Health and Care Bill

Lord Beamish Excerpts

2nd reading
Wednesday 14th July 2021 Commons Chamber

[Sajid Javid]

I listened carefully to what the hon. Gentleman said. As I have said, no final decisions have been made, but if he would like a meeting with a Health Minister, we can arrange that so that the matter can be discussed further.

I am also very grateful to another of my predecessors, my right hon. Friend the Member for South West Surrey (Jeremy Hunt), first for his leadership of the Health Committee, whose valuable report and recommendations we have taken on board, and secondly for his tireless dedication to the cause of patient safety, which sees its culmination in the Bill’s creation of the Health Services Safety Investigations Body. We must continue, in his words, that quiet revolution in patient safety. I have asked my officials to consider whether the Care Quality Commission could look broadly across the integrated care systems in reviewing the way in which local authorities and providers of health, public health and social care services are working together to deliver safe, high-quality integrated care to the public.

[Mr Kevan Jones (North Durham) (Lab)]

The Secretary of State talks of patient safety. May I ask him why the Bill contains none of Sir Bruce Keogh‘s recommendations on the cosmetic surgery industry, which are now 10 years old? In response to questions that I have asked, Ministers keep saying that the recommendations are going to be implemented. Could this not be an opportunity to improve patient safety in that area?

[Sajid Javid]

The right hon. Gentleman has raised an important matter. There are issues surrounding the cosmetic surgery industry, and I know that he has spoken eloquently about them in the House before. I do not necessarily agree that this Bill has to be the vehicle for any change, but if he wishes to discuss the matter further, I should be happy to meet him in due course, because it is important and it does require a fresh look.

Whenever the NHS is subject to change, it is tempting for some, who should actually know better, to claim that it is the beginning of the end of public provision. We know that that is complete nonsense, and they know it is nonsense, but they say it anyway. So let me very clear: our integrated care boards will be made up of public sector bodies and those with a social purpose. They will not be driven by any private interests, and will constantly make use of the most innovative potential of non-NHS bodies.

The spirit of this Bill is about holding on to what is best about the NHS and removing what is holding it back. That is something that we all want, and I am looking forward to a mature debate—[Laughter.] Perhaps that is too much to ask in this Chamber with this Opposition Front Bench, but I hope for, and I think the public expect, a mature debate on the Bill and on how we can achieve these sensible changes together.

In that spirit, the second theme of the Bill is cutting bureaucracy. As we have been tested during these past months, we have looked at the rules and regulations through new eyes. It has become increasingly clear which of them are the cornerstone of safe, high-quality care, and which are stifling innovation and damaging morale. It is that second group of rules and regulations that the Bill strips away, removing the existing procurement regime and improving the way in which healthcare services are arranged. Yes, this is about how we deliver better value for the taxpayer, but fundamentally it is about how we can free up NHS colleagues to deliver better care. We know that patients are better served when experts are free to innovate unencumbered by unnecessary bureaucratic processes. That is why the Bill will repeal section 75 of the Health and Social Care Act 2012, giving the NHS the flexibility for which it has been asking. I know that this is a point of agreement with the Labour party—

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[Jonathan Ashworth (Leicester South) (Lab/Co-op)]

I beg to move an amendment, to leave out from “That” to the end of the Question and add:

“this House declines to give a Second Reading to the Health and Care Bill, notwithstanding the need for a plan for greater integration between health services and social care services and for restrictions on junk food advertising to improve population health outcomes, because the Bill represents a top down reorganisation in a pandemic leading to a loss of local accountability, fails to reform social care, allows further outsourcing permitting the private sector to sit on local boards and fails to reinstate the NHS as the default provider, fails to introduce a plan to bring down waiting lists for routine NHS treatment or tackle the growing backlog of care, fails to put forward plans to increase the size of the NHS workforce and see them better supported, and fails to put forward a plan that would give the NHS the resources it needs to invest in modern equipment, repair the crumbling NHS estate or ensure comprehensive, quality healthcare.”

