Oral Answers to Questions

Lindsay Hoyle Excerpts

Tuesday 1st November 2022 Commons Chamber

[Neil O’Brien]

My right hon. Friend is so right, and she has been a powerful champion on this issue. We have invested £1.5 billion to get an extra 50 million GP appointments per year. The number of appointments in September was up 7% compared with the same month in 2019. We now have an extra 2,300 doctors working in primary care compared with 2019, and an extra 19,300 primary care professionals, on the way to the goal of 26,000 extra primary care professionals. This is hugely important, we are investing in it, and my right hon. Friend is right to campaign on it.

[Mr Speaker]

I call shadow Minister Andrew Gwynne.

[Andrew Gwynne (Denton and Reddish) (Lab)]

We know that, if poorer communities cannot afford to heat their homes, health inequalities will worsen significantly over the winter months and beyond. Despite the seriousness of this issue, the previous Health Secretary—that is the right hon. Member for Suffolk Coastal (Dr Coffey), in case Members are struggling to keep track—planned to ditch the Government’s long-promised health disparities White Paper. Does the current Minister intend to do the same? If he does, how will he seriously address the dreadful health inequalities that have widened after 12 Tory years?

[Neil O’Brien]

The hon. Gentleman implies that I disagree with him about this. In fact, the Government are working hard to clamp down on squalid housing. That is exactly what we were doing in my previous Department, DLUHC, and I have just mentioned some of the things that we are doing: the £37 billion we are spending to help people to meet the cost of living, the £15 billion of that that is targeted on the very poorest households, and the £12 billion that we are investing in making people’s houses easier to heat. We will continue to tackle health disparities across the board.

[Mr Speaker]

We now come to SNP spokesperson, Martyn Day.

[Martyn Day (Linlithgow and East Falkirk) (SNP)]

The NHS Confederation wrote to the former Chancellor raising its concerns about rising energy costs and the knock-on effects on health and on NHS services. We all know that this winter we will see people making the choice between heating and eating. Both routes will inevitably lead to more illness and worse health outcomes, so what action are Ministers taking, with their colleagues in Cabinet, to avoid this public health catastrophe?

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[Mr Speaker]

I call the shadow Minister, Liz Kendall.

[Liz Kendall (Leicester West) (Lab)]

The previous Health Secretary promised £500 million social care discharge funding for this winter, but it is 1 November and not a single penny of that money has been seen. I am afraid that the political chaos and incompetence over the last few weeks means that local services cannot properly plan and thousands more elderly people are trapped in hospitals when they do not need to be, with all the knock-on consequences for the rest of the NHS. Will the Minister now tell us: is this money still available? When will it be released? Can she guarantee that it will be genuinely new funding, not found from cuts made elsewhere?

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[Steve Barclay]

My hon. Friend raises an important point, particularly for category 3 and 4 ambulance journeys. As she highlights, there are numerous aspects to the challenge of ambulance delays: the blockage in the flow from social care and delayed discharge, which we have debated many times in the House; issues in accident and emergency with pre-cohorting, post-cohorting and triaging nurses; conveyance rates, which often vary significantly between ambulance trusts; call handling, which we have put additional money into; and the work of the auxiliary service. My hon. Friend is quite right that within the portfolio of options, minor injuries units are an area that can help to relieve pressure on busy A&Es.

[Mr Speaker]

I call the shadow Secretary of State.

[Wes Streeting (Ilford North) (Lab)]

I welcome the Secretary of State back and welcome his team, but I have had boxes of cereal with a longer shelf-life than Conservative Secretaries of State. As a consequence of the turnover and chaos, the truth is that the NHS is not prepared for this winter—it cannot even get allocated funds out of the door.

Let us turn to the future. Over the summer, the Prime Minister promised to establish a “vaccines-style taskforce” to tackle the Conservatives’ NHS backlog on “day one” and to have overall waiting list numbers falling by next year. May I ask the Secretary of State who is on that taskforce, how many times it has met and what its programme of work is?

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[Steve Barclay]

My right hon. Friend raises an important point about face-to-face care, which matters to many constituents, but I gently remind him that in the Lincolnshire integrated care system, 71.9% of appointments were face to face in September 2022. It is not the case that every patient wants a face-to-face appointment; there can be instances in which an online service is better. For patients facing domestic violence, for example, it can often provide a much more convenient service.

[Mr Speaker]

Order. I know we are bedding back in, but Front Benchers have to think about Back Benchers. These are their questions as well, so please let us make sure that I can call as many of them as possible.

[Martyn Day (Linlithgow and East Falkirk) (SNP)]

The Scottish Government introduced new national guidelines to make it easier for retiring NHS staff to return to support the NHS, while drawing their pensions. However, there is a substantive issue of pension tax rules pushing senior clinicians to reduce their commitments or retire early. As we know, pension taxation is a wholly reserved matter, so will the Minister address this issue with Cabinet colleagues in order to find a permanent solution that will allow us to help the NHS retain senior staff?

Edenfield Centre: Treatment of Patients

Lindsay Hoyle Excerpts

Thursday 13th October 2022 Commons Chamber

[Mr Speaker]

I wish to notify Members that the police have launched an investigation into the allegation of misconduct at the Edenfield Centre. I therefore encourage Members to refrain from comments that may prejudice either the police’s ongoing investigation or any subsequent legal proceedings that may result from it.

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[Will Quince]

I thank my hon. Friend for his question, and he is absolutely right that patients and their families deserve and indeed expect the highest standards of care quality. Safe services are by no means—never, in fact— optional extras, and where there are failures to deliver to those standards, we must continue to be transparent so that we can learn and improve. Whether it is in the CQC or local trusts, I know that the Under-Secretary, my hon. Friend the Member for Sleaford and North Hykeham, will look at any and all options to improve transparency, and to make it far clearer where cases of this nature do take place. He is also absolutely right to point out that the vast, vast majority of those who work in our NHS provide the most incredible world-class care, and where they are let down by a tiny number of individuals, as they have been in this case, such people are letting down everyone who works in the NHS.

[Mr Speaker]

I call the shadow Minister.

[Dr Rosena Allin-Khan (Tooting) (Lab)]

I thank my hon. Friend the Member for Bury South (Christian Wakeford) for his work with the families who have been affected.

