Community Pharmacies: Devon and the South-west

Luke Evans Excerpts

Tuesday 17th December 2024 Westminster Hall

[Dr Luke Evans (Hinckley and Bosworth) (Con)]

It is a pleasure to serve under your chairmanship, Mr Betts, and to speak across the Chamber from the Minister for the first time.

As a GP, I am grateful for the fact that 38 million GP appointments are saved each year. Although the temptation is to try to thank everyone—it can feel like doing a set of prescriptions again—I pay particular tribute to the pharmacists, because whenever I used to get a call from a pharmacist, I always knew that they were right and that I should listen carefully to what they said.

As of January 2024, there were more than 10,000 pharmacies providing NHS services, with 80% of the population living within 20 minutes’ walking distance of a pharmacy. We know that the number of registered pharmacists also grew consistently under the last Government, up 61% in 2024 compared with 2010. I am pleased to hear that the Government are still committing to the NHS workforce plan. As we have heard today, there are still difficulties in meeting recruitment needs.

I congratulate the hon. Member for Tiverton and Minehead (Rachel Gilmour) on securing her first debate. As she rightly pointed out, there are many difficulties in the sector. I would like to take a quick canter through them. With five minutes, I have five questions to the Minister.

The first and most obvious issue is the community pharmacy contractual framework, which is so important to the financial agreement for 2024-25. This was a deal struck in July 2019 to provide £2.59 billion in annual funding to NHS pharmacy services. Under the last Government, in 2023, the NHS published a delivery plan for improving access to primary care, which included a £645 million investment over two years to expand community pharmacies. However, the delays in the negotiations are having an impact on pharmacies across the country. In a recent letter, Community Pharmacy England wrote that

“there will not be a community pharmacy sector left to deliver the Contractual Framework, let alone the future ambitions of the Government and the NHS.”

Question No. 1 is: can the Minister provide an update on the negotiations? When will it start, and will there be published terms of reference?

My next question relates to the impact of the increases in national insurance contributions and the national living wage—the Government’s choice to place a burden of about £50 million on the sector, as has been set out. The Government have exempted secondary care, but made no such commitment to community pharmacies. Question No. 2 is: was the Health Department aware of the Treasury’s decision, and did it raise concerns about pharmacies and the impact the changes would have? After all, it has led the National Pharmacy Association to vote in favour of collective action for the first time in their history, saying:

“The sense of anger among pharmacy owners has been intensified exponentially by the Budget, with its hike in national insurance employers’ contributions and the unfunded national living wage increase, which has tipped even more pharmacies to the brink.”

Question No. 3 is: what mitigations are planned and when for? As we have heard from the Prime Minister, the Chancellor and the Health Secretary, it will be done in the usual way. Decisions are being made now, so could they please set that out?

Let me turn to the evolving model of Pharmacy First. The programme has shown just how capable pharmacies are, and it has been welcomed. There is great potential for the service to benefit patients, yet recent data from NHS England identifies that GP referrals to Pharmacy First in England can vary quite significantly across integrated care boards. For example, in Greater Manchester, there were 11,683 referrals, whereas in Cornwall and Isles of Scilly, there were 612. There could be obvious reasons for that, such as demographics or locations, but question No. 4 is: can the Minister clarify what the Government are doing to promote Pharmacy First services, and share that data?

I was pleased to hear the hon. Member for Mid Dorset and North Poole (Vikki Slade) discuss the issue of dispensing GPs. There are 948 dispensing GPs, and they account for 7% of prescriptions, covering almost 9 million people, many of whom are in rural areas. Not much is mentioned about what they do, so I am keen to understand the Government’s position on dispensing GPs. Question No. 5 is: will the Minister set out how he perceives the landscape? Given the time constraints of this debate, perhaps he can write and give me an idea of what it would look like.

Finally, the pharmacies stepped up during the pandemic. They were the lightning rod not only for getting medications out but for providing the much-needed vaccinations that allowed us to relieve lockdown. Christmas is one of their busiest times—I have seen that at first hand. I would like to put on record our thanks, from both sides of the House, for the fantastic job that they do.

[The Minister for Care (Stephen Kinnock)]

It is a real pleasure to serve under your chairship, Mr Betts. I thank the hon. Member for Tiverton and Minehead (Rachel Gilmour) for ensuring that this really important debate can take place today. I start by acknowledging and paying tribute to the outstanding work of community pharmacy teams in Devon, the south-west and right across the country. I have heard so many examples, showing just how many patients and communities rely on pharmacy services, and the lengths to which they go to deliver care. I thank them for their professionalism, hard work and dedication in providing excellent standards of patient care.

It is a credit to them that surveys show that nine in 10 people who visit pharmacies feel positive about the experience. Community pharmacies are often the most accessible part of our NHS, allowing people to access professional healthcare advice right there on the high street. They are also vital in supporting rural communities and people living in remote locations. Furthermore, as community pharmacies provide more clinical services, they help to relieve pressure in other areas of the NHS. That includes freeing up GP appointments, preventing hospital admissions and reducing overall pressure on secondary care.