Well, the Secretary of State talked a lot, but he did not say very much. Look at the context of where we are. Yesterday, we recorded 36,000 covid infections. Hospital admissions have increased to over 500 a day, up 50% in a week. Waiting lists are at the highest level on record, currently at 5.3 million. Some 336,733 people have been waiting over a year for treatment, over 76,583 people are waiting over 18 months, and over 7,000 people are waiting over two years. Some 25,889 people are waiting more than two weeks from urgent referral to a first consultant appointment for cancer. Emergency care is grappling with some of the highest summer demands ever seen. Two hundred and fifty thousand people are waiting for social care. NHS staff are exhausted, facing burnout. We went into this pandemic with 100,000 vacancies across the NHS and a further 112,000 vacancies across social care.

The answer from the Secretary of State is to embark on a top-down reorganisation when we are not even through the pandemic—a reorganisation that will not deliver the integration needed, because reforms to social care are delayed again; a reorganisation that will not deliver more care but in fact, in periods of stretched health funding, could well deliver less care; and a reorganisation that is, in effect, a Trojan horse to hide a power grab by the Secretary of State.

Let us be clear why this reorganisation is taking place. The Government have come forward with this Bill because of the mess of the last reorganisation—the mess that the Secretary of State supported and voted for, and the mess that he spoke out for in this House, saying that it would modernise the NHS and that the

“concept of GP commissioning has been widely supported by politicians from all parties for many years. May I urge my right hon. Friend to keep putting patients first by increasing GP involvement in the NHS?”—[Official Report, 4 April 2011; Vol. 526, c. 773.]

Why, if he believed that then, has he U-turned now? And it was a mess that we warned of. My hon. Friend the Member for Leicester West (Liz Kendall), who opposed that Bill in this House, warned the Government that it would increase bureaucracy and increase the fragmentation that the Secretary of State has just complained about from the Dispatch Box.

Ministers said that that reorganisation under Lord Lansley would reduce bureaucracy, and Back Benchers told us that it would reduce bureaucracy, but what ended up happening? Billions were wasted and thousands of NHS staff were made redundant. That was the Government’s priority then, and now they are asking us to clean up their mess today. They also told us that that reorganisation would improve cancer survival rates, and where are we today? We are still lagging behind other countries on cancer survival rates. Perhaps the Secretary of State could have come to the Dispatch Box and apologised for that Lansley reorganisation and 10 wasted years.

The Secretary of State talked about NHS leaders, but the truth is that NHS leaders asked for a simple Bill to get rid of the worst of the Lansley restructuring and instead re-embed a sense of equity, collaboration and social justice in our NHS structures. That is not what this Bill is. Of course, the Secretary of State secretly agrees with me. According to The Times, he wrote to the Prime Minister saying that there were “significant areas of contention” that were yet to be resolved with the Bill, and that he wanted to delay it. The Secretary of State was only back five minutes and already Downing Street was overruling him. When it overrules him on his choice of spin doctors, he walks; when it overrules him on the future of the NHS, he puts his career first and stays in the Cabinet.

I listened carefully to the case made by the Secretary of State. He talked of the need for greater integration between health and social care and the need to provide better co-ordinated care, and he referred to an ageing population.

To be frank, that was a speech that Health Secretaries and their predecessor Social Services Secretaries have been making more or less since 1968, when Richard Crossman proposed the first set of NHS reorganisations. Indeed, there were echoes of the Secretary of State’s speech in that made by his predecessor Keith Joseph, when he came to this House in 1972 to set up the area health authorities, bringing together hospitals and community care and working more closely with local authorities because we needed seamless care. Those authorities were of such a size that, within a year, they were rearranged again into district health authorities. Given the size of some of the integrated care systems that the Secretary of State is proposing, I suspect that the seeds of the next reorganisation are being sown today.

Yesterday, the Secretary of State told the House that his

“three pressing priorities for these critical…months”

were

“getting us…out of this pandemic…busting the backlog”

of non-covid care, and

“putting social care on a sustainable footing for the future.”—[Official Report, 13 July 2021; Vol. 699, c. 163.]

