.

Hospice Funding

Karin Smyth Excerpts

Thursday 19th December 2024 Commons Chamber

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

(Urgent Question): To ask the Secretary of State for Health and Social Care if he will make a statement on hospice funding.

[The Minister for Secondary Care (Karin Smyth)]

I am grateful to the hon. Member for Sleaford and North Hykeham (Dr Johnson) for asking that important question. This Government want a society where every person receives high-quality, compassionate care from diagnosis through to the end of life. We will shift care out of hospitals into the community to ensure that patients and their families receive personalised care in the most appropriate settings. Palliative end of life care services, including hospices, will have a big role to play in that shift. Most hospices are charitable, independent organisations that receive some statutory funding for providing NHS services. The amount of funding that each charitable hospice receives varies both within and between integrated care board areas.

On children and young people’s hospice funding, the Minister for Care met representatives from NHS England and Together for Short Lives and one of the chairs of the all-party parliamentary group for children who need palliative care to discuss children’s palliative and end of life care, and that funding stream was discussed at length at that meeting.

This Government recognise the range of cost pressures that the hospice sector has been facing over a number of years, so today I am delighted to announce the biggest investment in hospices and end of life care in a generation. We are supporting the hospice sector with a £100 million boost for adult and children’s hospices, to ensure that those hospices have the best physical environment for care, and with £26 million in revenue to support children and young people’s hospices. The funding will support hospices and deliver much needed funding for improvements, including refurbishment, overhaul of IT systems and improved security for patients and visitors. It will help hospices in this year and next year in providing the best end of life care for patients and their families in a supportive and dignified physical environment.

Hospices for children and young people will receive that further £26 million in funding for 2025-26 through what was, until recently, known as the children’s hospice grant. We will set out the details of the funding allocation and dissemination in the new year.

We completely understand the pressures that people are under. To govern is to choose, and the Chancellor chose to support health and social care in the Budget. The alternative is not to fund. The sector has suffered from 14 years of underfunding, and we are righting that historic wrong. This Government are committed to ensuring that every person has access to high-quality palliative and end of life care as part of our plan for change. We are taking immediate action to make our healthcare fit for the future. I am sure that the hon. Member for Sleaford and North Hykeham and everyone in the House will welcome this announcement. I thank her for giving me the opportunity to give the House an early Christmas present.

--- Later in debate ---

[Dr Caroline Johnson]

After the confusion of yesterday, I welcome the fact that further details on hospice funding have been announced, albeit by our dragging them out of the Government on the very last day of Parliament before the recess.

On 30 October, the Chancellor decided to break her election promise by increasing employers national insurance contributions and reducing the threshold at which employer contributions are payable. It was later confirmed that hospices would not be exempt from the increase in costs. Now the Government have announced new funding for the sector, which they have the audacity to call

“the biggest investment in a generation”.

Let us be clear about what is going on: the Government are taking millions of pounds off hospices and palliative care charities, and then think those hospices and palliative care charities should be grateful when the Government give them some of that back. That is socialism at its finest.

We will look more closely at the funding announced today, but despite many questions from right hon. and hon. Members, to date the Government have refused to give any clear answers on how much their tax rises will cost hospices. I will try again: will the Minister please tell us how much the Government estimate they will raise from taxing hospices more? Was an impact assessment ever produced on how hospices will be hit, and how that will affect the care that they provide? Do the Government expect the funding that they have announced today to cover the additional costs in their entirety?

At the heart of this discussion are charities that provide compassionate care to terminally ill people in their final days, weeks and months. While hospices were left without information, Hospice UK reported that 300 beds have already closed, with many more closures to come. Does the Minister accept any responsibility for that? Ultimately, it is patients who will pay the price.

While we welcome this update for hospices, when will the Health Secretary come forward with more details on the many other health providers who have been hit by Labour’s tax increases, including GPs, community pharmacies and dentists? Will they be expected to be similarly grateful for getting back some of the money that the Government have taken from them?

[Karin Smyth]

To govern is, indeed, to choose. The Conservative party chose neither this sector nor any other health sector and it refused to govern. Within five months, we have not only increased the funding to the health sector to stabilise it but made today’s announcement.

Beneath all that, there might have been a welcome for the announcement—I am not entirely sure—whereas the sector is pleased to have the money. The chief executive of Hospice UK said:

“This funding will allow hospices to continue to reach hundreds of thousands of people every year with high-quality, compassionate care. We look forward to working with the government to make sure everyone approaching the end of life gets the care and support they need”.

The chief executive of Haven House children’s hospice said that it is

“very positive to hear about the government’s plan to invest significantly in the wider hospice sector; we hope that there will be as much flexibility as possible to determine locally how this new money is spent.”

This is an important issue for many hon. Members, and we look forward to working with the sector in the new year on the specifics of the announcement.

[Clive Efford (Eltham and Chislehurst) (Lab)]

This is a very welcome announcement and I am sure the hospices are breathing a sigh of relief after the level of funding they endured for 14 years under the Tories. If we are to move palliative care out of hospitals and into care situations or people’s homes, the money needs to be passported to the hospice sector for it to play its part. Integrated care boards have been charged under the Health and Care Act 2022 to provide that funding. Will the money go through ICBs or will it be passported straight to the hospice sector?

[Karin Smyth]

My hon. Friend makes an important point about the need for more people to be treated at home. That is absolutely the direction of travel that we want to see. This money will help, for example, with technology to support more people to be treated at home. ICBs are responsible for commissioning and allocating funding, so that will be done in the normal way.

[Mr Speaker]

I call the Liberal Democrat spokesperson.

[Helen Morgan (North Shropshire) (LD)]

I wish you and the whole team a very merry Christmas, Mr Speaker.

Last week, I visited Hope House in my constituency, where I met beautiful young Esmay, one of hundreds of children cared for by the hospice every single year. She is nearly three and has a life-threatening heart condition. Esmay’s family do not know what the future holds for her, but they know that Hope House will be there to support them, as it has since before she was born.

There are 300,000 people like Esmay treated in hospices every year, and just one third of their funding comes from the NHS. That leaves institutions such as Hope House and nearby Severn hospice reliant on generosity and unable to plan as they wait for confirmation of the funding they will receive from the NHS. That situation has been made more difficult this year because of the increase to national insurance contributions, which Hope House estimates will cost £177,000.

Funding is welcome, and I welcome the Minister’s commitment today. Will she explain whether the increase that she has announced today will cover the NIC hike for hospices and the increase in the living wage that was announced at the Budget? Will she also commit to providing future settlements in a timely manner so that hospice managers can budget effectively for the coming year?

[Karin Smyth]

I thank the hon. Lady for her questions and for welcoming the announcement. She will know that, in the past 14 years, the sector has been neglected, like the rest of the NHS and social care system. As we have repeatedly said, to govern is to choose. We have improved the settlement for the sector this year. Today’s welcome announcement can be used by the sector to manage some of those pressures and deliver the sorts of services it wants for the future.

[Josh Fenton-Glynn (Calder Valley) (Lab)]

Does the Minister agree that the amazing staff at Overgate hospice in my constituency should be focused this Christmas on caring for their patients and not on funding? Will she confirm that this funding allows them to do so? Also, in April I will be running the London marathon for the Overgate hospice’s big build appeal. Will the Minister sponsor me?

[Karin Smyth]

That is possibly one of the cheekiest questions I have ever heard asked here, and I am obviously going to have to say yes. Frankly, rather him than me, but good luck to my hon. Friend on doing that. I know that many hon. Members raise money for their local constituencies and that the marathon is an important part of that.

We understand how different hospices are funded differently throughout the country. We want to make sure that end of life care, with all the different options that people have in their local systems, is well supported. It is really important for people to have some of that security, and I know that this announcement will be welcomed by my hon. Friend’s local hospice, as it is by the sector today.

[Sir Bernard Jenkin (Harwich and North Essex) (Con)]

Merry Christmas, Mr Speaker.

The St Helena Hospice in Colchester, which serves my constituency and that of the Labour hon. Member for Colchester (Pam Cox), estimates that the national insurance increase will cost it £300,000 in a full year. Can the Minister now give a guarantee that the hospice will be compensated by the Government in full?

[Karin Smyth]

It is good to hear the hon. Gentleman supporting his local hospice with his neighbour, my hon. Friend the Member for Colchester (Pam Cox). We will announce allocations for the whole sector and the NHS in the usual way in the new year.