For far too long, however, Governments have failed to recognise the essential role of community pharmacies in safeguarding the nation’s health. On 4 July, we inherited a system that has been starved of funding, with a 28% cut in funding in real terms. In many ways, it is on its knees, with far too many closures happening across the country. Lord Darzi’s report laid bare the true extent of the challenges facing our health service. Even he, with all his years of experience, was truly shocked by what he discovered. His report was vital, because it gave us a frank assessment—a diagnosis—so that we can face the problems honestly and properly. It will take a decade of national renewal, lasting reform and a long-term plan to save our NHS. We have committed to three key shifts: from hospital to community, from analogue to digital, and from sickness to prevention. Our 10-year plan will set out how we will deliver these shifts to ensure that the NHS is fit for the future.

To develop the plan, we must have a meaningful conversation with the country and those who work in the system. We are therefore conducting a comprehensive range of engagement activities, bringing in views from the public, the health and care workforce, national and local stakeholders, system leaders and parliamentarians. I urge Members, their constituents, and staff across health and social care to tell us what is working and what needs to change. They should visit change.nhs.uk and make their voice heard.

The Government are committed to restoring the NHS to its founding promise that it will be there for all of us and our constituents when we need it. However, as identified by Lord Darzi’s review, primary care is under massive pressure and in crisis. I recognise that it is a really challenging environment for colleagues in all parts of the NHS, including in community pharmacy, but we remain resolute and determined to fix this situation.

Pharmacies are based in, and are a key part of, the communities that they serve. They are ideally placed to help to tackle inequalities and to increase the reach of and access to NHS services. This includes delivering a range of health advice and support services, helping to relieve pressure on and improve access to the wider NHS. Community pharmacies are a vital part of our NHS that must be recognised in the development of the Government’s 10-year plan. They are central to the three big shifts in healthcare that I outlined earlier. I know that pharmacies can and should play an even greater role in providing healthcare on the high street. This will be imperative if we are to deliver across the Government’s mission—not just on the health mission, but on growth and opportunity.

A healthy society and workforce are pre-conditions for prosperity and growth. We have a staggering 2.9 million people who want to work, but are unable to do so because they have been failed by our health and care system for the last 14 years. Community pharmacy has a pivotal role to play in getting our economy back on its feet and fit for the future, whether that is by identifying those with risk factors for disease such as high blood pressure, or ensuring that people can access and use their medicines to best effect. As a Government, we are fully committed to working with the sector to achieve what we all want: a community pharmacy service that is fit for the future.

I am keen to unlock the potential of the whole pharmacy team. We want pharmacists to be providing new and impactful clinical services, including our future pharmacies prescribing service. We want pharmacy technicians to have more responsibility in supporting the pharmacists, to help people to deliver the best possible health outcomes.

Every day, pharmacy teams facilitate the safe supply of medicines to patients, enabling them to manage health conditions as part of their daily lives in Devon, the south-west and right across the country. They also provide vital advice on prescriptions, over-the-counter medicines and minor ailments. But pharmacies do not just dispense medicines and offer advice. They do much more. They positively impact patients’ health and support the wider NHS by providing a wide range of clinical services. Many offer blood pressure checks, flu or covid-19 vaccinations, contraception consultations and many more locally commissioned services.

[Dr Evans]

The Minister is espousing brilliantly what community pharmacies do. That all comes under a contractual framework, and one of the key things that pharmacies are asking for is when the negotiations will start and what the terms of reference will be. Will the Minister address that point?

[Stephen Kinnock]

I thank the shadow Minister for that intervention. I am as frustrated as everybody else about the delay. The reason for the delay is that the negotiations did not get over the line before the general election. The general election came, and we have spent a lot of time now clearing up the disastrous mess that the previous Government made of the system. I can say that we are now very focused on getting these negotiations started early in the new year. I know that hon. Members across the House will be very interested in that, in terms of the contractual framework, the medicines margin and all of the funding. We have a statutory duty to consult with the sector before we can make any announcement, but we are confident that we will start the negotiations early in the new year.

We supported Pharmacy First in opposition, and we will build on that programme in the future. We look to create an independent prescribing service, where prescribing is an integral part of the services delivered by community pharmacies. We are also doing a lot of work on the IT infrastructure to make sure that the sector can more easily prescribe and refer through better IT. That is an important part of our shift from analogue to digital. We need pharmacies delivering services that help patients to access advice, prevention and treatment more easily—services that help people to make best use of the medicines they are prescribed and that ease some of the pressures in general practice and across parts of the NHS.

There are more than 10,000 pharmacies in England. They are busy dispensing medicines, offering advice and providing these services. Patients across the country can also choose to access around 400 distance-selling pharmacies that deliver medicines to patients’ homes free of charge. They play a vital role in reaching the most isolated members of our society.

I am very keen to ensure that the hon. Member for Tiverton and Minehead has a minute at the end of the debate to sum up. In the short time I have, I want to say a couple of words about her constituency, where there are 15 pharmacies. We are aware of the closure of one pharmacy in her constituency since 2017 and that the local population instead get their medicines from the neighbouring dispensing GP. I also note that, according to the latest data, there are 203 pharmacies in Devon; across the south-west, there are 916. Where closures have occurred across the south-west, the ICBs are working through the process of approving applications from new contractors. Some applications have already been granted. Following approval, the new pharmacy contractor has 12 to 15 months in which to open a pharmacy, so the ICBs are also working with GP practices and other contractors to minimise any temporary disruption for patients.

Community pharmacies are a vital part of the NHS and communities across our country. The Government are committed to supporting them now and into the future. I look forward to working with pharmacists across the country and hon. Members across this House as we progress our plans to embrace the skills, knowledge and expertise in pharmacy teams.