But absent from his speech was any credible explanation of how this reorganisation will meet his objectives that he outlined to the House yesterday. In fact, in the last 30 years, we have seen around 20 reorganisations of the NHS. Have any of them delivered the outcomes that Health Secretaries have promised from the Dispatch Box? Well, not according to analysis in The BMJ, which observes:

“Past reorganisations have delivered little benefit”.

Why should this one be any different?

The question for me is: how will the 85-year-old with multiple care needs experience better whole-person care as a result of the restructuring that the Secretary of State is embarking upon? How will waiting times for elective surgery for cancer and mental health be improved by this reorganisation? How will health inequalities that have widened and life expectancy advances that have stalled be corrected by this reorganisation? To those questions, the Secretary of State had no answer today: the Bill fails those tests because it is a badly drafted Bill and could in fact even worsen health outcomes.

Let me outline our specific concerns. On the proposed integrated care boards, the Bill collapses the remaining 100 or so clinical commissioning groups into 32 integrated care systems differing in geographical size and with some covering populations up to 3 million or 4 million. In some parts of the country, the ICSs are not based on the NHS agreed boundaries, but currently on centrally drawn-up boundaries for political reasons. We know that Cheshire will be combined with Merseyside. Glossop is cut off from Greater Manchester and allocated to Derbyshire. Frimley is split up, leading the former Prime Minister, the right hon. Member for Maidenhead (Mrs May), to complain in an Adjournment debate recently:

“Do not break up Frimley ICS. Just for once, let common sense prevail.”—[Official Report, 29 June 2021; Vol. 698, c. 238.]

These boundaries and the way in which they were proposed by the previous Secretary of State, the right hon. Member for West Suffolk (Matt Hancock), prompted NHS Providers to warn that the disruption could lead to

“a worsening of patient care”.

And then, of course, we have the design of the integrated care system, split across two committees—a partnership board containing people from local authorities, the third sector and others, and then an NHS board responsible for spending the money, for commissioning. The Secretary of State has moved away from GP commissioning, of course; he wants the NHS board to commission now. Those two boards will probably have different chairs, but the NHS board only has to have “regard” to the partnership board strategy. Nor is it clear how local authority seats—the one local authority seat—will be decided when they cover more than one council and possibly even councils of different political persuasions, so we will see how a consensus can be built then.

Other important voices are left out. Mental illness accounts for roughly a quarter of the total burden of illness, yet there is no guarantee that mental health providers will get the seats on these boards, when we know that mental health services are under pressure and the Secretary of State tells us that the mental health backlog is one of his personal priorities. The pandemic has also reminded us that the health and wellbeing of our community is not just in the hands of large hospitals or general practice. It is also in the hands of our directors of public health, who have shown exceptional local leadership throughout this crisis, standing on the shoulders of their forebears, who in the past confronted diseases such as cholera, smallpox and diphtheria. Test and Trace would have been far safer in their hands from the outset, by the way, and what is their reward? They are sidelined. Public health, again, should be properly represented on the NHS boards and we will table amendments to that effect.

[Mr Kevan Jones]

Does my right hon. Friend agree that it is not just about their being sidelined; it is actually about the budgets for public health, which have been pushed off into the autumn? If the consultation paper that went out last year is anything to go by, County Durham would lose 19% of its budget. How can we effect these changes without its being divorced from what will be provided in terms of cash?

[Jonathan Ashworth]

My right hon. Friend is absolutely right. I will come to the financial flows in a few moments. But how on earth can we have a triple aim of trying to improve health outcomes for a population and not even give public health a voice and a seat on the decision-making body that decides health plans for an area?

The Secretary of State talks about integrating health and social care. There is no seat for directors of adult social services on these committees, either. And what about patients? Patients were not mentioned very often by the Secretary of State in his speech. Patients will always come first for the Opposition. They have no mandated institutional representation, either—no guaranteed patient voice—so we have yet another reorganisation of the NHS whereby patients are treated like ghosts in the machine. It is utterly unacceptable. This is fragmentation, not integration, with a continued sidelining of social care.