[Sarah Edwards (Tamworth) (Lab)]

St Giles Hospice in my constituency has funding challenges like any other. One thing that staff mentioned to me was the sustainability of when they are contracted to do things. Is the Department considering the timing and not just the funding, to enable better planning and better staff planning?

[Karin Smyth]

Yes, stability and understanding longer-term planning is important for this sector as well as for many others. Certainly, we want to make sure that we work with the sector and the wider NHS, so that we deliver our longer-term 10-year plan, but get to that process in the next few years.

[Bob Blackman (Harrow East) (Con)]

Merry Christmas, Mr Speaker.

St Luke’s Hospice in my constituency covers the whole of Brent and Harrow. I helped to form it back in the 1980s. The staff tell me that the biggest problem they face is that, every time there is an increase in nurses or doctors’ pay, it is never passed on to them, so they have to find the money from charitable giving. The Minister’s announcement of extra money is of course welcome, but she has failed to answer the question: will it cover the national insurance increase, or not?

--- Later in debate ---

[Karin Smyth]

All hon. Members support their local hospices, which I know is important, but I have to remind the House of the parlous state of the sector that we inherited after 14 years of the previous Government. If Conservative Members, many of whom were part of that Government, had wanted to rectify the way in which hospice funding was allocated, or indeed that end of life care was managed, they had plenty of opportunity to do so. This Government have hit the ground running. We have fast-tracked these measures, and this announcement today is clearly a part of that. I hope that they all welcome it; it is just a shame that they did not do it themselves.

[Helena Dollimore (Hastings and Rye) (Lab/Co-op)]

Merry Christmas, Mr Speaker.

May I welcome this record investment in our hospices from the Labour Government? The Conservative Government had 14 years to do that, but they shirked that responsibility. Will the Minister join me in thanking the amazing staff and volunteers at Saint Michael’s Hospice and Demelza hospice in my constituency who do such amazing work all year round to support families and children who need amazing care?

[Karin Smyth]

I am delighted to support my hon. Friend in the work that she has been doing with St Michael’s and Demelza hospices. She is absolutely right to highlight that, and I hope that she will be able to meet the staff in the new year and discuss how they can best use some of this funding.

[Caroline Voaden (South Devon) (LD)]

I wish you, Mr Speaker, and all the House staff, a very merry Christmas.

Following on from the hon. Member for Calder Valley (Josh Fenton-Glynn), next year I will be taking part in a strictly dancing competition for my local Rowcroft Hospice. However, I am pretty sure that, even if all the Members in this House sponsored me, I would not be able to raise the £225,000 needed by Rowcroft to cover the additional national insurance contribution payments that it will have to make. Will this extra funding, which is very welcome, be additional funding, or will it be just enough to cover the extra costs that have been imposed on the hospice sector through the increase in national insurance contributions in the recent Budget?

[Karin Smyth]

I have to say that dancing is more my style than marathon running, so I wish the hon. Lady luck with that. At least she did not ask me for any money. I refer her to my earlier answer: this is additional money to support the hospice sector. It is a £100 million boost for adult and children’s hospices to ensure that they have the best physical environment for care, and £26 million in revenue to support children and young people’s hospices. We look forward to working with the sector in order to best deploy that in the New Year.

[Melanie Ward (Cowdenbeath and Kirkcaldy) (Lab)]

Merry Christmas to you and your team, Mr Speaker.

Our hospices do an amazing job, and I look forward to visiting my local hospice in the next few days, but Scottish hospices have warned that they might have to turn patients away because of the funding crisis that they face under the SNP. Does the Minister agree that the Scottish Government must at least match the level of investment that she has announced today? They must have a similar level of ambition for Scottish hospices, and provide fresh investment for our hospices, which do an amazing job in Scotland.

[Karin Smyth]

As my hon. Friend highlights, this is a devolved issue for the Scottish Government. We hope that they match our ambition, as she rightly puts it. I wish her well with her local hospice, and I hope that the Scottish Government take note of what we are doing here in England.

[Neil O'Brien (Harborough, Oadby and Wigston) (Con)]

Over 7,000 charities and voluntary groups have written an open letter to the Chancellor warning that the national insurance increase will cost them £1.4 billion and have a devastating impact. At this time of the year, ahead of Christmas, many charities, including hospices, are trying to raise funds. I know that the Chancellor did not go into politics to be the Grinch who stole Christmas for charities, so will the Minister please look at this again, and exempt charities and voluntary groups, including hospices, from this cruel tax increase, which is sucking up good will and donations and really hurting valuable charities?

[Karin Smyth]

The hon. Gentleman was a Government Minister, so he had plenty of opportunities to change the system, had he wanted to do so at the time.

[Rachel Hopkins (Luton South and South Bedfordshire) (Lab)]

I thank the Minister for her announcement of a huge funding boost for the hospice sector. Will she join me in thanking all the brilliant staff at Keech hospice, which serves Luton South and South Bedfordshire, and especially all the volunteers who are out fundraising with Smiley Sam and Santa’s train across the streets of Luton, including Farley Hill tomorrow and Wardown Crescent on Saturday?

[Karin Smyth]

I thank my hon. Friend for making that point, and wish the volunteers well in their weekend activities. She is right to highlight not only staff but the hundreds of thousands of volunteers across the country who work to support the hospice sector and others with end of life care. That support is so important for people receiving end of life care and their families. It is something that I have experienced; my father died over the Christmas period a number of years ago. It is a hard time of the year to have a death, and I warmly support what those volunteers are doing this weekend.

[Paul Holmes (Hamble Valley) (Con)]

The fact that the Minister has come here expecting us to welcome her announcement and congratulate her on giving money that her Government took away in the first place really beggars belief. Mountbatten hospice in my constituency needs an extra £1 million because of the NICs increase that her Government have brought forward. Will she guarantee to Mountbatten and the charitable sector, including hospices—which the last Government increased funding for, before she comes back to me with that answer —that today’s announcement will cover the £1 million that her Government have taken away in NICs?

[Karin Smyth]

What beggars belief is that person after person—man after man—on the Opposition Benches still feels able to get up and defend their record in government. Not once have we heard that they agree with Lord Darzi’s diagnosis, or that they welcome the extra investment that the Chancellor found by choosing to support the health sector in the Budget. I am afraid that, until they reach that conclusion, they are destined to be on the Opposition Benches for a very long time.

[Warinder Juss (Wolverhampton West) (Lab)]

Merry Christmas to you and your team, Mr Speaker.

Compton Care hospice in my constituency provides specialist palliative and bereavement care, 24 hours a day, 365 days a year. Having previously discussed the lack of funding with the hospice, I am sure that it will welcome the extra funding that has been announced today. Will the Minister please join me in thanking Compton Care hospice and its incredible staff for the care that they will continue to provide throughout the Christmas period?

[Karin Smyth]

I welcome my hon. Friend’s comments, and I am very pleased to thank Compton Care hospice for all its work. He is right to highlight that the care is 365 days a year, around the clock.

[Lisa Smart (Hazel Grove) (LD)]

Hospices such as St Ann’s in Stockport provide really high-quality care to my constituents and others at what is often the toughest point in their lives, but they are struggling in a system that is no longer fit for purpose. It is of course welcome that the Government are providing additional funding for them. One of the challenges that the hospice sector faces is a really high rate of staff vacancies, so I would be grateful if the Minister would confirm whether the 10-year plan for the NHS includes a specific workforce plan for our hospice sector, so that it continues to care for our constituents at the toughest point in their lives.

[Karin Smyth]

The hon. Lady makes an excellent point about the stability of the workforce across the piece, from diagnosis to the end of life. We absolutely need to consider support for all parts of that through the 10-year plan. I encourage hon. Members and others to ensure that they keep making those points. We are getting excellent contributions from the public, patients and staff, and we look forward to developing the plan over the next few months and years.

[Matthew Patrick (Wirral West) (Lab)]

I welcome the largest funding increase for hospices in a generation. If that cannot bring some Christmas cheer to the Conservative Benches, it will in my constituency of Wirral West where Claire House hospice does such important work all year round. I was there just last week for their Christmas carols. Will the Minister take the opportunity to thank them for the important work they do in my constituency of Wirral West?

[Karin Smyth]

I thank my hon. Friend for his contribution and, indeed, for his singing. Those events bring joy to people at a particularly difficult point in their life, and they are very welcome.

[Martin Vickers (Brigg and Immingham) (Con)]

Any increase in funding for the hospice movement is of course welcome, but let us be honest: it is giving with one hand and taking with the other. The two excellent hospices that serve my constituency—St Andrew’s in Grimsby and Lindsey Lodge in Scunthorpe—tell me they want certainty. The Minister says they will be told early in the new year. Can the Minister give a categorical assurance that in the first half of January hospices will be told how much extra they are getting from the £100 million she mentioned?