I want to pick up on a point of clarification, if I may. The Minister mentioned in his response that the Government are putting an additional £2.3 billion into mental health. Over the last four years, 21 different Ministers have mentioned this same funding at that Dispatch Box on 67 different occasions as being spent in myriad different ways. I know that the Government are on the ropes, but this just shows that they are out of ideas and out of money.

Patients and their families rightly expect to be safe in in-patient settings. The footage of inappropriate use of restraint and seclusion, the bullying, dehumanisation and sexualisation of patients by staff, the verbal and physical abuse, mistakes over medication and falsification of records all made for extremely disturbing viewing. Each of these would be cause for significant concern, but together they point to a scandalous breach of patient safety. It should not have taken an undercover investigation to bring to light poor patient care. Why are the Government not across this?

Since “Panorama” aired, I too have received correspondence from families who have gone through similar experiences and from former staff at Edenfield who were bullied out of their jobs. What are the Government doing to tackle this toxic culture? The Government’s failure to learn from past failings, and to implement recommendations on reducing restraint, segregation and seclusion, is costing people their lives and traumatising too many patients, as evidenced in these reports. I sent a letter to the Secretary of State after “Panorama” aired. When will I receive a response? Is the Secretary of State even taking this seriously?



In 2019, the Government committed to reducing the need for restraint and restrictive intervention, yet the use of restraint has soared. Will the Government be conducting a rapid review into mental health in-patient services? What are the Government doing to tackle staff shortages, and what are they doing to ensure that patients’ complaints about their care are taken seriously? To have a “Dispatches” investigation into another trust less than two weeks after “Panorama” aired demonstrates that this is not a one-off. What are the Government doing? People are losing their lives.

[Mr Speaker]

Order. May I remind Front Benchers that we have set times? Please time your speech before you come to the Dispatch Box, otherwise it is not fair.

Oral Answers to Questions

Lindsay Hoyle Excerpts

Tuesday 19th July 2022 Commons Chamber

[Maggie Throup]

I have read the hon. Lady’s Committee’s report with interest and I recognise the points she has raised. We know that vaccine hesitancy among ethnic minority groups has reduced over the course of the covid-19 vaccination programme, but we will not rest on our laurels. We continue to work closely with our valued communities and community leaders to provide advice and information at every opportunity, and we have materials translated into 28 different languages. There have been many ways in which we have reached out to those communities. For example, we have had vaccination sites in mosques—I visited one in Small Heath in Birmingham—and the Bangladeshi community have come together and encouraged people to get a “jab with your jalfrezi”. We are looking at every different way of reaching out to ensure that we reach all those communities.

[Mr Speaker]

We now come to the Scottish National party spokesperson, Martyn Day.

[Martyn Day (Linlithgow and East Falkirk) (SNP)]

Vaccination remains one of the most important ways to protect ourselves and others against covid-19, so I welcome the Secretary of State’s announcement that he has accepted the independent advice from the Joint Committee on Vaccination and Immunisation on the autumn covid-19 booster programme, but what additional steps does the Minister feel need to be taken to encourage vaccine uptake among those with a hesitancy for the additional boosters?

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[Maria Caulfield]

My hon. Friend is right; the delayed discharges and being able to free up those beds has a knock-on effect on A&E, which in turn has a knock-on effect on ambulances being able to unload. We have the £2 billion better care fund, which is supposed to be addressing just that, to help integrated care boards deliver and help patients get out of hospital. I have a meeting with all the integrated care boards tomorrow, so his is a timely question, but I am happy to meet him as well.

[Mr Speaker]

I call the shadow Minister, Dr Rosena Allin-Khan.

[Dr Rosena Allin-Khan (Tooting) (Lab)]

Thank you, Mr Speaker. A&E waiting times are through the roof, and we have people waiting without a bed—not even a trolley. This is removing the dignity that every patient deserves, but, sadly, it is not a one-off; this is commonplace up and down the country. It is not the Health Secretary who is on the receiving end of it, but staff, who are running from patient to patient trying to ease pain, diagnose illness and save lives—most importantly, it is of course the most vulnerable themselves. When the Minister hears reports such as this, does she not feel ashamed of the decisions her Government have made over the past 12 years?

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[Nicola Richards (West Bromwich East) (Con)]

8. What steps he is taking to improve cancer outcomes.

[Mr Speaker]

I welcome you to the Dispatch Box, Minister.

[The Parliamentary Under-Secretary of State for Health and Social Care (James Morris)]

Thank you, Mr Speaker. The Government are focused on improving the early diagnosis of cancer in England to aid cancer outcome rates. That was set out in the NHS Long Term Plan, setting an ambition of seeing 75% of people diagnosed within stages one and two by 2028. Progress has continued on delivering the Long Term Plan. That includes increased investment and public awareness campaigns, rolling out targeted lung health checks, and introducing non-specific symptom pathways to speed up diagnosis.

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[Gillian Keegan]

Between March 2020 and March 2022, we made nearly £3.3 billion available to support discharge, recognising the pressures faced by the health and social care sectors, as they manage the demands of covid-19. Under section 75 of the National Health Service Act 2006, funding can be pooled across health and social care to ensure the effective use of available resources. That allows funds such as the better care fund to be used to support discharges, and I know that many integrated care systems are focused on doing that and pooling more resources.

[Mr Speaker]

We come to shadow Minister Karin Smyth.

[Karin Smyth (Bristol South) (Lab)]

I do appreciate that it has only been two weeks, but the Secretary of State will be familiar with the use of root cause analysis to solve problems; however, yesterday he spoke for almost eight minutes on ambulance delays with scant reference to social care. Had he been badly briefed?

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[Maria Caulfield]

To put this in context, I make no apologies for all the efforts that were made to secure PPE for frontline staff. We delivered more than 21.5 billion items of PPE to keep frontline staff safe during a time when we had a dangerous virus that no one knew anything about, we had no vaccine and there was a global push on the market resources. Those products that we procured that did not meet the standards for health and social care were used in other avenues. For example, we donated masks to transport operators and to schools, so that we could reopen the economy and to help them to keep safe.

[Mr Speaker]

I call SNP spokesperson, Martyn Day.

[Martyn Day (Linlithgow and East Falkirk) (SNP)]

While the Tories flogged off PPE contracts to party donors and friends of Ministers through their unlawful VIP PPE lane, the Scottish Government’s processes ensured value for money, as we have heard; their PPE costs were less than a third of the UK Government’s. Will the UK Government follow Scotland’s example in future, and refuse to engage in cronyism and corruption?