There is a loss of local accountability as well, because there is no explicit requirement that the boards meet in public or publish their board papers. Although NHS England has stated that that is its preference, it is not required; nor is there any commitment, despite the wide geographical spread of some ICSs, for meetings to be made accessible online. But, of course, the White Paper did indicate that the independent sector could have a seat on an ICS, and the explanatory notes to the Bill state that

“local areas will have the flexibility to determine any further representation.”

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[Mr Kevan Jones (North Durham) (Lab)]

In opening this debate, the Secretary of State said that the Bill would improve patient safety. One area in which it does not do that is the area of cosmetic surgery. In April 2013, the Government commissioned Sir Bruce Keogh to do a review of this industry following the PIP—Poly Implant Prothèse—implants scandal. He came forward with some very sensible and clear recommendations to improve safety in the cosmetic surgery industry and to make sure that patients were protected. The review highlighted the fact that those buying a ballpoint pen have more protection than people having non-surgical procedures in this sector. These recommendations have sat on the shelf in the Department of Health since then. I have asked numerous times when they are going to be implemented, only to be told tomorrow, but tomorrow never seems to come.

We did see some change with the private Member’s Bill of the hon. Member for Sevenoaks (Laura Trott)—the Botulinum Toxin and Cosmetic Fillers (Children) Act 2021 —which, for example, limited botox for under-18s, but this business is a wild west when it comes to regulation. There is a missed opportunity in this Bill not only to get proper patient safety, but to implement Sir Bruce Keogh’s recommendations, which the Government say they support but somehow do not want to implement. This is a multibillion-pound industry, and patients are being put at risk. It is mainly women who, in this sector, need protection. I hope that the Government will implement the Keogh recommendations in this Bill, and I put the Minister on warning now that I will be tabling amendments for that. This is important, and I do not yet understand the reason why the Government are not doing it, because the royal colleges support this and a large number of Members of Parliament have backed these reforms. They do need to be implemented, and we are missing an opportunity to do so.

May I touch on one last thing about public health? I agree with my right hon. Friend the Member for Leicester South (Jonathan Ashworth) that public health, strangely enough, has been forgotten about in this crisis. If we had actually concentrated on putting the main focus on public health and supporting directors, I think we would have had a better outcome. This is not just about this Bill forgetting about public health; it is about the money that goes with it. Under the fair funding formula being touted last year, County Durham would have lost £19 million in public health funding, while Surrey would actually have increased its budget by £14 million a year. That cannot be right. Public health now needs to be at the centre of our healthcare locally, and the Government have to ensure not just that it gets a voice in this Bill, but that local directors of public health get the finance and support they desperately need.

Health and Care Bill

Lord Beamish Excerpts

Report stage
Tuesday 23rd November 2021 Commons Chamber

[Richard Graham (Gloucester) (Con)]

I rise to speak on amendment 10. I want to start by relaying a conversation that I had soon after being elected 11 years ago in Gloucester. I talked to the chief executive of a hospital trust—he has subsequently moved on—and asked him how many nurses a year we needed to replace those who have retired and resigned, and to cope with increasing demand, not just in the hospital trust but including district nurses and nurses to cover the whole panoply of our needs in the county of Gloucestershire. He explained that we needed roughly 400 a year at that time. I asked him how many we were training. He said that the University of the West of England trains around 120 graduates a year from its nursing outlet in Gloucester. How do we meet the gap, I asked, and he said, “Well, we advertise. We try to encourage people from London to look for a change in their lifestyle and we recruit from abroad.” I asked him where that got us to. He said, “Well, it increases the numbers, but it never gets us enough. We struggle with a permanent shortfall of recruitment.”

Over the next few years, I worked on three things. The first was to support the Government push to create nursing associates. The second was to encourage the University of Gloucestershire to become a nursing teaching university and to submit an application to get pilot project status for the nursing associates’ training. Both of those came to pass. They were a credit to the Government, a credit to the university and a credit to the Nursing and Midwifery Council that supported them. None the less, we were, and are, still short; that gap has not been closed.