[Karin Smyth]

I thank the hon. Gentleman for welcoming the announcement. As I said, we will be working with the sector in the new year and then we will make allocations accordingly.

[Gareth Snell (Stoke-on-Trent Central) (Lab/Co-op)]

Stoke-on-Trent is wonderfully served by the Dougie Mac and Donna Louise hospices. They are part of a healthcare system in Staffordshire and Stoke-on-Trent that the Minister knows has a £90 million projected deficit. What oversight will there be to ensure that the money that goes to the ICBs reaches the hospices and that the team in Staffordshire and Stoke-on-Trent do not try to use some of this welcome new money to fill holes elsewhere?

[Karin Smyth]

My hon. Friend makes an excellent point —one that was raised earlier. It is vital that ICBs work with all providers to understand the needs and how they are best met. I know he will be diligent, as he already has been, in pursuing what is happening with the funding with his local ICB. We will work with Hospice UK to ensure that that happens across the piece.

[Seamus Logan (Aberdeenshire North and Moray East) (SNP)]

The hon. Member for Cowdenbeath and Kirkcaldy (Melanie Ward) calls for a fresh approach by the SNP Government in Holyrood, but she clearly expects us to do that with fresh air, because part of the £750 million additional cost from the national insurance contributions will fall on hospices. On Tuesday, she had the opportunity to vote against that cost. Will the Minister confirm that there will be Barnett consequentials for Scotland? How will she address the problems that Marie Curie in Scotland faces?

[Karin Smyth]

I admire the hon. Gentleman for keeping on the same wicket. In the Budget, this Government made the greatest allocation to the health sector. What the Scottish Government do with their consequentials and how they manage that is entirely a matter for them, and if they are not doing a good job, the public need to vote for someone else.

[Harpreet Uppal (Huddersfield) (Lab)]

I wish you, the team and all the wonderful staff on the parliamentary estate a merry Christmas. I very much welcome this big investment into local hospices, and I know it will be welcomed by my local children’s hospice Forget Me Not and Kirkwood hospice, which do invaluable work in my constituency. What assessment has the Minister carried out on long-term sustainable funding for the sector, particularly in relation to statutory funding and the increasing role that hospices play in the community and in people’s homes?

[Karin Smyth]

My hon. Friend is absolutely right to highlight that need. As I said earlier, end of life care and its stability as part of the wider system, which is a commissioning role for ICBs, was not addressed by the last Government over 14 years. As part of our 10-year plan, that will be important to do.

[Sir John Hayes (South Holland and The Deepings) (Con)]

We can all agree that hospices, such as St Barnabas in Lincolnshire, do vital and valued work. I hope we can also all agree that every Government—Labour and Tory—have increased national health spending, for that is simply a matter of fact. I ask the Minister to show a little wisdom in contrition in acknowledging that the national insurance increase that was imposed on charities and hospices has done immense damage. We welcome the funding today—of course we do—but she needs to be straightforward: was she, or any of the Health team, consulted before the Budget about the impact of the NI increase on hospices, health charities, pharmacies and so on? May I advise her to put down the folder and tell us what she really thinks?

[Karin Smyth]

I have scribbled my own note—the right hon. Gentleman says that he “agrees”— but the issue is that his Government did nothing over 14 years to support or make a change. That is why the announcement we are making is so important. I reiterate my earlier point, which I will repeat every time I am at the Dispatch Box: the Conservatives have not read the Darzi report; if they do not agree with the diagnosis, they cannot agree with the solution. That is their fundamental problem.

[Amanda Martin (Portsmouth North) (Lab)]

I welcome the announcement of additional funding, as will many families across the country. Although it is not in my constituency, Rowans Hospice is used by people in Pompey. Indeed, my nan Pearl and my very dear friend Fiona spent their last few weeks in the hospice’s care, and what a wonderful place it is. At a city council meeting this week, concerns were raised about the future of that amazing service. Will the Minister confirm that the Government are committed to ensuring that every person has access to high-quality end of life care?

[Karin Smyth]

That is absolutely what we want to do, and today’s announcement is a step towards it. As my hon. Friend highlights, hospices are very special places, but most people want to die at home with their loved ones, in the place they know well, and many parts of the sector will be able to use this money to help more people to die peacefully at home.

[Tim Farron (Westmorland and Lonsdale) (LD)]

This additional funding will benefit hospices serving Westmorland communities—St Mary’s, St John’s, Eden Valley and the children’s hospice, Jigsaw—only if two things happen. First, the Government must provide additional funding to match the national insurance increases that those hospices will have to bear, and secondly, the Government must ensure that the integrated care boards in south Cumbria and north Cumbria pass on that money in full and on time. Will the Minister press them to do so? On the Morecambe bay end, will she press them on the closure of the Abbey View ward at Barrow hospital? The trust is planning to close that end of life ward, which will put additional pressure on our local hospices but without any additional funding to support them.

--- Later in debate ---

[Karin Smyth]

The commissioning of those services is the responsibility of the ICBs, and we expect them to do that. They are responsible from diagnosis to end of life. In the past few months, I have met many hon. Members from across political parties to discuss issues in their ICBs. I know that he will, like others, be assiduous in pursuing the ICB to ensure that funding goes to the right place.

[Alistair Strathern (Hitchin) (Lab)]

I wish you, Mr Speaker, and the fantastic staff across the estate a happy Christmas.

I thank the Minister for the way in which she and her team have listened to me and colleagues, who arrived in this place with real concern about the state of palliative care after years of under-investment by the previous Government. The funding announced today will be welcomed by Keech hospice and Garden House hospice, which provide fantastic palliative care for constituents in and around my area. Will she join me in thanking them for the fantastic work that their staff and volunteers do all year round to support people in incredibly difficult moments in their lives? Will she also assure them that palliative care will remain at the front and centre of the Government’s mind in the difficult work of getting health services working again?

[Karin Smyth]

I am happy to support my hon. Friend, who makes an excellent point, in his work with local providers. He congratulates me, but the work has been done mainly by the Minister for Care, my hon. Friend the Member for Aberafan Maesteg (Stephen Kinnock), and by the Secretary of State, who have personally taken on this issue. They are visiting hospices today, so they could not be here even though they wanted to. We are committed to supporting people throughout their life, from diagnosis to end of life.

[Robbie Moore (Keighley and Ilkley) (Con)]

I have been contacted by vast numbers of families and relatives of those who have been wonderfully cared for by Sue Ryder Manorlands hospice in Oxenhope in the Worth valley. They are all concerned about the impact that the rise in employer national insurance will have on them. Those at Manorlands are deeply concerned that it will cost them hundreds of thousands of pounds. In answering the urgent question, the Minister has announced additional funding, but can she confirm whether it will cover the cost of those rises to Sue Ryder Manorlands hospice in my constituency? Did the Government carry out an impact assessment of the negative impacts that the Budget would have on those in the charitable and hospice sectors?

[Karin Smyth]

The hon. Gentleman asks the same question again. Through the Budget, this Government have allocated more money to the health service than the previous Government—a record announcement—and we have announced money again this morning. To govern is to choose. The last Government neither governed well nor chose to support the health sector from diagnosis to end of life; this Government have, and will continue to do so.

[Alison Bennett (Mid Sussex) (LD)]

Some weeks before the Budget, I visited both St Catherine’s hospice and St Peter and St James hospice, which serve my constituents. I had not expected how quiet and empty those hospices were, because of the empty beds and mothballed wings that had been closed due to a lack of funding. Evidently, the funding crisis in the hospice sector was very deep before the Budget, but the Budget has only made it worse through the NIC increases. As such, I will try again: will the welcome funding announced today cover the cost of those NIC increases?

[Karin Smyth]

As Lord Darzi’s report announced, the entire sector has been under pressure and struggling since the disastrous Lansley reforms—they were part of the coalition Government—through to when we took over in July. We will fix the NHS and rebuild it to make it more sustainable and fit for the future. That includes everything from diagnosis to end of life care.

[Blake Stephenson (Mid Bedfordshire) (Con)]

For my sins, I too will be running the London marathon next year. I will be running to raise money for Keech hospice; I know, as do other hon. Members who represent constituencies in Bedfordshire, what fantastic work that hospice does and the care it provides to our county. The Minister has been asked lots of times to comment on the impact of the NIC increases, which are going to hurt hospices in constituencies all around the country, so may I ask the question in a slightly different way? Does the Minister think that Keech hospice, taken in the round, will be financially better off or worse off next year as a result of both the Budget and this announcement that she has been dragged to the House to make?