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[Steve Barclay]

My hon. Friend will be aware that the matter is devolved to the Welsh NHS, but I can say that in the last financial year, the Government allocated £70 million to NHS England to specifically address dementia waiting lists and increase the number of diagnoses. To further support recovery of the dementia diagnosis rate and access to post-diagnostic support, NHS England is funding two trusts in each region to pilot the diagnosing advanced dementia mandate tool, which will improve access to diagnosis.

[Mr Speaker]

I call shadow Secretary of State, Wes Streeting.

[Wes Streeting (Ilford North) (Lab)]

I welcome the Secretary of State to his first oral questions and, as this is likely to be his last oral questions, also wish him the best for the future. I associate myself with his remarks about his predecessor, who of course resigned from the Government on a point of principle as others chose to remain loyal; on that note, I also pay tribute to the former Minister, the hon. Member for Charnwood (Edward Argar), for the diligent approach he took to his work and the spirit in which he engaged with the Opposition. One of the contenders for the Conservative leadership says that public services are in a state of disrepair. Another describes the NHS backlog as frightening. A third called ambulance waiting times appalling, and of course the Secretary of State for Culture, Media and Sport said that the former Health Secretary’s preparation for a pandemic was “found wanting and inadequate”. They are right, aren’t they?

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[Steve Barclay]

We will respond shortly to the independent pay review body, which, as part of its recommendations, weighs up the pressures on the cost of living and the other factors within its remit. The Government are delivering more doctors, more nurses, more appointments and more treatments, investing in our estate and planning for the future. That includes investment in research and development, and in future technology through our life sciences. That not only delivered the vaccine that allowed us to lift the covid restrictions that the Opposition wanted to retain, but will unlock the technologies of the future.

[Mr Speaker]

I call the Chairman of the Health and Social Care Committee, Jeremy Hunt.

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

May I recommend some scintillating summer reading to the Secretary of State: the study of 4.5 million patients that showed that people who see the same GP over a long period are 30% less likely to go to hospital and 25% less likely to die? Will he, after reading that, consider changing the GP contract to get rid of the micromanagement, and replace it with what doctors and patients want, which is the ability to have a long-term relationship?

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[James Morris]

I thank the hon. Gentleman for his question, and I deeply sympathise with patients and families who are dealing so courageously with the difficult conditions that he describes. The Government are taking an evidence-based approach to unlicensed cannabis-based products to ensure that treatments are safe and effective before they can be considered for routine funding within the NHS. Whether to prescribe cannabis for medicinal use must remain a clinical decision, and public funding arrangements apply, as they do for all other medicines. The Government remain committed to research and catalysing the generation of evidence to support the use of these products. The National Institute for Health and Care Research remains open—

[Mr Speaker]

Order. I call Mary Robinson.

[James Morris]

The National Institute for Health and Care Research remains open to receiving research proposals in this area as a priority.

[Mr Speaker]

Order. Minister, when I stand up, please do stop. You are the one who is dragging this out, so you tell these people why they cannot get in.

[Mary Robinson (Cheadle) (Con)]

I welcome the confirmation of the cohorts to be vaccinated against covid-19 and flu this autumn. Will my hon. Friend advise the House and my constituents whether the two vaccines will be co-administered?

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[Mr Speaker]

I thank the hon. Lady for notice of her point of order. The Government’s guidance states:

“Written statements should be issued at 9.30am where possible…If the statement cannot be issued by 12.30pm, the department should endeavour to notify the Chair of the relevant select committee and/or any other member with an interest.”

It states that that should include “Opposition front bench spokespersons”. Hopefully, the Chief Whip has heard the message and will want to deal with it.

Ambulance Services and National Heatwave Emergency

Lindsay Hoyle Excerpts

Wednesday 13th July 2022 Commons Chamber

[Maria Caulfield]

I can reassure the right hon. Lady that I am the Minister responsible for ambulances, which is why I am standing here at the Dispatch Box. The Secretary of State has been out on visits this morning, meeting clinical teams; it is important that he hears at first hand from those who are on the frontline. I got into politics to make sure that those of us who work on the frontline—[Interruption.] The right hon. Lady rolls her eyes; maybe she does not have much respect for those of us who worked on the frontline. We are dealing with this situation, and will be supporting the ambulance service over the coming months. The right hon. Lady’s response is extremely disappointing.

[Mr Speaker]

I granted the urgent question because the shadow Secretary of State tabled it and normally we would expect a Secretary of State to come. I recognise that they may be busy in other areas, but it is something we ought to be aware of. More and more, we are seeing fewer Secretaries of State across all Departments, not just this one.

[Helen Morgan (North Shropshire) (LD)]

Last Friday, I passed by Royal Shrewsbury Hospital. It is in a neighbouring constituency, but it serves my constituents. It was not a particularly bad day, but there were eight ambulances with their doors open in the heat, waiting to transfer patients. This is not a new situation and I have repeatedly raised the issue in this place: on my first day in Parliament with the Prime Minister; with the Secretary of State for Health in an Adjournment debate; and in a Westminster Hall debate with the hon. Member for Charnwood (Edward Argar). All those people have now resigned. Shrewsbury and Telford Hospital Trust has declared its fifth critical incident this year. When will the Government end the chaos and infighting, and start taking steps to prevent avoidable deaths in Shropshire and across the country?

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[Maria Caulfield]

The hon. Gentleman makes a very constructive suggestion—one of the first of the afternoon, if I may say so. There were lessons during covid that are being rolled out across emergency services. We are looking at best practice in those parts of the country where response times are better to see if we can share it. I am very keen to look at any option that relieves the pressure. We are investing in 111, which enables people to have alternative ways of getting urgent care directed to them. We are looking at 111 being able to make direct referrals as well, so there are a number of options. I am happy to take suggestions from any hon. Member if they are keen to see those happening in practice.

[Mr Speaker]

You have tempted me and I should not really, but it would be very helpful if you reopened Chorley A&E for 24 hours rather than 12 hours. It would reduce the number of ambulances queueing at Preston and Wigan, and we would have more ambulances on the road.

Draft Mental Health Bill

Lindsay Hoyle Excerpts

Monday 27th June 2022 Commons Chamber

[Mr Speaker]

Order. The shadow Minister cannot give way; this is a statement.