Rare Autoimmune Rheumatic Diseases

Luke Evans Excerpts

Tuesday 10th December 2024 Westminster Hall

[Dr Luke Evans (Hinckley and Bosworth) (Con)]

It is a pleasure to serve under your leadership, Dr Huq, and thank you for the introduction.

I thank the hon. Member for Strangford (Jim Shannon) for his detailed canter through a subject that needs to be highlighted. He hit the nail on the head in relation to improving clinical pathways. We, as a House, need to think about the best way to do that, and to help the NHS to do that. He exemplified that by telling Zoi’s story.

As the hon. Member for Bootle (Peter Dowd) rightly highlighted, the impact on patients is the crux of the matter, which was also personified by the hon. Member for Mid Sussex (Alison Bennett) with her story about Carrie—what she and her mother have to go through, and the difficulties they are living and breathing every single day. The co-ordination of care is so important. The hon. Member for East Londonderry (Mr Campbell), who is no longer in his place, made a timely and pointed intervention about clinicians, awareness and training.

Being a clinician, and bringing that experience to the House, I believe it is difficult to identify the issues because they are often masked by other conditions. A random screening test may conclude rheumatoid factor, anti-CCP antibodies, ESR, CRP, ANA, ANCA, and even anti-ro and anti-la. All those may be positive or negative, and can be indicative of, but not definitive about, some of those conditions. That is part of the problem we have with those rare diseases. With 170,000 people affected, they are uncommon but common enough for us to see them. I certainly have treated several patients with conditions such as systemic lupus erythematosus, Sjögren’s or Raynaud’s.

When we think about these conditions, we need to break them into two distinct groups: the connective tissue disorders, such as lupus, scleroderma, myositis and Sjögren’s, and vasculitis disorders, such as ANCA-associated vasculitis, giant cell arteritis and Behçet’s. By their nature, because they are rare, they are hard to diagnose. I hope that in the future, we may well have artificial intelligence to help clinicians to identify, or at least to think about, the differential diagnosis when it comes to dealing with those patients.

It is a broad and difficult topic to break down, so it will be helpful to look in turn at the framework to address rare diseases, the research behind it, the diagnosis, the workforce, and, finally, the treatment. A framework to help the approach is important, so under the previous Government, the UK rare diseases framework was published in 2021 to set out a vision to improve the care for people with rare diseases. It set out four priorities: delivering early diagnosis, increasing awareness among health professionals, improving access to a specialist team and providing co-ordinated care. In essence, that is the care pathway.

The framework was designed to improve the speed of diagnosis, the co-ordination of care and the access to treatment. As RAIRDA said:

“The UK rare disease framework (2021) has been a significant step in securing equity of treatment for rare diseases, and going forwards, it is crucial that the Government does not lose sight of the work done to date to drive changes for people living with rare conditions.”

Therefore, I ask the Minister my first question: how do the Government intend to build on the UK rare diseases framework to ensure that it remains adequately funded and relevant?

Next, we need the research, and that is the hardest part. As I mentioned, some of the tests cannot even diagnose conditions such as Behçet’s syndrome; it is often a clinical diagnosis. The establishment of the Genomics England project, further mapping the genetic codes of individuals with rare conditions, was a move hailed by researchers worldwide. The programme, although ostensibly broad, directly benefits patients with rare autoimmune rheumatic diseases by identifying genetic markers and enabling targeted treatments. My second question to the Minister is: what progress has been made in expanding genetic research to uncover new treatment options for such diseases?

Earlier this year, the Government published an action plan that includes significant new commitments against each of those four framework priorities, including the health inequalities that we have heard so expertly talked about today. The action plan highlighted the significant investment in driving research on the diseases, including £14 million to the Rare Disease Research UK platform. That facilitates greater collaboration between academics, clinical and industry research, as well as people living with rare diseases, research charities and other stakeholders to try to accelerate the understanding, diagnosis and therapy of these diseases. I was pleased to stand on a manifesto commitment to take forward the rare disease action plan.

I fully accept that more needs to be done, and the new Government must work closely with their delivery partners on the matter. I was pleased that in a recent written response, the Government reiterated their support for research into rare diseases. They further highlighted that the Department for Health and Social Care has invested £2.2 million to enable the National Institute of Health and Care Research to carry out research programmes related to rare genetic diseases, and of course the £340 million to Genomics England.

I did my medical training at the University of Birmingham medical school, which has the University of Birmingham Centre for Rare Disease Studies, a collaboration to try to pull together all the academic research. That is translational research. As we keep saying, these diseases are rare so, by definition, to do the trials, we need to have a wide pool to pull people together to try to work things out. I hope the hon. Member for Strangford will be interested in the fact that that university has joined with the Queen’s University Belfast to research and collaborate across the four nations, including with Newcastle University. In 2015, I had the privilege of visiting that centre, and this is a note for him to look into that. Will the Government continue to increase funding specifically for rare autoimmune rheumatic diseases, especially within the Medical Research Council’s care for rare disease programme?

Then we need to look at workforce and testing capacity. Over the last few years, the Government have allocated £2.3 billion to community diagnostic centres, of which there are almost 170 across the country. Those are really important for doing blood tests, ultrasounds, MRI scans and CT scans. In my constituency, I am lucky enough to have had £24 million invested; one is being built as we speak. That is revolutionary for our area, because for too long people had to travel to the likes of the George Eliot Medical Centre or to Leicester. Now they can have these tests in their community, providing swifter access. I hope that that will help people like Zoi, about whom we have heard, by making sure that she is one of the lucky ones who gets swift access.