[Karin Smyth]

I have not been dragged—I am very happy to be here. The reality is that the health sector in its entirety, from diagnosis to end of life care, will be better off this year than it was last year or the year before under the hon. Gentleman’s Government.

[Gideon Amos (Taunton and Wellington) (LD)]

I place on record my thanks to all those in my constituency who will be caring for others over Christmas, whether they are unpaid family carers or paid care providers. That includes the registered nurses and registered care providers who have written to me to say that there will be an extra cost of £615 per employee as a result of the changes in the Budget. I will not attempt to ask whether the money announced today will cover national insurance contributions, but I will ask what the Government will do to help registered care providers. Where will the money come from to enable them to meet their increased national insurance contributions?

[Karin Smyth]

As the hon. Gentleman knows, this Government have allocated an extra £12 billion in this year for the health and care sector. The full allocation to cover the entire area of health and social care will be announced in the new year.

[Jim Shannon (Strangford) (DUP)]

It would be churlish of anybody in this Chamber not to welcome the money that the Government are setting aside. I thank the Minister and the Government for that announcement, but what discussions has the Minister had with Cabinet colleagues to secure exemptions from national insurance contribution hikes for hospice workers? I think of Marie Curie—I spoke about that charity yesterday in Westminster Hall, and the Minister probably has a Marie Curie in her constituency. We know what that charity does. Unlike the mainstream NHS, it will not be exempted, yet it carries out the end of life care that the NHS simply cannot provide. Further, what help will be provided to carers in the community? The withdrawal of their service would leave the care system decimated.

[Karin Smyth]

The hon. Member makes an excellent point about carers and their support. We made announcements about that in the Budget, and we will make more general announcements about allocations in the new year.

[Mr Speaker]

May I gently say that I know you welcome being here, Minister, but it would have been easier if the announcement had come as a statement rather than through having to grant an urgent question? When Ministers are going out—quite rightly—to visit hospices, we should be told at the same time. It would be nicer and easier for us all to do it that way, but I thank the Minister for coming.

I would also say to all of us that our hospices matter. In the case of those hospices that serve my constituency—the children’s hospice of Derian House and St Catherine’s— I wish them all the best for Christmas. I thank all hospices for the duty they carry out on behalf of our constituents.

Winter Preparedness

Karin Smyth Excerpts

Wednesday 18th December 2024 Commons Chamber

[The Minister for Secondary Care (Karin Smyth)]

With permission, Madam Deputy Speaker, I would like to make a statement on winter preparedness. Before I begin, I want to say a very special thank you to all the staff who will be keeping our NHS going over the Christmas holidays and into the new year. When I was a manager in the NHS, I worked on winter planning, so, if I may, I will say an additional thank you to all the people who are often unseen: the managers and admin staff who also keep the system going. I know how hard it is for people to work in the system with the challenges that winter can bring through increased demand and higher rates of infection.

There are things that we cannot predict. Storms Bert and Darragh have added pressure, and we might have a cold snap. I know that many people like a winter cold snap of snow and ice, but it is not something that the NHS ever wants to see. The NHS has excellent people who have done this before and, unlike last year, thanks to the new Government, many of them will not be on strike. While we cannot control the weather, we can plan, prepare and pull together, so today I want to update colleagues with the current picture before moving on to the things that we are doing.

NHS England and the UK Health Security Agency will publish the latest statistics tomorrow morning as usual, but we do know that levels of seasonal illness are high. The most recent figures show that last week there was a 350% increase in flu cases compared with the same week last year, but that is comparable to levels we saw two years ago. Norovirus cases are high, but covid rates are low, and although rates of RSV—respiratory syncytial virus—have been high, we expect them to start coming down over the next few weeks.

I want to make it clear that the current rates for both bed occupancy and ambulance delays are unacceptably high. I will shortly come to measures about how we are dealing with that capacity.

I will not rehearse the Darzi investigation and his findings, except on one thing. I remind the House that he found “a perpetual bed crisis”, particularly during peak periods like winter cold snaps. That means that every winter our staff have been wasting precious time solving process problems, ringing round wards to find beds and desperately trying to hold the system together. We can see that in the figures.

On an average evening in 2009, a patient would have been 39th in the queue when they arrived at a typical accident and emergency department. In 2024, they are 100th. The four-hour A&E standard has not been met for nearly a decade and ambulance response times have not been consistently achieved since their introduction in 2017. In November, the average ambulance response time stood at 42 minutes, which is more than double the NHS constitutional standard. A third of the 2.3 million people who attended A&E last month waited more than four hours, and one in 10 of those people—more than 150,000—waited for more than 12 hours.

Those life and death delays are the result of deep structural issues in the NHS that cannot be fixed overnight. But this winter, NHS staff will be on the frontline, not the picket line, because we took a different approach on how to work with staff and the unions. To resolve the resident doctors’ dispute, we spoke to them on day one, we met them in week one, and by week four we had negotiated a deal to end their strikes. That is why, for the first time in three years, the Government are fully focused on winter and not on planning for strikes.

This is what we are doing. First, the NHS is managing extra demand by strengthening same-day emergency care and offering more falls services for older people, with upgraded 24-hour live data centres. Secondly, we are continuing to support systems that are struggling with direct intervention through the NHS urgent and emergency care tiering programme.

Thirdly, the Secretary of State is chairing weekly meetings with me and senior leaders to ensure that we are managing pressures across the entire system. Last week, he specially convened with trusts and told them to prioritise patient safety by focusing on key metrics, including improving emergency ambulance response times, addressing handover delays and tackling the longest waits in A&E. We have made it crystal clear that we do not want trusts to prioritise patients who can be seen and discharged more quickly over those with the greatest clinical need, because this Government will always prioritise people, not performance. This morning, the NHS published a letter outlining how it is prioritising patient safety.

Fourthly, I am taking steps to ensure that we get a clear picture of what is happening on the ground. I recently visited Newham hospital’s A&E, Bristol Southmead hospital and the head offices of NHS England to see the aforementioned operational control centre, where it receives data in real time and responds to problems as they emerge. Fifthly, we launched a national communication campaign in the autumn to encourage people across the country to take their winter vaccines, with a particular focus on people who are less likely to come forward.

That last point is essential, because the best and easiest way to keep people out of hospital this Christmas is to encourage them to come forward and get vaccinated. Last year, people who received a covid vaccine were half as likely to be admitted to hospital than those who did not. So far, we have delivered over 17 million flu jabs and 9.5 million covid jabs, and we have introduced the first ever public vaccination campaign for RSV, with over a million and counting vaccinations delivered to protect young babies and the elderly. In total, we have delivered nearly 28 million vaccinations for this winter, and I thank every person who has come forward to protect themselves and the vulnerable.

Now, I would like to speak directly to anyone who has not yet been vaccinated. No one wants to be separated from their family and stuck in hospital this Christmas, and there is a real risk that people may inadvertently take flu home to loved ones this year. Please protect yourself, your family and the NHS, and book that appointment today, because tomorrow is the last day you can book a vaccine through the NHS app or website, although after tomorrow there will be local solutions.

While we tackle winter pressures in the short term, we are fixing the foundations of our NHS with long-term reform. Two weeks ago, the Prime Minister spoke to the nation about our plan for change, and set out our ambitions for the health service over this Parliament. We will get a grip on waiting lists and return to 92% of patients waiting no longer than 18 weeks from referral to treatment by the end of this Parliament. We are also taking action on social care, introducing the largest increase in the carer’s allowance weekly earnings limit since 1976. We will ensure that carer’s allowance meets its objectives, while reviewing unpaid carer’s leave and looking at the benefits of introducing paid carer’s leave.

We will publish an improved better care fund framework, using £9 billion of funding to provide better, more integrated health and social care for patients and people who draw on care. We are helping disabled people on low incomes adapt their homes through the disabled facilities grant. The Employment Rights Bill is already in Committee, laying the foundations for the first ever pay agreement for care workers as a first step towards building consensus on the long-term reform needed to create a national care service. By the end of our first year in government, we will deliver an extra 2 million operations, scans and appointments through innovation, investment in additional capacity and productivity gains.

We are sharing the best of the NHS with the rest of the NHS, with our Further Faster teams. These are teams of experts that are supporting 20 trusts with long waits to tackle waiting lists and increase productivity. They have been deployed to five trusts so far, and we are already seeing improvements—for example, in theatres. For this financial year, the Government have committed £12 billion more in everyday spending on health and social care than was planned by the last Government in the spring Budget.