[Dr Allin-Khan]

We need to advance the mental health equality framework and there must be culturally appropriate services and the freedom for local areas to look at their specific populations in order to have the most suitable approaches. Culturally appropriate community provision is vital for mental health services that are truly joined-up and effective and that, crucially, work well for patients. Will the Secretary of State also provide reassurances on the future of community care and on how they will work with local authorities across the country to deliver community provision that works?

Mental health staffing levels are absolutely crucial to ensuring that mental health services are fit for purpose. More than a year and a half ago, I asked the Secretary of State’s predecessor about the future of mental health staffing. The proposals that have been set out today go well beyond what has been committed to in the long-term plan. Labour has a plan: to recruit an extra 8,500 mental health staff to treat 1 million additional patients a year by the end of our first term in office. Will the Secretary of State outline when we will get the workforce settlement? What reassurance can he give on filling training places?

For too long, the Government have had their head in the sand when it comes to mental health. They have failed on eradicating dormitories from mental health facilities, failed on cracking down on the use of restraint, and failed on getting on top of waiting times. We cannot have this kicked into the long grass and, if it gets lost in the political quagmire of Conservative in-fighting, should the Government call an early general election, people will suffer. We cannot have the Government fail on mental health legislation any longer. This is a once-in-a-generation opportunity; we simply must get this right for everyone who depends on these vital services.

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[Sajid Javid]

The hon. Lady is right to raise the matter. I can tell her— helpfully, I hope—that the Bill is not that important in terms of getting what she wants to see, which is more care for people when they present themselves at A&E with mental health challenges. That is work that is already prioritised with the NHS. During the pandemic, as she and other hon. Members will understand, there were increased issues around mental health and people not getting care in the normal way; that is why we have put record resources into the NHS, including into A&E provision of mental health services.

[Mr Speaker]

I call the Chair of the Health and Social Care Committee.

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

I commend my right hon. Friend’s courage in talking about his family’s tragedy, which is one of the most difficult things to do in politics. I also thank my right hon. Friend the Member for Maidenhead (Mrs May) for her commitment to mental health, which is unparalleled among any Prime Minister I have known in this place; it made an enormous difference to me when I was Health Secretary.

I support wholeheartedly what the Health Secretary has said today. I hope that he does not mind my saying that in one instance it does not go far enough: there are still 2,000 people with autism and learning disabilities in secure institutions, effectively incarcerated, even though they would be better off in the community. It is a human rights scandal. As part of the remedy, would he consider changing the rules on sectioning so that, after a short period, anyone who wanted to keep someone in a secure unit would have to reapply for sectioning every week or two, so pressure is put on the system to find a better solution?

Access to GP Services and NHS Dentistry

Lindsay Hoyle Excerpts

Tuesday 21st June 2022 Commons Chamber

[Mr Speaker]

I call the shadow Secretary of State for Health.

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[Wes Streeting]

I am very, very grateful to the hon. Lady for that intervention. Our party has been clear: we did not want to see the strikes go ahead. We believe the strikes could have been averted if the Government had shown responsible action. The absolute brass neck of the Secretary of State! It is one thing pretending they have not been in government for the last 12 years; now they are pretending they are not in government today and that, somehow, it is down to me, the shadow Health Secretary. Somehow, if I had uttered the magic words, “Don’t go ahead,” the RMT would have said, “Oh no, the shadow Secretary of State for Health has spoken now. We better put a stop to it.” [Interruption.]

[Mr Speaker]

Order. I want to help a little bit. We do not want to open up a debate that is not down for today. We have got a little bit carried away. The hon. Member for Kensington (Felicity Buchan) got in, and I was quite right to allow a response, but I think we have heard enough now.

[Wes Streeting]

Thank you, Mr Speaker.

I was about to quote the great political philosopher, Jonn Elledge, who, in response to what the Secretary of State said, commented on Twitter that we are

“all as ants before the might of the all powerful shadow health secretary”.

When is the Health Secretary going to wake up to the fact that he is in government, he has responsibilities, he is discharging the greatest crisis in the history of the NHS and he is doing nothing about it? Instead of lecturing the Opposition, when is he going to show some leadership and get on with governing?

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[Dr Johnson]

As part of that, I suggest that the hon. Gentleman remembers that GPs take 10 years to train. He is right to say that we have been in government for 12 years, but most of the current GP shortage is because the previous Labour Government did not train those GPs at the time. One of the first things the Conservative Government did was to set in train the opening of five medical schools to increase the number of medical students. We had enough doctors but they do take 10 years to train. The reason I stood up to intervene on the hon. Gentleman was to say that one of the challenges that doctors—I refer to my entry in the Register of Members’ Financial Interests, as a doctor—and members of staff face is being abused in a surgery. I wonder whether he would like to apologise for some of the comments he has made on social media—

[Mr Speaker]

Order. Interventions are meant to be questions. I know that the hon. Member is down to speak. I would not want you to use up your speech now; I want you to save something for later.

[Wes Streeting]

Let me first say in response to the final point the hon. Lady made that there is absolutely no excuse for abusing NHS staff whatsoever. Most people in this country do not blame NHS staff for the state of the NHS; they place the blame squarely where it belongs, with the Government who have been in power for the past 12 years. Her first point would be more powerful if we did not have 1,500 fewer full-time equivalent GPs now than we did when her party came to power. Her point would have been more powerful if her party had not whipped its MPs to vote against having a workforce plan for the NHS, but I am afraid that that is what it did. Conservative Members cannot run way from their choices and decisions, and from the fact that they have now been in government for 12 years and there is no one else to blame but themselves. In communities right across the country, we now see the consequences of their mismanagement.

Oral Answers to Questions

Lindsay Hoyle Excerpts

Tuesday 14th June 2022 Commons Chamber

[Sajid Javid]

The hon. Lady is right to talk about the importance of eye care services. That is why we are putting record investment into dealing with those covid backlogs. As she rightly points out, many of those are in eye care and ophthalmic facilities and surgeries. That record investment is going in, and we will keep it under review to make sure it is leading to the outcome that we all want to see.

[Mr Speaker]

We now come to shadow Minister, Andrew Gwynne.

[Andrew Gwynne (Denton and Reddish) (Lab)]

More than 2 million people are affected by the backlog in cancer care. Smoking is the leading cause of cancer, and we know that a key component of tackling the backlog is prevention. Given that, can the Secretary of State assure the House that no current or former tobacco lobbyist working in or with No. 10 will have any influence on the Government’s tobacco control plan, prevention strategy or planned response to the Khan review?