One other thing that I have done recently is to support the close engagement with the Government of the Philippines, who have kindly allowed us to carry on recruiting nurses from the Philippines to the United Kingdom during the pandemic. I ask everyone here to join me in paying tribute to the roughly 35,000 nurses from the Philippines who have made such a difference to our NHS. All those things have helped, but anyone who has played the role that all of us in this House have over the past two years will know that the people problem is the greatest problem that we have.

I chaired, first every week and now every two or three weeks, a meeting between all the MPs in Gloucestershire, the heads of the NHS trusts, public health and the county council. Time and again, the same issue comes up in a slightly different way: it is about people. Yes, we could build extra wards. Yes, we could convert offices into wards. Yes, we could build bed capacity, but we do not have more people to look after the patients in them. Yes, we have plenty of spaces in care homes, but we need to be able to send people back to their home from hospital, because that is how they recover best, and we do not have enough domiciliary care workers.

We have gone round and round for the past 10 or 11 years on this issue of staff—doctors in primary care surgeries, nurses everywhere and domiciliary care workers. I do not believe that we can resolve this problem until we start planning for the needs in different parts of the country and then working out how we can provide the training, the skills and the recruitment of individuals to make that happen. Of course it will not be perfect. Of course disasters such as the pandemic will make a bad situation much worse. We recognise that, but until we start that process, I do not believe that things will change. For as long as I am MP for Gloucester, I am absolutely certain that I will be having the same conversations about human resources—the people who deliver the care and health that all the people in my constituency and across the county and country need and deserve. It is not the best use of MPs’ time to constantly have to sit down with our health professionals in local NHS trusts to work out how we are going to mind the gap. That whole process has to be started from higher up, in the Department of Health and Social Care.

Today, we have an amendment that has enormous support not just from the Select Committee that my right hon. Friend the Member for South West Surrey (Jeremy Hunt) chairs, but from outside this House from the royal colleges, the NHS trusts and many others beside. I am frustrated that the Government have so far not indicated whether they will accept the amendment. In their hearts, the Minister and his colleagues, all good people trying to do their best, recognise that this problem will have to be tackled. Perhaps part of the solution will be in the White Paper that we are all so eagerly waiting for and that we wish that we had been able to have a few days ago, before the votes last night, on which I supported the Government on the basis of trust. None the less, there comes a time when we have to say and vote for what we believe in. I do believe that we need this change and that the Government can and should do it, and I will vote for it.

[Mr Kevan Jones (North Durham) (Lab)]

I rise to support new clause 1, which stands in the name of the right hon. Member for Romsey and Southampton North (Caroline Nokes), myself and 18 other right hon. and hon. Members from across the House. I first took an interest in this subject through a constituent, Dawn Knight, from Tanfield in my constituency. Dawn raised issues around the cosmetic surgery industry having been a victim of a particular hospital group. She has been a tireless campaigner in ensuring not only that victims get a voice, but that we press for more regulation.

I join others in paying tribute to the all-party group on beauty, aesthetics and wellbeing for its recent report and to my hon. Friends the Members for Swansea East (Carolyn Harris) and for Bradford South (Judith Cummins) for their work on that report, which highlights what my hon. Friend the Member for Ellesmere Port and Neston (Justin Madders) called the “wild west”. That is exactly what it is: it is a wild west without any regulation. It is a multibillion-pound industry, which is not only putting people at risk, but costing the NHS money.

In April 2013, the Health Secretary at the time—Andrew Lansley, now Lord Lansley—commissioned Sir Bruce Keogh to carry out a review of the regulation of cosmetic surgery. The review came out not only when we were having problems in the sector itself, but when interest was heightened around Poly Implant Prothèse breast implants, which people will well remember. When the review concluded, it explicitly advised the Government to increase regulation of the cosmetic surgery industry to prevent unlicensed treatments and increase patient safety. The review stated that a person having a non-surgical procedure

“has no more protection and redress than someone buying a ballpoint pen or a toothbrush”,

and

“dermal fillers are a crisis waiting to happen.”

As the right hon. Member for Romsey and Southampton North said, that crisis has actually happened already.

I have been campaigning on this issue for a number of years, during which time I have gone through a succession of Health Ministers, all of whom have come back with two points. The first is, “We are going to implement the Keogh recommendations”. But because Ministers were too terrified previously to make any health legislation, they were reluctant to bring those recommendations forward in that way.