We are giving our capital-starved NHS the funding it so badly lacked over the past decade, setting aside at least £1.5 billion next year, which will create additional capacity, including new surgical hubs and diagnostic scanners, and new beds across the estate. That will enable 30,000 additional procedures and over a million diagnostic tests as they come online. That is the difference that a Government of service make. We have also been clear that investment must come with reform. Lord Darzi has given us the diagnosis, and the cure can be found in shifting the NHS from treatment to prevention, hospital to home, and analogue to digital.

Harold Wilson once called himself an optimist who carries a raincoat. As someone who has worked in our NHS at this critical time, I am fully aware of the challenges we face and the effort required. I am making sure that we have a firm hold on problems in the short term, while we do the work of fixing the foundations of our NHS with long-term reform. Over the past 14 years, we have limped from one crisis to the next, improvising and making do with sticking plasters. It cannot go on. It is bad for patient care and it is totally demoralising for staff.

We are building a health service that is fit for the future, ready to face every winter with confidence, and we will publish our 10-year plan for health in the spring. Anyone who thinks that we cannot do it should remember: we have fixed the NHS before, and we will fix it again. The public rightly expect us to put an end to the annual winter crisis, and that is what we will deliver. I commend this statement to the House.

[Madam Deputy Speaker (Ms Nusrat Ghani)]

I call the shadow Secretary of State.

[Edward Argar (Melton and Syston) (Con)]

I am grateful to the Minister for early sight of her statement—as I have said before, it is typically courteous of her. I echo the gratitude that she expressed to those in our NHS, and also those in the social care workforce who will be working hard throughout the festive period. As she alluded to, the NHS is already feeling the pressure this winter. We know that winter is always tough for the NHS, irrespective of who is in government, but services are feeling the strain even earlier than in previous years. A tidal wave of flu infections has led to a 70% increase in hospital cases in just seven days, and the national medical director of the NHS has warned of a “quad-demic” of health emergencies as cases of covid, norovirus, RSV and winter flu are all on the rise.

Meanwhile, in October, the longest A&E waits of over 12 hours increased by over a quarter in just one month, reaching the third highest monthly figure since comparable records began in 2010. Of course, all that has come before the cold weather really hits and before more vulnerable pensioners are left in freezing homes, unable to put the heating on after the winter fuel payment was scrapped for a large number. What assessment has the Minister and the Department made of the potential impact of that on hospital admissions this winter?

In government, we recognised that the NHS faces unique challenges in winter. We also recognised, as I know the Minister does from our previous discussions, the importance of flow in the NHS, with all parts of the system working together. That is why last year we provided £200 million to boost NHS resilience specifically during the peak winter months, which was accompanied by £40 million to bolster social care capacity and improve discharges from hospital. That followed the £1 billion announced earlier that year to boost capacity by delivering 5,000 additional beds, 800 new ambulances and 10,000 virtual ward places.

The Secretary of State himself has admitted that there will almost certainly be a winter crisis. There have been warnings from the Royal College of Emergency Medicine, the Royal College of Nursing and directors at NHS England. Yet in today’s statement, in contrast to the steps we took, we heard a lot about data, meetings and co-ordination, but very little in concrete terms to increase capacity specifically over the winter period. That will give scant reassurance to those working in the system or patients needing the system. In fact, earlier this year, the Secretary of State suggested that there would not be any specific new funding for the NHS to cope with winter pressures.

The Minister will know that I have tabled a number of written questions in recent days, met in many cases by what seems to be the standard DHSC response for named day questions of a holding answer. As the pressure continues to grow, I have a number of specific questions for the Minister while she is at the Dispatch Box. Will the NHS receive more resources specifically to increase bed and A&E capacity this winter? Are there enough hospital beds and ambulances for this winter, or is she taking steps to increase them? As of the 1st of the month, how many people who were medically fit to be discharged had not been, for a variety of other reasons?

I am grateful for the update that the Minister provided on winter vaccinations. What assessment has she made of the supply of the flu vaccine? There are some suggestions that pharmacies and others have run out and are waiting for more deliveries. How many additional 111 and 999 call handlers have been recruited specifically for this winter?

We talked briefly about the need for the system to work as a whole. In that context, what is the impact of national insurance contributions on hospices, social care and GPs? The Secretary of State told the Health and Social Care Committee this morning that hospices would get an update from him before Christmas, but at Prime Minister’s questions in response to the Leader of the Opposition, the Prime Minister appeared to say that it will be after Christmas. Can the Minister clarify that for the House, because it is an important point?

Finally, what meetings has the Secretary of State personally had with Julian Redhead and Sarah-Jane Marsh, the NHS winter leads, and when was the first of those meetings specifically on this subject? I am very happy for him to write to me if that is easier, given the complexity.

As seasonal flu piles yet more pressure on NHS systems, it is more important than ever that it gets the resources and support that it needs. There are many promises of reform, but the NHS needs an immediate capacity boost in beds over winter. So far, the Government have kicked reform into the long grass in favour of yet more consultation, and their preparations for winter have lacked the urgency and focus that patients and NHS staff demand. In government, the Conservatives always put extra support in place to keep the NHS going through the tough winter period, boosting capacity and increasing support. This Government need to get a grip and do the same.

[Karin Smyth]

I will do my best to address that range of questions. First, as even a stopped clock is right once—[Interruption.] Yes, twice. On that basis, I agree with the right hon. Gentleman. On correspondence and answers to parliamentary questions, again, the situation we inherited is not satisfactory. I apologise to all Members who are waiting for correspondence—it is something we are taking a grip of. We want to respond positively to questions. The Conservatives did not; we will make sure that starts to happen.

On capacity in the system, again, I remind Members that we came into office in July, which is one quarter of the way through the planning and financial year. We very rapidly looked at the plans that were baked in by the previous Government—I appreciate that the right hon. Gentleman was in the Ministry of Justice at the time, not the Health and Social Care Department—to see whether they were fit for purpose. We wanted to make sure we brought stability to the system. There are, in fact, more beds currently available in the system than last year. If there is a need to increase capacity due to a likely cold snap, the system is absolutely ready to respond in its usual way. That is why we are meeting weekly.

On meetings with clinical and managerial colleagues at NHS England—who, frankly, I see more often than many members of my own family—I can tell the right hon. Gentleman that we started those meetings immediately. I would have to check the exact date, but it was certainly in the summer. I have had fortnightly meetings since September, which, as I said, we can move to monthly meetings, chaired by the Secretary of State. We began getting a grip from day one, knowing that winter was coming, which is why I am monitoring the situation weekly. It is also why we visited the operational centre, to understand in real time what is happening across every single system and every single trust—be that ambulance issues or problems at the front end and in A&E. The one question I do not directly have the answer to is what the daily figures are; I will try to get those figures to the right hon. Gentleman later.

We all know that waiting for discharge to assess is a massive problem. That is why, as I said in my statement, we want to take a grip of the better care fund, to ensure it works better and to stabilise the social care system. I am not particularly versed in issues on supply, so I apologise if that is wrong. We will certainly get back to the right hon. Gentleman on that matter, because we want people to be taking the vaccinations where necessary.

I can confirm that we want an announcement on hospices before Christmas. On winter fuel and its impact, as Opposition Members know, we will continue to monitor the impact of all situations on individuals to ensure they are supported in the community. We urge people to make sure they access pension credit. [Interruption.] I have just addressed that, but if I have missed anything, I will come back to it.

[Rachael Maskell (York Central) (Lab/Co-op)]

Despite York’s new emergency department, a consultant has described to me the situation in emergency medicine, where patients are waiting for days to be discharged and 50 patients are waiting to be placed on wards. We know we have inherited a broken NHS. Will the Minister say what she is doing first to enable primary care to pull more patients out of emergency medicine, in order to see people in the community, and secondly to invest in social care, which will clearly address some of the backlog and the logjam in patient flows?

[Karin Smyth]

My hon. Friend’s comments reinforce how much pressure, we understand, is front facing. A&E is demonstrative of the overall pressure in the system, not just at discharge but, as she rightly says, in primary care. We took action in the summer to improve primary care, increasing the number of GPs available in the system. It is absolutely critical that primary care community services are integral to winter planning at a local level. That is what we expect from every single system. We will continue to monitor that over the winter period and into the spring. If those services are not involved in planning for any particular systems, enabling them to monitor the surge and flow of people, we very much want to understand how that is working.