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[Ms Marie Rimmer (St Helens South and Whiston) (Lab)]

People with dementia deserve to be treated with dignity and respect. There are ways to enable those living with dementia to lead the lives they want. This is what the all-party group on dementia inquiry is currently investigating. Will the Secretary of State commit to attending the all-party group’s inquiry—

[Mr Speaker]

Order. Sorry, but that is not relevant to the question, which is about dentistry.

[Ms Rimmer]

I have Question 5 on dementia.

[Mr Speaker]

I cannot jump questions; this question is about dentistry so I now call the shadow Minister, Feryal Clark.

[Feryal Clark (Enfield North) (Lab)]

Members across the House have been calling on the Minister to fix the crisis in NHS dentistry, but she seems intent on burying her head in the sand. The Government have no plan, with the Minister running scared from even talking to dentists at a conference last week. Patients are suffering as a result, with a third of adults and half of all children not having access to an NHS dentist. In Wakefield alone, a child under 11 is admitted to hospital every day for tooth decay. Does the Minister agree that the people of Wakefield should bear this in mind next Thursday?

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[Edward Argar]

I am grateful to my hon. Friend for drawing attention to this important issue as well as for highlighting what is going on in Norfolk and the opportunities to learn from that. The Government have put record funding into mental health, and I understand that my right hon. Friend the Secretary of State is due to meet him and supporters of the campaign soon.

[Mr Speaker]

I call the shadow Minister.

[Dr Rosena Allin-Khan (Tooting) (Lab)]

Working a shift in A&E just two days ago, I could not have felt prouder of the teams of nurses who form the foundation of our NHS. As the Minister is so gushing about the Government’s track record, will he explain why specialist food banks are being opened up in hospitals? Will he explain why, in a report by the Royal College of Nursing, 83% said that staffing levels on their last shift were not sufficient to meet patients’ needs safely and effectively? These lifesavers need a Government who are on their side. Only Labour will deliver for the NHS workforce and ensure that nurses and patients get what they rightly deserve.

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[Lucy Allan]

Orthopaedic surgery at the Princess Royal Hospital has still not restarted since the pandemic. That is causing huge suffering for those who have been waiting for surgery, in some cases for several years. A hip replacement is transformative to quality of life and reduces other care needs, but orthopaedic surgeons continue to be paid despite not operating, and no alternative is being offered to patients—they are not even being given an expected operation date. Will implementing the Messenger review require NHS leadership to be more accountable to the public so that decisions such as refusing to restart much-needed surgery can be challenged?

[Mr Speaker]

This is a strange grouping, but it is a very important question, so do answer it, please.

[Sajid Javid]

I thank my hon. Friend for her tireless campaigning on the issue, which she brought up recently in the Health and Social Care Committee. I am pleased to tell her that elective orthopaedic surgery at the Princess Royal Hospital will resume from 20 June.

My hon. Friend is right about the importance of the Messenger review. There were many examples of excellent leadership in it, but sadly there were also examples of poor leadership, including bullying and blame cultures. That is why it is essential that we have this huge reform.

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[Maria Caulfield]

My hon. Friend has been campaigning on this issue for a long time, particularly on the tragic case of his constituent, Vicky Clarke. I have met the all-party parliamentary group on medical cannabis under prescription and we have had debates on the issue in this place and in Westminster Hall. The key is to get those products licensed, and we have been in discussion with the Medicines and Healthcare products Regulatory Agency on how to do this. It is about gathering the evidence base. I am pleased to say that NHS England and the National Institute for Health and Care Research have recently announced two clinical randomised controlled trials to try to build that evidence base to get more of these products licensed.

[Mr Speaker]

We now come to the Scottish National party spokesperson, Martyn Day.

[Martyn Day (Linlithgow and East Falkirk) (SNP)]

The lack of evidence on the quality, safety and efficiency of cannabis-based products for medical use is the main barrier to their being prescribed by NHS clinicians, which is why the SNP continues to support the development of clinical trials. Without proper funding, the UK Government are holding back potential successful health outcomes, so what steps are they taking to increase the priority of medicinal cannabis in research funding?

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[Sajid Javid]

I am happy to respond to my hon. Friend. He is right that we of course want to ensure that everyone has timely access to NHS dentistry and that the profession is an appealing career choice. Health Education England has a dental education and reform programme, which will help retain new dentists in the NHS by placing training in areas of greatest need, and offer more flexibility and more career pathways. I can also tell him that, in Lincolnshire, commissioners are already looking at ways to support NHS dentistry through support such as the golden hello incentives.

[Mr Speaker]

I call the shadow Secretary of State.

[Wes Streeting (Ilford North) (Lab)]

I associate myself with the Secretary of State’s remarks as we remember the anniversary of the Grenfell Tower tragedy and support the families in their ongoing quest for justice. I also associate Opposition Members with your remarks, Mr Speaker, on the 40th anniversary of the end of the Falklands war.

Last night’s shocking BBC “Panorama” investigation into Operose Health revealed the extent of the crisis in GP surgeries, with patient referrals and test results left unread for up to six months, and with patients being seen by less qualified staff standing in for GPs without supervision. This is exactly what happens when private profit is placed above patient health and safety. Why is the Secretary of State asleep at the wheel instead of launching an investigation into this scandal?

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[Sajid Javid]

My sincere condolences to the family of David Hopkins. Cancer diagnosis and treatment is an absolute priority, which is why we are putting £2.3 billion into campaigns and new initiatives to encourage people with suspected cancer to come forward. I am pleased that the referral rate is currently 120% of the pre-pandemic level. I will, of course, read the APPG’s report. I visited the largest neurology hospital in the UK last month with my hon. Friend the Member for Hexham (Guy Opperman), and I am determined to ensure that our investment in this vital area of research goes straight to the frontline.

[Mr Speaker]

I call the SNP spokesperson, Martyn Day.

[Martyn Day (Linlithgow and East Falkirk) (SNP)]

The Government have noted that Sir Robert Francis will give evidence on his work on the infected blood inquiry on 11 and 12 July, and said that they will act after hearing his evidence. What discussions has the Secretary of State had with Cabinet colleagues on the potential impact on victims’ mental health of the lengthy waiting times for compensation in relation to contaminated blood?