Within that, we also need the people who can do the tests and understand the specialisms, so will the Minister tell us whether the Government will be expanding the network of CDCs any further? On staffing, the last Government brought forward the NHS workforce plan. How are this Government looking at addressing rheumatology and radiology in that plan to make sure there are no gaps?

Treatment is the one thing we are looking for. We have the diagnosis, but we need the treatment. Innovative drugs are coming, including immunotherapies, but they often come with high price tags. NICE is looking at how to speed things up, but will the Government commit to accelerating the processes so that we can make sure people get these innovative drugs as quickly as possible? We should not forget that standard drugs are used as well, including methotrexate. They can be quite dangerous, so I ask the Government what they are doing to ensure safe use of such drugs. Disease-modifying medications are important, but they can have high toxicity if not used properly, so they can cause harm. Safety is really important.

The previous Government’s legacy is one of frameworks being established, investment being made and a road to improve lives. For the 2024 general election, RAIRDA published a manifesto that called on the Government to ensure that rare diseases remain a priority, to develop a quality standard for rare diseases and to develop better support for specialist networks. How will the Government work to consider and address those points? I hope this debate has highlighted exactly those calls, because we unanimously agree that this is what we need: research, networks, support and treatments for the individuals who are suffering.

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

It is a pleasure to serve under your chairmanship, Dr Huq. I thank the hon. Member for Strangford (Jim Shannon)—I want to call him an hon. Friend because he is a friend, but convention dictates that I must call him an hon. Member—and I welcome the fact that he cares so much about health-related issues. I now see him more than I see my wife, because he is always in debates about a whole range of health conditions, and he brings so much passion to those debates. Importantly, he highlights rare diseases. I thank him for the way he made his case this morning, and for speaking about Zoi’s experience. When we humanise these things, we make them all the more impactful.

I thank my hon. Friend the Member for Bootle (Peter Dowd) for his contributions, and I thank the Liberal Democrat spokesperson, the hon. Member for Mid Sussex (Alison Bennett), for humanising the issue through Carrie’s story; that is crucial. The shadow Minister, the hon. Member for Hinckley and Bosworth (Dr Evans), brings his professional experience to this debate, and that cannot be underestimated. I confess that I am not a medical professional, but in health debates it is important to listen to the expertise of those who work in the sector and on the frontline. I thank him genuinely for the way he has approached the debate. This is not a party political, knockabout debate; it is something on which we all want to see progress. The beauty of Westminster Hall is that we can leave the knockabout to the main Chamber, and in this room we can get into the detail of important subjects that are often overlooked. I pay tribute to those who are affected by rare disease, including rare autoimmune rheumatic diseases, and to their families.

The work of patient organisations such as RAIRDA is vital in raising awareness and campaigning to improve the lives of people who are living with rare diseases, and I thank those who dedicate their lives to this community. It is important to make the point that although rare diseases are individually rare, they are collectively common. One in 17 people will be affected by a rare condition over their lifetime. People living with rare diseases may face additional challenges in accessing health and social care. As the hon. Member for Mid Sussex said, this applies to a whole range of health services, including dentistry, and I hope that the Minister responsible for dentistry will pick that up. I will ensure that he receives her comments, because dentistry is often overlooked when it comes to people with rare conditions.

We are committed to improving the lives of people who are living with rare conditions. As the hon. Member for Strangford mentions, the UK rare diseases framework outlines four priorities to achieve this aim: helping patients to get a final diagnosis faster; increasing awareness of rare diseases among healthcare professionals; bettering co-ordination of care; and improving access to specialist care, treatments and drugs. Rare diseases are a priority for the Government. In England, we publish a rare diseases action plan annually, which details the specific steps we are taking to meet the shared priorities of the framework. Each action has an owner, desired outcomes and detail about how we will measure and report on progress. This Government are committed to delivering on the priorities framework, and we are working to publish the next England action plan in early 2025.

The UK rare diseases framework comes to an end in 2026, and I know that the rare disease community would like the policy to continue, to maintain the momentum and progress made over the lifetime of the previous framework. It is UK-wide and agreed across the devolved nations, and I am more than happy to discuss it further with colleagues in Wales and Scotland and, for the hon. Member for Strangford, with Mike Nesbitt, the Health Minister in Northern Ireland. I am the UK Health Minister with responsibility for engagement with the devolved Administrations when it comes to health and social care; indeed, we have a meeting with them and with the Secretary of State tomorrow to discuss a whole range of subjects. I am more than happy to discuss this issue further with colleagues to see if we can maintain four-nation co-ordination in this area. I believe that if we can do so, we should. I give the hon. Member for Strangford my commitment that I will take the matter up with the devolved Health Ministers to see if we can continue the four-nation approach.

In England, I am committed to working towards the four priorities of the framework, which were identified through the 2019 national conversation on rare diseases. Alongside the evaluation of England’s rare disease action plans commissioned through NIHR, the Department will undertake engagement next year to inform future policy decisions. The Government are committed to providing the best diagnosis and care for rare diseases, as set out in the UK rare diseases framework. Good diagnosis should be timely and accurate, and I know that people living with rare diseases often face journeys that are years long—diagnostic odysseys—before they receive an answer.