[Madam Deputy Speaker (Ms Nusrat Ghani)]

I call the Liberal Democrat spokesperson.

[Helen Morgan (North Shropshire) (LD)]

I express my thanks and those of my Lib Dem colleagues to everyone working over the Christmas period to keep people healthy and safe. Preparedness for winter is absolutely critical for our health and care system, and a quick look at what happened last year shows us why. Ambulances across England collectively spent a total of 112 years waiting outside hospitals to hand patients over, and a quarter of a million people waited more than 12 hours to be seen. Every winter we are warned of a winter crisis. Under the Conservatives, crisis became the norm not just in winter but all year round.

This year is very concerning so far. A&Es have overflowed through spring, summer and autumn. At my local hospital trust, Shrewsbury and Telford, one in three ambulances have had to wait more than an hour to hand over patients, while patients with devastating cancer diagnoses have had to wait months for crucial scan results. Across England, more than 7 million people are on waiting lists. Meanwhile, I am afraid, we have not heard enough from the Government on fixing one of the root causes of this crisis, which is our broken social care system.

The scale of the crisis is demonstrated by the challenges facing ambulance services across the country at the moment. October—before the winter—was the third worst month ever for handover delays at West Midlands ambulance service, which covers my constituency. The equivalent of 130 ambulance crews are out of action, waiting every single day. Now these overstretched ambulance services are formally changing their advice to reflect the pressure they are under. At times of peak demand, even category 2 patients—those suffering a heart attack or a stroke—will be asked to make their own way to a hospital. People in North Shropshire have long had to put up with some of the worst ambulance waits in the country, and they have come to harm as a result. It may no longer be the case that they can rely on an ambulance arriving.

Action is urgently needed to prevent more preventable deaths this winter. I am sure the Minister shares my alarm that ambulances may not be reaching people facing life-threatening situations. If she does, will she commit today to the Government tackling the handover delays paralysing the ambulance service by accepting Liberal Democrat proposals to make a £1.5 billion fund to provide more staffed beds, and by agreeing to urgent cross-party talks to fix the crisis in social care?

[Karin Smyth]

I think I have addressed the Government’s plans on social care. The hon. Lady makes an excellent point on ambulance delays, which we know to be a problem, and particularly so in the west midlands. That is one of the things I have asked the system to look at particularly, so that the Government and hon. Members can better understand the particular problems in their particular systems. We know that ambulance and handover delays are a particular problem in some systems. We are making sure that clinical and managerial leads from NHS England are visiting those systems and that they are understanding in depth the process issues in some places, where they may not be adopting the best practice that can be learned from others.

We need to roll out best practice across the country. When the Secretary of State and I visited the operational centre of the London ambulance service, we sat in on some hear-and-treat calls; in dealing with people in mental health crises, in particular, some places are doing that better than others. Those are the sorts of examples we want to learn from. I absolutely hear what the hon. Lady says about the unacceptable delays in particular parts of the country. That is very much on our priority list.

[Madam Deputy Speaker]

I call a member of the Health and Social Care Committee.

[Jen Craft (Thurrock) (Lab)]

Last week, I visited Basildon hospital, which is relied on by my constituents and people across Essex. Staff in the emergency department told me that they were operating under intense pressure all year round, and that it is indeed winter all year for them. That is due to a lack of beds, the terrible condition of parts of the estate and inadequate primary care services, meaning that people turn up at the ED when they should be somewhere more appropriate. What steps is the Minister taking to turn the page on 14 years of decline, and to ensure that Basildon and hospitals across the country have the resources and structures they need to better manage seasonal and year-round pressure?

[Karin Smyth]

My hon. Friend has already been a fantastic advocate for her local NHS services. Like the hon. Member for North Shropshire (Helen Morgan), my hon. Friend is absolutely right to highlight the acute pressures all year round. We did not always have winter crises under the last Labour Government. It was tough; I worked during some of that time, and it did happen, but getting used to such levels of bed occupancy and pressure in the system all year round is a direct legacy of the Conservatives and what they did to the NHS, particularly with the Lansley reforms, and their refusal to take a grip of it. This matter of a summer crisis going into a winter crisis is a real problem. That is why we are committed to these short-term measures to stabilise and support the system over the winter. However, as I said in my statement, we will also look at medium and longer-term reform so that we do not have to revisit this scenario year on year.

[Madam Deputy Speaker]

I call the Chair of the Health Committee.

[Layla Moran (Oxford West and Abingdon) (LD)]

Last Friday, I visited Sherwood Pharmacy in Abingdon. Ben, who owns it, told me that local pharmacies stand ready to help. In fact, they are more than keen to help, but there are two things that he needs from the Government. First, there needs to be a real push for GPs to refer people to pharmacies, in particular for vaccinations, so that we are not collecting patients in one already overstretched part of the system and they can do what they do best. Secondly, there needs to be a general plea to the public that they can go to their pharmacies for those things. I note that in her statement the Minister did not mention pharmacies once. Let us be honest, this question is not going to do it either. How do we ensure that the message—“Go to your pharmacy and get vaccinated, you can do it faster there”—gets out there this winter?

[Karin Smyth]

I thank the Chair of the Select Committee for her point. She is right that I did not mention pharmacies, which was an omission on my part. We are running an advertising campaign, “Think Pharmacy First”, to ensure people use pharmacies. She is absolutely right that they stand ready. I will visit mine over the next few days to make sure I am vaccinated. Their support, working with primary care, is critical. Again, in some places relationships are working well and pharmacies support people in the community—that is apparent in the statistics. We are absolutely committed to ensuring that that works better, as part of our long-term reforms.

[Madam Deputy Speaker]

I call a member of the Select Committee.

--- Later in debate ---

[Josh Fenton-Glynn (Calder Valley) (Lab)]

Last week, Calderdale and Huddersfield NHS foundation trust’s bed occupancy was at 99.6%. Some 20.1% of those beds, because of the failure of social healthcare and community care, were taken up by people who could be treated elsewhere. All I want for Christmas is a reassurance that, next Christmas and next winter, social care will be on a more secure footing.

[Karin Smyth]

My hon. Friend is absolutely right to highlight those shocking levels of bed occupancy. As I said earlier, running consistently at that high level of occupancy is something we should never have got used to. That discharge rate is demoralising for staff, very bad for patients and a sign of the pressure in the system. We absolutely must ensure the system is incentivised and works properly to make our hospital-to-community commitment, one of our three shifts, operate in practice. People do not want to be in hospital when they do not need to be and it is not the best place for them to be. We will be saying more about that in the new year.

[Wendy Morton (Aldridge-Brownhills) (Con)]

We hear today about a massive backlog at the Department for Work and Pensions in processing pension credit and winter fuel payment claims. Bearing in mind that cold homes increase winter deaths and hospital admissions, and that we are debating winter preparedness today, what discussions has the Minister had with the DWP to ensure that those in my constituency who are waiting for their winter fuel payments will receive them before the Christmas break? Will she commit to publishing a full impact assessment of that decision on the NHS?

[Karin Smyth]

I thank the right hon. Lady for her question. We have discussed this issue a number of times in this place. We absolutely understand the impact of cold and heat on the system and on people. It is something we need to address more generally. She will be aware that discussions on this issue are continuing with the DWP. If there are specific examples she wants to raise with me or the Department, I am very happy to look at them.

[Chris Vince (Harlow) (Lab/Co-op)]

I welcome today’s statement and take a moment to thank emergency services in Harlow and across the country who are giving up spending time with their families at Christmas to keep us all safe. East of England ambulance service has set up a new process to support paramedics and Princess Alexandra hospital, which will give them a direct line to a GP who can triage patients and send them to the right department straight away. What is the Department of Health and Social Care doing to work with ambulance services across the country to learn from that and share good practice?

[Karin Smyth]

Again, my hon. Friend is already representing the people of his constituency so well by getting to the heart of what is happening on the ground, learning it for himself and bringing such examples to the House. He is absolutely right that there are such examples across the country, working differently in different systems, which are challenging other systems to look at that practice. That is why we say we want to bring the best of the NHS to the rest of the NHS. That is exactly what we mean. I am confident in the work happening centrally at NHS England. It is learning from such examples and wants to go around the country to ensure that we spread those sorts of ideas to other places. We are looking at them all very closely.

[Madam Deputy Speaker]

I call Andrew George, a member of the Select Committee.