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[The Minister for Health (Edward Argar)]

I am grateful to my hon. Friend; he rightly alludes to the fact that he is a strong champion of his constituents and has met me on a number of occasions to argue the merits of the Thornberry health centre. As he will be aware, we now have a multi-year capital settlement for our NHS, which will allow us the opportunity, through local systems, to consider the most appropriate projects for investment.

[Mr Speaker]

Like Chorley.

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

T2. Planned to process 300,000 tests a day, the Rosalind Franklin laboratory is handling just 30,000 a day. I understand that some scientists working there are being paid for five days but working just one day a week. Given that the lab cost £1.1 billion, almost twice the original budget, what does this say about the Minister’s oversight of the programme?

[Sajid Javid]

I am afraid that it was not clear to me which tests the hon. Gentleman was talking about; all I heard was “300,000 tests”. So if he cares to write to me, I will respond properly to his question.

[Mr Speaker]

I call the Chair of the Select Committee, Jeremy Hunt.

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

Has the Secretary of State read the study in the British Journal of General Practice that says that people who see the same GP over many years are 30% less likely to go to hospital, 30% less likely to need out-of-hours care and 25% less likely to die? If he has, will he consider changing the GP contract to restore individual patient lists and reverse the change of two decades ago so that everyone has their own family doctor?

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[Edward Argar]

It was a great pleasure to visit my hon. Friend before the jubilee weekend and to meet the staff who do such an amazing job at his local hospital. As ever, his puts his case clearly and firmly for a new hospital to replace the QE in King’s Lynn, and we hope to be able to announce the longlist of those expressions of interest in due course.

[Mr Speaker]

Including Chorley, I hope.

[Neale Hanvey (Kirkcaldy and Cowdenbeath) (Alba)]

T4. In response to yesterday’s urgent question on GDP, the Minister cited a drop in covid test uptake to explain the drop in GDP. Coronavirus test device approvals have been moving at glacial speed, with UK companies having to spend significant money preparing to mitigate this. Monkeypox also indicates unexplained changes in viral behaviours, and we know that covid is once again on the rise, so domestic diagnostics should be a vital component of effective prevention and strategic planning. Will the Secretary of State or a Minister meet me to discuss how best we harness these resources?

Health and Social Care Leadership Review

Lindsay Hoyle Excerpts

Wednesday 8th June 2022 Commons Chamber

[Mr Speaker]

I call the shadow Secretary of State, Wes Streeting.

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[Sajid Javid]

The hon. Lady is right to highlight the importance of this issue and she will know that my predecessor had asked for a review on it. It was done and we have accepted its outcome, and it is being implemented. I hope she will understand that in implementing the outcome of that review it is important that we listen to clinical advice from within the NHS and make sure that we put the interests of each patient first.

[Mr Speaker]

I call the Chair of the Select Committee, Jeremy Hunt.

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

I thank the Health Secretary for this excellent report and commend Sir Gordon Messenger and Dame Linda Pollard for all their work in putting it together. It has some very important recommendations. People who run hospitals are doing one of the most difficult jobs in Britain today, and anything we can do to give them better support in their careers will help all of us.

Does my right hon. Friend agree that the elephant in the room is that one thing that makes their job most difficult: we have more national targets in the NHS than any other health system anywhere in the world? That means not only that there is a risk of patients turning into numbers, but that we remove the autonomy from managers to show the leadership that Sir Gordon is advocating in this report. So as my right hon. Friend implements the recommendations, will he look at the role of national targets in the NHS and whether we need to simplify and reduce them?

North East Ambulance Service

Lindsay Hoyle Excerpts

Monday 23rd May 2022 Commons Chamber

[The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)]

Can I start by saying how horrified I was to read the concerns raised about the North East Ambulance Service in reports over the weekend? My thoughts are first and foremost with the families affected by the tragic events described. I cannot imagine the distress they are going through. It is hard enough to lose a loved one suddenly, but to have fears that mistakes were made that could have made a difference, and more than that, that the facts of what happened were not revealed in every case, goes further. They have my unreserved sympathy and support.

In healthcare, a willingness to learn from mistakes can be the difference between life and death, and it is because of this that, as a Government, we place such a high value on a culture of openness and a commitment to learning across the NHS. That is why the allegations raised by The Sunday Times this weekend are so concerning. As was made abundantly clear by the Secretary of State’s predecessor almost a decade ago, non-disclosure agreements have no place in the NHS and reputation management is never more important than patient safety.

The Government are wholly supportive of the right of staff working in the NHS to raise their concerns. Speaking up is vital for ensuring that patient safety, and quality of services, improve, and it should be a routine part of the business of the NHS. That is why, over the last decade, substantial measures have been introduced to the NHS to reduce patient harm and improve the response to harmed patients, including legal protections for whistleblowers, the statutory duty of candour, the establishment of the Health Services Safety Investigations Body and the introduction of medical examiners. It is also why, in response to a recommendation of the Sir Robert Francis “Freedom to speak up” review in 2015, the Government established an independent national guardian to help to drive positive cultural change across the NHS so that speaking up becomes business as usual. However, when it comes to patient safety, we cannot afford to be complacent. It remains a top priority for the Government and we continue to place enormous emphasis on making our NHS as safe as possible.

I note the concerns raised in this weekend’s reports. They have been subject to a thorough review at trust level, including through an external investigation, and the trust’s coronial reporting is subject to ongoing independent external audit and quarterly review by an executive director. I also note that the Care Quality Commission has been closely involved. However, given the seriousness of the claims reported over the weekend, we will of course be investigating more thoroughly and will not hesitate to take any action necessary and appropriate to protect patients.

The Government are also committed to supporting the ambulance service to manage the pressures it is facing. We have made significant investments in the ambulance workforce, with the number of NHS ambulance and support staff increasing by 38% since 2010. Health Education England has mandated a target to train 3,000 paramedic graduates nationally per annum from 2021, further increasing the domestic paramedic workforce to meet future demands on the service, while 999 call handlers have been boosted to over 2,400, so we are very serious about improving resources for the service.

I fully appreciate the concerns of right hon. and hon. Members across this House, and we will be pleased to meet any who have constituents affected by the reports this weekend so we can look at the issue more fully.

[Mr Speaker]

Can I just say that it is three minutes—and that means three minutes, not three minutes and 40 seconds —and I am sure whoever writes these speeches can actually time them through? I say to those on both Front Benches that we have to think about Back Benchers, who need to get their hospitals mentioned and their ambulance trusts as well.