As the shadow Minister set out, many health professionals are involved in a patient’s journey, from those in specialist testing and genetic screening to GPs and primary care professionals. Raising awareness of rare conditions among those professionals is one way in which we can help to speed up diagnosis. I know that every experience of living with a rare disease is unique, and, with more than 7,000 identified rare diseases, we focus on addressing shared challenges across all rare diseases.

Although the increasing use of genetic testing is an groundbreaking tool in diagnosis, many conditions, including rare rheumatic autoimmune diseases, do not have an identified genetic component, so it is important that overall awareness, diagnostics and quality of care continue to serve all people living with rare conditions. NHS England is working to improve awareness of rare diseases among healthcare professionals, including those in primary care, through the NHS England genomics education programme, which includes non-genetic rare diseases. The GEP provides education and training to support the specialist and wider workforce to diagnose rare conditions early and to know how to deliver the best possible care for patients and families—the shadow Minister mentioned that. Working with partners such as Medics 4 Rare Diseases, the GEP has created genomic notes for clinicians, GeNotes, an innovative digital educational resource for healthcare professionals. The GEP works to provide information to GPs where and when they need it—for example, by presenting at primary care educational events, producing blended learning modules for GP trainees or ensuring regular reviews of the curriculum of the Royal College of General Practitioners.

The shadow Minister rightly mentioned research. I reassure him that the Department of Health and Social Care—this started on the previous Government’s watch, and we rightly are continuing the progress—supports research into rare diseases through the NIHR. The NIHR is the nation’s largest funder of health and care research, and it welcomes funding applications for research into any aspect of human health, including rare diseases. The usual practice of the NIHR and other research funders is not to ringfence funds for expenditure on particular topics. The “Rare Diseases Research Landscape Project Report” described investment of almost £630 million from MRC and NIHR programmes in rare disease research over five years. We are now working with the rare diseases community to further understand the gaps and the priorities, and to get them into those research pathways so that we can, we hope, fill the gaps.

As many rare diseases are chronic and affect multiple body systems, those living with rare disease face complex condition management, and interact with many specialists and providers of health and social care. That can include travelling across the country to access highly specialised care from experts. All of that can add up to a significant emotional and physical burden, and deepens existing inequalities. Co-ordination of care is essential to ensure that care is effectively managed, that the burden on patients and their carers is minimised and that healthcare professionals are working together to provide the best possible joined-up and high-quality care.

Last year, we hosted a workshop with RAIRDA to explore how best to support people living with “non-genetic” rare diseases. That highlighted the importance of specialised networks of care in delivering high-quality care at value for money. As we heard from the hon. Member for Strangford, networks, such as the Eastern Network for Rare Autoimmune Disease, are an example of best practice. I encourage integrated care boards to consider similar models across the whole country for types of rare diseases. I am more than happy to look closely at how we can seek to spread that best practice across the country, across different rare disease types and across ICBs, because patients with rare conditions deserve the same quality, safety and efficacy in medicines as other patients with more common conditions.

NICE, the MHRA and NHS England are working to understand and to address challenges preventing treatments for rare conditions from reaching patients who need them. I take on board precisely the points that the shadow Minister raises about the new drugs, how we ensure faster access and how we create the environment whereby clinical trials are more readily available in the United Kingdom. I want to assure Members that that is a central part not just of our health mission but of the Government’s economic mission, because we want the United Kingdom to be a base for investment in life sciences, in medtech and in access to clinical trials, so that our patients win as well as our economy. We have to ensure that safety is foremost in our deliberations. Safety is paramount, and we must ensure, in whatever regulatory regime that we have to encourage the life sciences, medtech and data industries into the UK, that safety is never compromised. I take on board fully the comments made by the shadow Minister.

NICE has also been working with RAIRDA to create a quality standard for rare diseases. That will find commonalities across the more than 7,000 identified rare diseases to develop standards that will drive quality improvement across multiple rare disease groups. Although the majority of rare diseases are genetic, others, such as rare autoimmune rheumatic diseases, do not yet have an identified genetic cause, as I said. A study by Genetic Alliance UK suggests that such conditions often have higher prevalence, impacting on a significant number of people, so it is important that both genetic and non-genetic conditions are considered.

Approximately 3.5 million people in the UK live with a rare condition, and addressing shared challenges across all conditions will be central to this Government’s approach. In addition, shared challenges across the health and social care system are often exacerbated for people living with rare diseases, such as access to mental health support—something else that the hon. Member for Mid Sussex mentioned. A central mission of this Government is to build a health and care system fit for the future.

The hon. Member for Strangford referred to our 10-year health plan. I reassure the House that that is intended to focus on the three shifts needed to deliver a modern NHS—not just fixing our NHS, but making it fit for the future, for the next 10, 20 or 30 years, putting it on a modernised footing as well as fixing the fundamentals. The three shifts are moving from hospital to community, from analogue to digital and from sickness to prevention. Those shifts offer opportunities to improve time to diagnosis and care for people living with rare diseases. Many highly specialised services for rare diseases must be delivered in hospitals to ensure the high standards of expert care that we want to see, but we can improve co-ordination of care to deliver better treatments closer to where people live, where possible. While many rare diseases are not preventable, early diagnosis can lead to interventions that improve health outcomes.

On the point made by the shadow Minister about community diagnostic centres, the Government’s commitment is to continue that programme. Indeed, I have seen the benefits of it myself—I got to open the new CDC at Crownpoint in Denton in my constituency in July. It is already having a game-changing impact on the local community, giving faster diagnosis and getting people into treatment more quickly, with better outcomes and better patient experiences for those who access the facilities.