[Andrew George (St Ives) (LD)]

In the far west of Cornwall, in a medical emergency we cannot look for additional support from the north, west or south, because it is sea. The urgent treatment centre at Penzance hospital was closed two and a half years ago, under the Conservatives, adding pressure to the only emergency department for the next 100 miles, which is in Truro, and the out-of-hours doctor service has no doctors. The Minister mentioned in her statement that the NHS urgent and emergency care tiering programme is able to help. Will she use her influence to reopen the urgent treatment centre so that we can have a 24/7 emergency service in the far west of Cornwall?

[Karin Smyth]

The hon. Gentleman tempts me to make commitments from the Dispatch Box, which I am not going to do. He makes a very serious point. The sea is an issue for many hon. Members—beautiful though it is, it has an impact on the ability of the system to manage different areas. Looking at different solutions for populations such as those he represents—be that 111, hear and treat systems, more use of technology, and pharmacies and community out-of-hospital care—is exactly what we think is the right way to go in the next few years, as part of the long-term plan. That may or may not be a building with services. We need to look at that in the round and learn from what works well in different sorts of systems.

[Several hon. Members rose—]

[Lizzi Collinge (Morecambe and Lunesdale) (Lab)]

When I started working in public health, winter pressures were just that: seasonal flu and extra hip fractures. Under the Conservatives, winters started getting longer and longer. How will our 10-year plan ensure that seasonal pressures actually become seasonal and manageable again?

[Karin Smyth]

My hon. Friend makes an excellent point. We need to get back to normal and we need to recognise that there are different things happening to the system at different times of the year, much of which is predictable. We need to ensure that the system is strong enough to be able to cope with those differences.

[Dr Neil Hudson (Epping Forest) (Con)]

As we come into the height of winter, will the Minister join me in thanking all the amazing people on the frontline who are diagnosing, treating and caring for people right across the country? With multiple infectious disease challenges, the impact of cold and extreme weather, and the risk of falls and accidents, will the Government please now rethink their policies on winter fuel cuts and national insurance rises, which will exacerbate the situation and compromise the delivery of primary healthcare, social care and hospice care?

--- Later in debate ---

[Karin Smyth]

I join the hon. Gentleman in thanking everyone who works in the system. As I said, the NHS is getting £12 billion more this year from this Government than it had from the previous Government in the spring Budget. We are now focused on ensuring that money is used properly.

[Peter Swallow (Bracknell) (Lab)]

Let me take this opportunity to thank healthcare workers in Bracknell Forest, who will be working so hard across the Christmas period to keep patients safe this winter. Does the Minister agree that we must ensure that we have not only the right investment in our health services but the right reforms, so that we can fix the broken NHS and get it back on its feet?

[Karin Smyth]

My hon. Friend is absolutely right. We want to make sure that taxpayers’ money is used efficiently and effectively in the right places for the right treatment at the right time. That is why we are looking at our long-term plan. That is why we want to stabilise the system, so we do not have to keep coming back here year after year with a so-called winter crisis.

[Mike Martin (Tunbridge Wells) (LD)]

I note that the Minister thinks that the absence of the word “pharmacy” from her statement was an omission. I wonder whether she also thinks that the absence of the words “general practice” was an omission. I have been visiting some of my local GP surgeries, and one told me that, as a result of the NIC rises, it is facing charges of £40,000. That equates to a staff member, so it will have to consider laying off a member of staff. Will the Minister please explain how GPs laying off staff will help them to cope with the winter crisis?

[Karin Smyth]

As I think the hon. Gentleman knows, I cannot talk about individual cases from the Dispatch Box, but we will be making announcements on that subject very shortly.

[Lewis Atkinson (Sunderland Central) (Lab)]

I thank the Minister for her statement, and also thank my recent former NHS colleagues, especially those in Sunderland, for what they will be doing over the winter. The Minister has rightly highlighted unacceptable levels of bed occupancy as we go into winter; we know that as bed occupancy increases to unacceptable levels, there is a rise in patient safety risks. What assessment has she made of the patient safety monitoring regime over the winter, linked to those risks?

[Karin Smyth]

We have made it absolutely clear, as did the NHS in its letter today, that patient safety is the watchword this winter. We have targets in relation to monitoring the performance of the system, but we absolutely want to ensure that patients are kept safe as we go through the next few months.

[Lincoln Jopp (Spelthorne) (Con)]

Yesterday I spoke to an elderly gentleman who was taking himself off to his local pharmacy to receive the RSV jab, but because he was over 80 he was going to pay more than £200 for it. Will the Minister please tell us how much the RSV jab costs the Department when it is free for 75 to 80-year-olds, and how much guidance or limitation it places on the profit that can be taken by chemists who give it to people who are over 80?

--- Later in debate ---

[Karin Smyth]

I think the hon. Gentleman knows that I cannot do that from the Dispatch Box, but my officials will have heard his request and what he has said about that specific case, and I will ensure that he receives an answer.

[Alice Macdonald (Norwich North) (Lab/Co-op)]

I pay tribute to the hard-working NHS staff in Norwich and in Norfolk as a whole. Norfolk County Council has used artificial intelligence to identify more than 1,000 people who are risk of being admitted to hospital because of falls this Christmas. Does the Minister welcome that use of AI, and will she expand on how we are using technology, now and in the future, to help alleviate winter pressures?

[Karin Smyth]

I do not wish to test your patience, Madam Deputy Speaker, but good falls practice has not been prioritised over the past decade, and the failure to prioritise it and continue the work that I know was being done many years ago is yet another testament to the failure of the Conservative party. My hon. Friend is right to refer to the way we can use AI to help the system to improve, so that this hugely preventable problem, which is so damaging to the elderly in particular, no longer occurs.

[Greg Smith (Mid Buckinghamshire) (Con)]

Winter pressures come around every year for all sorts of reasons. The difference this year was the political choice to take the winter fuel payment away from millions of pensioners. Worse still, the 44,000 pensioners living with a terminal illness will lose that payment. I cannot believe that a Minister as diligent as the hon. Lady has not carried out an impact assessment of the cost to the NHS of people being left in cold homes. My right hon. Friend the Member for Melton and Syston (Edward Argar)—the shadow Secretary of State—and my right hon. Friend the Member for Aldridge-Brownhills (Wendy Morton) asked for such an assessment. May I give the Minister another chance to commit to publishing it?

[Karin Smyth]

The hon. Gentleman is wholly wrong to say that winter crises happen under every Government in every year. They happened, and became a fact of the NHS, under his party’s Government. The key difference this year, which the Conservatives will still not address, is the fact that doctors are not on strike. Doctors are working in the system, caring for patients and doing their job, because this Government, on day one and week one and week four, delivered the negotiated settlement with the doctors. We cannot run the NHS and we cannot manage a winter crisis without doctors in the frontline, and that is where they are. That is what the difference is.

[Laura Kyrke-Smith (Aylesbury) (Lab)]

It is great to be going into the winter for the first time in four years without doctors being on strike. Last week I visited the new emergency medical receiving unit at Stoke Mandeville hospital, a 21-bed facility to provide quicker care for patients who come in from ambulances and as a result of GP referrals but require only short admissions. The early results look very promising. Does the Minister agree that we must take these pockets of good practice from across the NHS and ensure that other parts of the NHS learn from and adopt them to help us get through this winter and future winters?

--- Later in debate ---

[Karin Smyth]

I commend my hon. Friend for, as a new MP, getting to grips in detail with what is happening in her local system and challenging that system, while also giving us those examples of good practice so that we can all learn from them. As she says, many parts of the NHS across the country want to learn from them, and we want to ensure that they are mainstreamed where possible. There are different solutions for different systems, but she is absolutely right to highlight that one.

[Manuela Perteghella (Stratford-on-Avon) (LD)]

I refer the House to my entry in the Register of Members’ Financial Interests as a member of the University College London Hospitals NHS Foundation Trust.

The upcoming rise in national insurance contributions could cost our GP surgeries the equivalent of more than 2 million appointments a year. General practice is the cornerstone of the NHS; it is our front door. Many GPs in my constituency have written to me to express their serious concerns. Does the Minister recognise that hiking costs for family doctors will only worsen pressures on our hospitals, pushing more people towards A&E and preventing many from receiving the care they need?

[Karin Smyth]

We recognise all the costs to GPs, as contractors, and to many other parts of the system, as we have said many times in the House. We also recognise the improvements that we have made to the system by improving the number of GPs and funding the NHS by more than the last Government did. We will continue to look at that in the round to ensure that we have a sustainable system.

[Paul Waugh (Rochdale) (Lab/Co-op)]

One of the main reasons I became a politician was the fact that my wife is a midwife. She would come home night after night complaining bitterly about staff shortages on the wards. Can the Minister reassure me that maternity services will receive all the funds they need over the winter, and will she join me in thanking all those maternity staff who work so hard over Christmas, over the new year, and all year round?