I call the shadow Secretary of State, who I am sure will stick to the allocated time.

[Wes Streeting]

I pay tribute to the courage of the whistleblowers, as well as The Sunday Times journalists David Collins, Hannah Al-Othman and Shaun Lintern, without whom none of this would have come to light. But with respect to the Minister, it should not have taken an urgent question to bring her to the House today. On what she said about the Department further investigating, what form will this investigation take, who will be involved and what assurance can she give the families that there will be both answers and accountability, which is what they deserve?

Peter Coates died after an ambulance did not reach him in time. An ambulance two minutes away could not be dispatched because the station door was faulty, and staff did not know about the manual override. The ambulance that was dispatched decided to stop at a service station, even though it had sufficient fuel. Information about these errors was then withheld by the service, statements were changed and staff were asked to withhold the mistakes from the coroner. Peter Coates’ family learned the full truth only when contacted by reporters last week. His is just one of what is thought to be 90 cases involving gross negligence, cover-ups and tens of thousands of pounds of taxpayers’ money offered in exchange for staff silence.

The Minister mentioned the CQC. Why did it fail to spot this, rating the service “good” in 2018? Why did it fail to spot the situation even after being tipped off in 2020? Why is taxpayers’ money still being offered to buy the silence of staff when non-disclosure agreements were supposedly banned in 2014? What role did under-resourcing and understaffing play in this scandal?

Record ambulance waits exist in every part of the country, with heart attack and stroke victims waiting longer than an hour for an ambulance. As for the North East Ambulance Service, it is advising the public to phone a friend or call a cab rather than wait, while presiding over gross negligence, cover-ups and taxpayer-funded gagging orders on staff. That is the record on its watch. It is a national disgrace. What are the Government doing about it?

[Maria Caulfield]

We take the patient safety element of this extremely seriously. To answer the hon. Gentleman’s questions on who we will be meeting, I am happy to meet all the families affected to hear their concerns and the actions that they want taken. We met with the CQC this morning on this specific example, but we will be meeting with the ambulance trust. I also want to meet the coroner, and we want to hear from the whistleblowers. I am very happy to meet any member of staff who wants to raise concerns so that we can get to the bottom of exactly what has happened.

This Government introduced the duty of candour. Mistakes will always happen, no matter how much money is put into the health service or how many staff it has, but when a mistake does happen the hospital trust or ambulance trust should be open and up front about it, start a proper investigation, and learn the lessons so that it never happens again.

[Mr Speaker]

I call the Chair of the Health and Social Care Committee.

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

I thank the Minister, who is a practising nurse, for her profound commitment to patient safety. What happened to Peter Coates, Quinn Evie Beadle and others was a terrible tragedy for them and their families. No doubt the paramedics made mistakes, but everyone makes mistakes in the course of their work. What is unforgivable is the cover-up by the North East Ambulance Service, and the fact that we made the families go through such hell to get to the truth.

At the heart of this is that we still make it far too difficult for everyone involved in such cases to distinguish between ordinary human error and gross negligence, with the result that the organisations responsible for people’s care default to a defensive, covering-up position. Will the Minister take this up with the Ministry of Justice to ensure much clearer delineation between the ordinary human errors that we all make and gross negligence, which is never forgivable?

Oral Answers to Questions

Lindsay Hoyle Excerpts

Tuesday 19th April 2022 Commons Chamber

[Sajid Javid]

That is exactly what the new integrated care systems are all about. My understanding is that the hon. Gentleman sat on the Health and Care Public Bill Committee, which made it a reality.

[Mr Speaker]

I call the shadow Secretary of State, Jake Berry. [Laughter.] Sorry, Wes Streeting.

[Wes Streeting (Ilford North) (Lab)]

Thank you, Mr Speaker. You have clearly had a happy Easter.

The fact is that the Government’s failure to fix the social care crisis is causing huge pressures on the NHS. As of last week, more than 20,000 patients were fit to leave hospital but could not be discharged because the care was not available, which means that 22,000 patients each month are waiting more than 12 hours in A&E and that heart attack and stroke victims have to wait more than an hour for an ambulance. We are used to hearing about winter crises, but is it not the case that, after more than a decade of underinvestment in the NHS, a failure to fix social care and the absence of a plan even to address the staffing challenge in the NHS and social care, we have not just a winter crisis but a permanent crisis in the NHS?<

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[Sajid Javid]

My right hon. Friend is absolutely right to raise this issue. We have heard time and time again in this Chamber about the pressures our constituents are facing in order to get that kind of face-to-face access to their GPs. We all know why the situation was particularly bad at the height of the pandemic, but we expect it to improve rapidly. The percentage of people being seen face to face is increasing substantially, in large part because of the measures the Government have taken, including the £250 million access fund that was announced a few months ago.

[Mr Speaker]

I call the SNP spokesperson, Martyn Day.

[Martyn Day (Linlithgow and East Falkirk) (SNP)]

Thank you, Mr Speaker.

Integration and service improvement cannot be delivered without sufficient staff, and the only way to attract people to a career in social care is by valuing them. In Scotland, they are already paid better than those in England and Wales, and through the national care service the Scottish Government will improve terms and conditions for care workers, through the introduction of national pay bargaining. Have the UK Government considered following the Scottish Government’s approach and commitments?

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[Sajid Javid]

My hon. Friend is right, and of course I will be happy to meet her and discuss this further, but I can also tell her that that is one of the key things we will be covering in our upcoming women’s health strategy.

[Mr Speaker]

I call the shadow Minister, Andrew Gwynne.

[Andrew Gwynne (Denton and Reddish) (Lab)]

Warm words from the Secretary of State, but people in the most deprived parts of England are almost three times as likely to lose their lives from an avoidable cause as those in the least deprived areas. With the cost of living soaring and the Resolution Foundation estimating that 1.3 million people will be pushed into poverty as a result of the Chancellor’s spring statement, those inequalities will worsen. Why will the Secretary of State not just admit that his Government have failed the poorest communities, and start doing something about it?