The only good news in the area has been private Member’s Bill of the hon. Member for Sevenoaks (Laura Trott), the Botulinum Toxin and Cosmetic Fillers (Children) Act 2021. That legislation was tightly focused—as all private Member’s Bill have to be—and banned botox injections for under-18s. I congratulate the hon. Member on that work. However, any other regulations have been left unfinished. I have sheaves of letters from former Health Ministers saying, “The Keogh recommendations will be implemented”, but they have not been to date. If we do not do that in this Bill, when will it be done? I doubt that the Department will come forward with a Bill just to implement those recommendations; that is wishful thinking.

There is clearly no regulatory framework in the UK at present for those performing aesthetic non-surgical cosmetic treatments. The area is completely unregulated and lacks any national standards. There is no consumer protection, education, training or qualifications for those administering such treatments. As my hon. Friend the Member for Brent Central (Dawn Butler) said, some people call themselves nurses with no qualifications whatever. There is a huge discrepancy between the standards and qualifications of the training of these people. The other side of the issue, to which I will turn in a minute, is the regulated system, which, frankly, is failing as well.

The right hon. Member for Romsey and Southampton North raised the issue of training. If hon. Members visit any website tonight, they will see huge adverts saying, “Become a dermal filler specialist: training and qualification online within half an hour”—even less time in some cases. The people offering such services have no qualifications whatever, because the qualifications are not worth the paper that they are written on, but these people start carrying out invasive procedures without anybody stopping them. They can do it in a kitchen, or in any area that has not been clinically cleaned and is not of a standard that we would expect for medical procedures. It is a multimillion-pound racket that includes both the people offering the training and those carrying out procedures. It is an increasing issue, which needs to be addressed.

We also need to address the issue of advertising. As I have said before in the House, the Advertising Standards Authority is frankly a complete waste of time. If hon. Members go on any website tonight, or even open the national newspapers, they will see people advertising these services—potentially dangerous procedures—without any qualifications. We might ask, “Why would people have these procedures?” Well, I suggest that everyone reads the Mental Health Foundation’s 2019 report on body image, which shows the increasing pressure on young people.

The right hon. Member for Romsey and Southampton North is correct that this issue mainly affects young women, but it is increasingly an issue for some young men. The pressure of factors such as advertising and photo enhancements lead people to think that there is the perfect individual, but—apart from you, Mr Deputy Speaker—I am not sure that there is. The foundation’s reports highlights the pressure that is put on young people, but particularly young women. If they look at prices for procedures, they end up going to people who are completely unqualified. It is a scandal that there is no legislation to prevent this.

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[Sarah Olney (Richmond Park) (LD)]

I rise to speak in support of amendment 10, tabled by the right hon. Member for South West Surrey (Jeremy Hunt), the Chair of the Health and Social Care Committee, because the amendment reflects the key issue facing the NHS and all our health and care services at this time: the workforce. Access to healthcare services is the No. 1 issue raised with me by constituents at the moment, and I know that concern is being echoed in other constituencies across the country.

People are experiencing the issue in many different ways. Some are struggling to get a GP appointment. I regularly speak to parents in great distress because of the lack of available help for their children’s mental health needs. The accident and emergency department at Kingston Hospital in my constituency has regularly had to ask patients to consider whether there are more appropriate sources of help for their needs. Patients waiting in the backlog of elective procedures are regularly having appointments rescheduled or cancelled. Ambulances do not always arrive when called.

The impacts are many and various, but when I speak to health service leaders in my local area, the answer is pretty much the same: there is a lack of available staff. Even in cases where lack of funds is not in itself a limiting factor, the lack of people with the relevant skills makes it impossible to fill all the vacancies they are able to pay for.

Many of these problems are covid-related. The current NHS waiting list is estimated to be over 6 million, and it is clear that much of that is because so many elective treatments were delayed during lockdown. Demand for mental health services has accelerated because of the impact of the lockdown, particularly on young people. Covid is still with us, of course, and workforces in every part of the economy are being impacted by the need for individuals to isolate when they have symptoms or test positive. Healthcare staff need to be more vigilant than the rest of us.