[Karin Smyth]

My hon. Friend is absolutely right. Many tragedies happen over the Christmas period—my own father died on 23 December. Those staff members go above and beyond to help people at difficult times, but also at times of great joy—babies do not wait for Father Christmas, do they?—and my hon. Friend is right to commend midwives and everyone else who is working at this time. We know that maternity services are particularly stretched across most of the country. Those midwives are doing a tremendous job in keeping the system working, and doing the critically important job of supporting women at a mostly joyous but sometimes very difficult time.

[Alison Bennett (Mid Sussex) (LD)]

At the start of this week, 300 patients were ready to go home from my local NHS hospital trust in Sussex. That bears out the statistic in Lord Darzi’s report that 13% of patients are medically fit for discharge. I am really concerned that we have now reached a point with winter pressures where corridor waits are normalised, not only in A&E departments but in the case of initiatives such as continuous flow models, with corridor trolley waits being pushed into regular wards. It is unacceptable that this has become normalised. Will the Minister expand on her comments about the national care service? When will the plans be published? Will the Government work with us on a cross-party basis, and why did this work not begin sooner?

[Karin Smyth]

As I said in my statement, we have begun plans to stabilise the workforce and the employment Bill is going through the House, so I do not agree with the hon. Lady on that point. We know that it will take a long time, and we will of course be working with colleagues to ensure that we do develop that national care service.

[Amanda Martin (Portsmouth North) (Lab)]

Let me begin by echoing the Minister’s words and thanking the fantastic NHS workers and those in the wraparound service who provide a vital service in Portsmouth all year round, but particularly in winter. Let me also thank all the Members who turned up for the joint NHS consultation with me and with the Under-Secretary of State for Education, my hon. Friend the Member for Portsmouth South (Stephen Morgan).

Unfortunately, owing to the scale of the damage done to the NHS by the last Government, our NHS providers have to make very difficult decisions at this time. Can the Minister reassure me and my constituents, that patient safety, and emergency services in particular, will be this Government’s first priority during the winter?

[Karin Smyth]

I am very pleased to reiterate that safety is the watchword for winter, as it is all year round, and to stress that that is why NHS England wrote about it today. I commend my hon. Friend for meeting her constituents locally, and I urge all Members to do the same. We are getting some fantastic ideas from staff and from patients about how to reform and change the system for the long term.

[Jess Brown-Fuller (Chichester) (LD)]

One in four people trying to contact their GPs last month were unable to get a same-day appointment, and one in 20 could not get through to their GPs at all. We know that these people end up in A&Es up and down the country, and that hospitals are already buckling under the strain. What is the Minister doing to improve support for GPs and frontline services during this winter crisis, especially while they navigate the challenges of the employer NICs rises?

[Karin Smyth]

I refer back to what I said in my statement about how we are supporting the system. We absolutely understand the importance of primary care, and of using 111 to make sure that people are directed towards getting the right care in the right place. We know that the system is under pressure, and we will continue to do all we can to support it in the longer term, as well as in the short term.

[Emma Foody (Cramlington and Killingworth) (Lab/Co-op)]

I recently visited Northumbria specialist emergency care hospital in Cramlington in my constituency. I met the staff there, who shared their concerns about winter pressures. Every year, they closely track the flu seasons in Australia, given that the patterns that emerge there are often what follows here. They are extremely concerned about what we are going into this winter. What steps has the Department taken to ensure that as many people as possible are vaccinated this winter?

--- Later in debate ---

[Karin Smyth]

I am working very closely with the UK Health Security Agency to make sure that, week on week, we are aware of the movement of different diseases and viruses through the system, and we will continue to publicise the campaign to get people vaccinated. Anything that hon. Members can do to support that campaign, and to make sure that people support themselves and their loved ones, will be gratefully received by the entire system. The campaign is something that everyone can get behind.

[Dr Danny Chambers (Winchester) (LD)]

While we all pay tribute to the NHS staff who work over Christmas, we should remember that they are not only missing Christmas with their families, but putting their own health at risk in caring for us.

On Monday, Winchester hospital declared a critical incident, saying that it could admit no more patients and asking people to seek treatment elsewhere. For years, the chief executive officer of the hospital has been requesting 160 extra social care packages, because the lack of social care is stopping the flow of patients through the hospital. She said that providing such packages is the single biggest thing that would help deal with the winter crisis. In September, Winchester hospital applied for winter crisis funding to put an urgent treatment centre on the front of its A&E department to help deal with the anticipated extra caseload. It is now December, and the hospital has still not heard whether it will get the funding. Given the number of critical incidents being declared, will the Minister meet me and the CEO to discuss how we can support the hospital through this situation, and how we can avoid having a planned crisis next winter?

[Karin Smyth]

As I said earlier, different systems have different issues. Funding has been allocated in advance to the NHS so that it understands which systems require funding, and that has now been baked in for this year. I cannot address the hon. Gentleman’s points directly from the Dispatch Box, but I am very happy for officials to take note of them and to check with the system on what is happening in his particular community. Obviously, it is important that Winchester hospital works closely with its local authority with regard to discharge. We want to improve the better care fund, and I am sure that he will work with the local authority and his hospital to make sure that it works better.

[Clive Jones (Wokingham) (LD)]

I declare an interest: I am a governor of the Royal Berkshire hospital, and I have a family member who has shares in a medical company.

The Royal Berkshire hospital has experienced its highest increase in emergency department attendances as we head into the winter period, yet the estate of the Royal Berks is crumbling, out of date and not fit for purpose. People with infectious diseases, such as flu, covid and norovirus, cannot easily be isolated due to poor air circulation, which only makes the situation worse. When will the Royal Berkshire hospital be rebuilt, and will the Minister visit it to see the full extent of our challenges?

Finally, may I wish the Secretary of State and the Minister a merry Christmas? They should take a short break but come back quickly to continue to clear up the Conservatives’ massive failures on the NHS.

--- Later in debate ---

[Karin Smyth]

Hopefully, we will make announcements on the Royal Berkshire hospital and others as soon as possible in the new year, as I know that this issue is of great concern to all hon. Members. We know that the system will be under pressure, and we thank everyone working in it. We want to make sure that everyone keeps well, and I will take this opportunity to thank the hon. Gentleman for his comments. I am looking forward to returning here in January, hopefully to answer more questions. I thank hon. Members for their questions this afternoon.

Healthcare Incidents: Suspected Criminal Activity Contributing to Death or Serious Harm

Karin Smyth Excerpts

Tuesday 17th December 2024 Written Statements

[The Minister for Secondary Care (Karin Smyth)]

I am pleased to announce that the memorandum of understanding (MoU), “Investigating healthcare incidents where suspected criminal activity may have contributed to death or serious life-changing harm”, was published today on www.gov.uk.

This MoU was recommended by Professor Sir Norman Williams’ rapid policy review into gross negligence manslaughter in 2018. The Williams review was set up to look at the wider impact of concerns among healthcare professionals that simple errors could result in prosecution for gross negligence manslaughter, even if they happen in the context of broader organisation and system failings.

Following this recommendation, the Department of Health and Social Care consulted with regulatory, investigatory and prosecutorial bodies to develop the new MoU, “Investigating healthcare incidents where suspected criminal activity may have contributed to death or serious life-changing harm”.

The MoU applies in England and has been formally signed by:

NHS England

National Police Chiefs’ Council

Health and Safety Executive

Crown Prosecution Service

Care Quality Commission

General Medical Council

Nursing and Midwifery Council

General Dental Council

Health and Care Professions Council

General Pharmaceutical Council

General Optical Council

General Chiropractic Council

General Osteopathic Council

The MoU will be used by signatories to help deliver early, co-ordinated and effective action following incidents where there is reasonable suspicion that a patient/service user’s death or serious life-changing harm occurred as a result of suspected criminal activity in the course of healthcare delivery.

The MoU specifically delivers on the following recommendations from the Williams review:

Updates and replaces the previous MoU from 2006;

sets out the roles and responsibilities of the signatories providing a framework for how organisations should work together to ensure a co-ordinated approach;

provides advice on communication including liaising with families and the public; and

supports the development of a “just culture” in healthcare which recognises the impact of wider systems on the provision of clinical care or care decision making. This includes considering the wider systems in place at the time of the incident, to support a fair and consistent evaluation of the actions of individuals and ensuring expert witnesses consider the effects of the wider systems in place during an incident.

[HCWS330]