The 10-year plan will ensure a better health service for everyone, regardless of condition or service area. On 21 October, we launched a national conversation on the future of the NHS, inviting views from across the country on how to deliver a health service fit for the future. Patients, staff and organisations can make themselves heard by logging on to the online portal, change.nhs.uk. I encourage hon. Members to do the same and to encourage their constituents to do likewise, if they have not done so already.

Unmet need remains, however, for people living with rare diseases, including rare autoimmune rheumatic conditions. I reaffirm that I am deeply committed, as is this Government, to working across the health and care system and with the rare disease community to address that need.

Finally, on workforce, the hon. Member for Strangford and other Members asked if the goal of the Government is to ensure that a patient gets the treatment, and that we get that treatment with the workforce we have. Getting that right workforce will be key. I reassure Members that the goal of the Government is to ensure that the patient, as they deserve, gets all the help that the NHS can offer in treatment, care and support.

The 10-year health plan will deliver those three big shifts on hospitals to community, analogue to digital, and sickness to prevention. To support delivery of the plan, the Secretary of State has confirmed that next summer we will refresh the NHS long-term workforce plan. That will help to ensure that the NHS has the right people in the right places with the right skills to deliver the care that patients need when they need it, not just today but in the future. The shifts we want to see in the delivery of healthcare will require us to rethink the kind of workforce we need in 10 years’ time.

[Dr Luke Evans]

I am grateful to the Minister for acknowledging the workforce, and for looking at the workforce plan. I was aware of the Health Secretary’s plan to revisit this, and the Minister talks about it being done next year. Does he have a timescale for how long the review will take? The danger, especially in healthcare, is that modernisation happens so quickly that, by the time we review something, it is already out of date and needs another review. This is always a chicken-and-egg situation. I would be grateful for a timescale.

[Andrew Gwynne]

We will refresh it next summer, and the Department is already beginning to think about whether this is what the shifts are intended to bring about, and whether these are the outcomes we want to see as a result of those shifts. If we are to have a neighbourhood health service that delivers much more in a community setting, how do we ensure we have the right skills and the right workforce to deliver that?

Particularly with the shift from analogue to digital, we will need a lot more tech-savvy clinicians, too. How do we build in some of the massive advances in artificial intelligence into medical devices and medical technology? We will be doing that concurrently with the 10-year plan to make sure that the workforce plan refresh is ready to go. This will allow us to embed the future, not just today’s practices, into the training and recruitment processes for the immediate future. The refresh will begin next summer, but it is a chicken-and-egg situation. We need to work out what the future of the NHS will look like, and then we have to ensure that we have the skills to meet that ambition—not just for today, but for the future.

In closing, I again thank my friend, the hon. Member for Strangford, for raising such an important matter, and I thank the rare diseases community for their continued and constructive engagement with the Government to help bring about meaningful change. I hope I have reassured the hon. Gentleman both on cross-UK working—and I take up his challenge to try to get colleagues across the devolved Administrations to agree to continue a UK-wide approach—and on my specific responsibility here in England. We will take forward the four areas identified in the UK plan. We will have a new plan for England, and we will seek to make the significant progress that I believe all Members of this House want to see happen.

I am more than happy to work collegiately with Members across the House, whose role is to scrutinise the Government, to hold our feet to the coals and to make sure we do what is in the plan at the best speed and pace for people living with these conditions. I also accept that I am not the sole fount of all wisdom in this area.

[Dr Luke Evans]

No!

[Andrew Gwynne]

I know the shadow Minister is surprised by that. Genuinely, whatever people bring to the table, whether it is personal experience, professional expertise or their constituents’ stories, we need to share that knowledge so that we can improve how we deliver the outcomes we want to see for people living with rare diseases. I stand willing and ready to work with hon. Members across the House, and indeed with organisations that champion this area, so we can get the best outcomes that people deserve.

Lobular Breast Cancer

Luke Evans Excerpts

Tuesday 10th December 2024 Westminster Hall

[Dr Luke Evans (Hinckley and Bosworth) (Con)]

It is a pleasure and an honour to serve under your stewardship, Ms Vaz, and even more of an honour to be part of this debate. I pay tribute to the hon. Member for Dulwich and West Norwood (Helen Hayes). Not only was her speech emotional, but it was powerful. Cressida, I am sure, is incredibly proud and Heather would be even more proud. That is because the hon. Lady has really done the subject justice today, not only by securing this debate but by bringing the whole room together and highlighting the most salient points. Often in these debates, there is a lot to cover, and the hon. Lady has done it with aplomb.

I also thank my hon. Friend the Member for Maidstone and Malling (Helen Grant) and the hon. Member for City of Durham (Mary Kelly Foy) for speaking up about their personal experiences. That is tough to do, and it is a testament to their constituents that they have put on record, in public, the trials and tribulations they have been through. It is important that people feel they can advocate in this space and lead by example in doing so.

That leads me on to the hon. Member for Bexleyheath and Crayford (Daniel Francis), who talked about his wife. He is an example of how important it is to have a powerful advocate. Partners and families do exactly that: they advocate for patients who are going through treatment. The fact that he is doing that here as well is incredibly powerful.

The hon. Member for Strangford (Jim Shannon) and I are starting to have regular conversations about health in Westminster Hall debates, with an hour and a half this morning and another hour and a half this afternoon. His passion for health topics is probably only superseded by the volumes of Hansard content he accounts for. He talked about networks, and in research it is important to make sure that we are bringing together the best brains from across the field for the biggest possible research pools. That is much needed.