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[Gillian Keegan]

The hon. Lady raises a very good question. Last year, we committed an additional £2.7 million to further expand Op Courage following the recent events in Afghanistan, and NHS England has put in place several bespoke services and initiatives to meet the needs of our armed forces community. In addition to Op Courage, there is the veterans trauma network, the veterans prosthetic panel and the veteran-friendly GP accreditation scheme, but given ongoing events in Ukraine, we will of course keep everything under review. I am very happy to meet the hon. Lady to discuss further what may be required.

[Mr Speaker]

We now come to the shadow Minister, Dr Rosena Allin-Khan.

[Dr Rosena Allin-Khan (Tooting) (Lab)]

Our veterans have risked their lives for our country and deserve excellent mental health support. We must go even further: from the military frontline to frontline workers who have kept us safe, everyone deserves proper mental health provision. People have stepped up to protect our country and save lives during the pandemic, so is it any wonder that teachers and NHS staff are so furious with the comments made by the hon. Member for Lichfield (Michael Fabricant), about how they would go back to the staffroom and have a “quiet drink”, in an attempt to justify the indefensible actions of the Prime Minister? What does this say about the effect of mental health on our frontline staff? Will the Minister please condemn those comments and apologise for the hurt caused by those remarks?

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[Edward Argar]

I am grateful to my hon. Friend, who takes a close interest in this issue, which she and I have discussed on a number of occasions. She is right to highlight the challenges that some more remote or rural communities can face in securing the workforce they need to meet their communities’ needs. The HEE work and the subsequent workforce framework will be looking at that across the whole range of different geographies and the challenges they face.

[Mr Speaker]

I call the SNP spokesperson.

[Martyn Day (Linlithgow and East Falkirk) (SNP)]

The Scottish Government have recently bought Carrick Glen, a private healthcare hospital, in order for it to become part of the national network of treatment centres, which once fully operational will have capacity for over 40,000 additional surgeries and procedures each year. In contrast, the UK Government have taken the path of further privatisation of the NHS, so what recent assessment has the Minister made of the impact on the workforce of further privatisation of NHS England?

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[Sajid Javid]

My hon. Friend is right to raise this. We are already in contact with the acute trust in Gloucestershire and some of the other trusts that are finding delayed discharge a particular challenge. My hon. Friend will know that, because of the pandemic, what has been a long-term challenge has become much more acute, not least because of the lost beds due to infection protection control and staff absences both in healthcare and in social care. Our delayed discharge taskforce is making a difference—the numbers are coming down overall—but we will be working with Gloucestershire.

[Mr Speaker]

I call the shadow Secretary of State.

[Wes Streeting (Ilford North) (Lab)]

Why does the Health Secretary think he has any licence to lecture the British people on their moral duty to pay taxes when he spent so many years avoiding his own?

[Sajid Javid]

rose—

[Mr Speaker]

Order. I am not quite sure that is relevant in topical questions.

[Sajid Javid]

I am very happy to answer if you will allow me, Mr Speaker. The hon. Gentleman could have asked me a question on anything to do with health and care—anything he wanted—but instead he chooses to talk about my personal affairs before public life. That was his choice. He could have asked me about the covid backlogs that he pretends he cares so much about. He could perhaps have given me suggestions—

[Mr Speaker]

Order. Secretary of State, I have got it. These are questions about your responsibilities. Now we can have another try—Wes Streeting.

[Wes Streeting]

Thank you, Mr Speaker. I would just say to the Secretary of State that he should be careful what he wishes for. I hope he will at least reply to the letter I sent him last Thursday—I will place a copy in the Library of the House. He has been stonewalling journalists’ questions, but since he says he wants to talk about the Government’s record, let me ask him about that instead. We went into the pandemic with NHS waiting lists already at 4.5 million. We went into the pandemic with NHS staff shortages of 100,000. We went into the pandemic with social care staffing vacancies of 112,000. So it is not just the case that the Tories did not fix the roof while the sun was shining; they dismantled the roof, removed the floorboards and now they have no plan to fix it. Where is the Secretary of State’s plan to fix the NHS crisis?

[Mr Speaker]

Order. Once again, I remind Members that topicals are short and punchy questions, not lengthy statements. A lot of Back Benchers on both sides deserve to get in to raise constituency matters, so please let us give them time. I do not want a lengthy fall-out, and these are Health questions.

[Sajid Javid]

Mr Speaker, you have been very generous to the hon. Gentleman: you gave him another try, but that was another failure to ask a question. Again, the hon. Gentleman is not asking about the serious issues, which again shows that he will play petty party politics and that Labour has no plan for the challenges this country faces.

[Mr Speaker]

May I just reassure the Secretary of State for Health that I was not being generous? The shadow Secretary of State had two questions, so I have not been generous in any shape, way or form.

[Mark Fletcher (Bolsover) (Con)]

T2. We have all seen the disturbing scenes in Shanghai recently. Does my right hon. Friend agree that this shows how dangerous a zero covid strategy is and that we were right to open up this country and to rely on our vaccines as the safest way out of the covid situation?

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[Several hon. Members rose—]

[Mr Speaker]

Come on; we have got to get others in.

[The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)]

I thank the hon. Lady for her question, and we have met to discuss this previously. I am happy to discuss with Health Education England whether one of its centres for dentist development could be suitable for her constituency.

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[Mr Speaker]

I call the Chair of the Select Committee, Jeremy Hunt.

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

The Secretary of State will have read the scandal exposed in The Sunday Times this weekend that six babies are born every month after being exposed to sodium valproate, which has been known for many years to cause disabilities. Last year the Government consulted on putting warning labels on valproate. Is it not time to go much further and ban the prescription of sodium valproate to epileptic pregnant mothers?

[Mr Toby Perkins (Chesterfield) (Lab)]

T7. The Secretary of State is right that we all want to get to the bottom of many important health matters, and we do not want what he described as personal affairs to get in the way of that. In order to ensure that the House concentrates entirely on those matters, will he welcome HMRC investigating whether he was claiming non-dom status on a solely—

[Mr Speaker]

Order. Let us move on. What a waste of a question. Dehenna Davison.

[Dehenna Davison (Bishop Auckland) (Con)]

Thank you, Mr Speaker. I will try not to make this one a waste. I was grateful to the Minister for meeting me to discuss my ongoing campaign to restore the A&E to Bishop Auckland Hospital. Many of my constituents face a long drive to get to Darlington or Durham, and given that swift treatment can be a significant factor in outcomes for conditions such as strokes and heart attacks, does he agree that having A&E services spread geographically rather than just in strong population centres is an essential part of keeping our community safe?