Many of these problems are also Brexit related. A lot of young Europeans decided to return to their home countries at the start of lockdown and have not since returned. Brexit has stymied our ability to recruit from the EU, shutting off an extremely important supply for all parts of the labour market, but the effect is being felt most markedly in health and social care, since it is having to manage the extraordinary demand of a global pandemic at the same time.

Many of these problems are also the result of a long-term failure to correctly predict or prepare for workforce demand. One of the huge advantages of a national health service is that it is possible to get clear data from right across the sector and to make appropriate plans and decisions. For some reason, that has not been done, and it is absolutely right that the Government should adopt amendment 10 to start to put that right.

I want to amplify a Backbench Business debate that I was able to bring to this Chamber a few weeks ago, in partnership with the right hon. Member for South Northamptonshire (Dame Andrea Leadsom) and the hon. Member for Newcastle upon Tyne North (Catherine McKinnell). It was on the subject of giving every baby the best start in life, and it was the firm view of all who attended that debate that the health visiting workforce needs to be substantially boosted to enable all new parents to receive a home visit from a trained healthcare professional. During the course of that debate, we heard of the many ways in which a health visiting workforce can support new families and the critical role they play in supporting babies and their families. One estimate is that the cost of poor parental mental health in the first year of life is more than £8 billion. It is clear that the cost of boosting our health visiting workforce would more than pay for itself in a very short time.

I also want to reflect briefly on a conversation I had with a constituent in the street in Richmond town centre on Saturday. Despite having two degrees, she was working in the care sector, and she was talking to me about her terms and conditions of work. She is employed by an agency and is not allowed to engage with any other agency. She is on a zero-hours contract, so she has to sit at home and wait to hear how many hours she might be required to work the following week. For various reasons that suits her, but I feel that it underpins the recruitment crisis we are experiencing in our social care sector, because that is no way to retain skilled and committed staff.

[Mr Kevan Jones]

Does the hon. Lady agree that it is not just about levels of pay and uncertainty for those individuals, but ensuring that we nationally accredit the qualifications of those individuals and address the career paths that do not exist in those sectors at the moment?

[Sarah Olney]

The right hon. Gentleman is absolutely right, and that is the point I want to make: we need to boost the status of our care home staff and improve their terms and conditions. We need to improve their pay. This lady who I spoke to on Saturday was telling me that she gets paid for the hours she spends in people’s homes, but not the time spent travelling in between. It is clear to me that the crisis of staffing we are experiencing in our care sector—I think every one of us as MPs is hearing about it regularly from our constituents, who are at the sharp end of that—is as much about workforce planning and improving terms and conditions. The Government needs to give that the most urgent attention, and amendment 10 would go some way to resolving that, although it will not resolve it entirely.

I know that Ministers will push back against the cost of boosting the workforce in all areas of the NHS, but they must surely realise the cost of failing to do so. The right hon. Member for South West Surrey. along with the hon. Member for Central Ayrshire (Dr Whitford), spoke about the cost of locum resource in the NHS. It is not just about the direct cost of locums or of worsening health outcomes as people wait longer for treatment; it is also about the lost productivity of days off sick, the cost of poor mental health as lives are put on hold and, as has been mentioned many times, the cost of exhausted and demoralised staff who are overwhelmed by the demands on the NHS. We cannot afford to continue to fail to effectively plan our healthcare workforce.

I am also very happy to support the amendments tabled by the hon. Member for North West Durham (Mr Holden) on virginity testing and hymenoplasty. I am delighted that the Government are adopting the provisions on virginity testing. We still have much to do to make this country a safe place for women and girls, but all progress is to be welcomed, and I am very glad that this opportunity to bring to an end the degrading practice of virginity testing has not been lost. I congratulate the hon. Member for North West Durham on all the work he has done and, although they may have left the Chamber, the representatives of the other charities referred to earlier. I hope in due course we will see the provisions for hymenoplasty as well, when the review has concluded.