I congratulate the hon. Member for Horsham (John Milne) on highlighting hope. The danger is that we spend too much time talking about difficulties, when over the past couple of decades, breast cancer actually provides a good story of how far advances have been made and survival rates improved. It is important that we point that out, so that not all is doom and gloom. There are fantastic survival rates for breast cancer, for example.

The hon. Gentleman paid tribute to Dr Susan Michaelis, as did the hon. Member for Wokingham (Clive Jones). As MPs, we are lobbied a lot, so to have got so many MPs signed up and to have secured debates here repeatedly, month on month and year on year, is an incredible testament to the character of Dr Michaelis.

The Lib Dem spokesperson, the hon. Member for North Shropshire (Helen Morgan), rightly highlighted access. When it comes to making sure we get diagnoses, access is key. The last Government rolled out community diagnostic centres—almost 170 of them. When it comes to diseases such as breast cancer, I hope that new MRI and CT scanners will become available, allowing us to have better screening pathways, because that is what often limits a screening programme. That access is now being widened so dramatically, with the Government confirming this morning that they are continuing with it, is a sign of great cross-party working, which we all know the NHS needs.

Much has been said about lobular breast cancer in this debate, and for me it matters because of the way it presents. One can take the doctor out of medicine but not the medicine out of the doctor, so I will use this opportunity to ensure that people are aware that they should regularly check their breasts. They should look for lumps but also for skin changes, or what we call peau d’orange—it looks a little like orange peel—on the breast. They should also look for slight changes, a little bit of discharge or blood. Lumps, bumps and discharge do not mean an individual has cancer; it simply means they need to be assessed.

One of the great things about the set-up in this country is that it is quick and accessible—a good success story—but we need to ensure that people feel comfortable and able to come forward. Cases have been highlighted where clinicians did not seem to trust women. It is important that clinicians trust women’s instincts. Women know their own breasts, and when they are aware of changes, they must be taken seriously. We have a chance through clinical pathways to do that, which is important.

We heard that 22 women a day in the UK are diagnosed with lobular breast cancer. As someone who has given that diagnosis, my next piece of advice for anyone unfortunate enough to receive a diagnosis of breast cancer is to ask whether it is lobular or ductal. That is often forgotten. As a clinician, I have never been asked that question, but it would help to change the narrative of expectations about what treatments may be available, and promote understanding. If a patient speaks to someone else with breast cancer, they might wonder why their treatment is different. It is important to educate people, not in a condescending way, but to appreciate the general difference. Treatments are becoming so specialised and nuanced that all will not be the same, and that can be quite disconcerting.

I pay tribute to those who are battling lobular cancer, the cancer survivors and the campaigners from Lobular Breast Cancer UK for their tireless work in raising the issue. Of course, the ultimate goal is to have a cure for lobular breast cancer. Advances in medical research and treatment options are moving us closer to that goal. In 2022, the Government invested £29 million into the Institute for Cancer Research and the Royal Marsden biomedical research centre to support research into cancer, including lobular breast cancer. That included a £1.3 million project to determine whether abbreviated forms of breast MRI can detect breast cancers missed in screening. That links to the point about having more MRI scanners, which might well enable better research to determine the way to pick these things up and improve the ability to deliver.

I am pleased the previous Government supported, through the National Institute for Health and Care Research clinical research network, 10 further lobular breast cancer-related studies. I am also reassured by the Lobular Moon Shot Project, which we have heard a lot about. I pay tribute to the former Member for Horsham, Sir Jeremy Quin, who did a lot to raise that issue. I am pleased to see the new hon. Member for Horsham standing in his shoes to raise it now. It would be useful to know if the £20 million for the five-year study is being looked at by the Government. It was raised several times with the previous Government, but an election got in the way and power changed hands. It would be interesting to see if the proposals have been reviewed and merit the Government taking them forward.

A key measure that has been missed to some extent is guidelines. Lobular Breast Cancer UK is to launch a campaign calling for national breast cancer guidelines to be updated to recognise lobular breast cancer. Will the Minister commit to reviewing and updating the guidelines with the National Institute for Health and Care Excellence? We have also heard about devolved powers. Scotland, for instance, has the Scottish Intercollegiate Guidelines Network. It would be useful to know whether the Minister will raise this issue with the devolved nations to ensure we have a joined-up approach, without any cross-boundary difficulties.

I do not want to turn this into a political battle because this is not the place, but I put it gently to the Minister that we have heard about the need for support, a lot of which comes from charities. The changes in national insurance contributions for employers have hit charities, including the likes of Breast Cancer Now, Macmillan and Marie Curie. They are not shielded from the rises. I will be grateful if the Minister considers raising with Treasury what can be done to help support those crucial nurses, advice lines and workers, so as to make sure that when people are going through these difficulties—we have heard how complex the scene can be, particularly in breast cancer—advice is accessible to all.

I thank all those who took part in this debate, and I remind people to regularly examine their breasts. If there is a change, seek help. If a diagnosis of cancer is given, ask if it is lobular or ductal. Finally, remember that no one is alone. As we have heard today, many people suffer from cancer and there is support out there—from the NHS, charities, family and friends—so do not be fearful. Speak out and get that support.

--- Later in debate ---

[Karin Smyth]

I thank the hon. Lady for that really important point. She highlights another important issue affecting the health of women and children, and I agree with her.

My hon. Friend the Member for Dulwich and West Norwood spoke about women’s health overall, which is an important priority for this Government, as are these forms of cancer and the wider preventive agenda. That is another point that can be made on the change.nhs.uk website, which I will keep plugging. The issues that have been raised on it by the public and staff are really interesting and informative.

My right hon. Friend the Secretary of State has been clear that there should be a national cancer plan. The hon. Member for Wokingham (Clive Jones) made helpful points about that opportunity. I will not take up his invitation for a meeting; his point would be better made by being inputted into the process with the organisations he is in touch with. That would help to shape the national cancer plan, which we can all buy into as a country. The plan will include more details about how to improve outcomes for all tumour types, including lobular breast cancer, and ensure that patients have access to the latest treatments and technology. We are now in discussions about what form that plan should take and what its relationship with the 10-year health plan and the Government’s wider health missions should be. We will provide updates on that in due course.

I thank my hon. Friend the Member for Dulwich and West Norwood for bringing this important matter to the House.

[Dr Evans]

I want to draw the Minister’s attention to the point about guidelines. Will she consider speaking to the devolved nations and, in England, to NICE, about guidance on lobular breast cancer?

[Karin Smyth]

I was going to come to that. I am not fully au fait with the change in guidelines that the hon. Gentleman referred to, so I will happily take that point away. He made a wider point about aligning across the devolved regions. Obviously, some of these issues are devolved and we have to respect the devolution arrangements. On the wider research, we should learn from each other, understanding that we have similar patient cohorts. There is lots of good medical work going on, and the Government are determined to work respectfully across the devolved nations. I will ensure that the hon. Gentleman gets a written answer on the specifics of his question.

Heartbreaking stories such as Heather’s remind us that diseases such as lobular breast cancer are complex. They are hard to catch, and therefore treat. Such tragic losses are a wake-up call for us all, and I commend all hon. Members for raising those stories. For people listening in, as well as those who have attended the debate, they are an important way to raise awareness. We are grateful to those who have shared their personal stories, which help us get the NHS back on its feet so that we can better serve the people who need it.

Improving cancer survival requires a multi-pronged approach to ensure that patients have timely access to effective treatments, built on the foundations of world-class research. We have already taken immediate steps to allow cancer patients to benefit from the most up-to-date technology. Through the recent Budget, we committed to surgical hubs and scanners to allow for 30,000 more procedures each year, and we are increasing capacity for tests. We have also committed another £70 million for radiotherapy machines. Lots of hon. Members have raised those points. I have outlined several measures today, and I assure Members that improving outcomes for cancer patients, including those with lobular breast cancer, remains a top priority for this Government.

Oral Answers to Questions

Luke Evans Excerpts

Tuesday 19th November 2024 Commons Chamber

[Mr Speaker]

I call the shadow Minister.

[Dr Luke Evans (Hinckley and Bosworth) (Con)]

The Royal College of General Practitioners has said the national insurance tax increase is expected to cost 2.2 million appointments. We know from answers to written questions that have been submitted that GPs, hospices and care homes are not exempt from the increases, and will not find out until April what, if any, mitigation will be put in place, so cutbacks are now being planned. Will the Secretary of State explain how his choice to tax GPs will increase GP access?

[Wes Streeting]

I can reassure health and care providers that we will be setting out allocations long before April next year. I recognise that people need to plan ahead of the new financial year. When deciding allocations, we take into account the range of pressures on different parts of the system. People have heard what I have said already about the need to shift out of hospital into primary and community services. The shadow Minister talks about choices; Conservative Members seem to welcome the £26 billion investment, but oppose the means of raising it. I am afraid they cannot do both. If they support the investment, they need to support the way in which we raise the money; if they do not support the way in which we raise the money, they need to spell out how they would raise it or be honest about the fact that if they were still in government, they would continue to preside over a mismanaged decline.

[Dr Evans]

One GP described the situation as “Schrödinger’s primary care”: GPs are seen as private contractors, so not exempt from the NI increases, but they are exempt from the small business relief because they are deemed to be “public”. Did the Department of Health team knowingly go along with the Treasury team’s plan to tax primary care without mitigation, leading to cuts? Or did it not understand or spot the complexity of what is going on, so mitigations have to be put in place now? Which is it?

[Wes Streeting]

I was terribly impolite; I should have welcomed the shadow Minister to his place in response to his first question.

Conservative Members seem to welcome the £26 billion investment and are happy to tell us how it should be spent, but they oppose the means of raising it. They cannot do all those things. They need to be honest with the country: either they support the investment in the NHS or they say they would cut it. Which is it?

Respiratory Health

Luke Evans Excerpts

Thursday 14th November 2024 Westminster Hall

[Dr Luke Evans (Hinckley and Bosworth) (Con)]

It is a pleasure to serve under your chairmanship, Mr Rosindell. This is my first day in my new role; it seems appropriate to take over this brief and speak in a debate on respiratory illness, because dealing with respiratory illness was my first ward job as a junior doctor. I worked for four months in accident and emergency department in the west midlands, and then my first ward job was dealing with respiratory conditions in Solihull hospital, so I have seen up front just how important respiratory medicine is.

I put on the record my thanks to the hon. Member for Strangford (Jim Shannon) for securing this debate. He may often get called last in the main Chamber, but he clearly has a trick for successfully securing debates. I look forward to perhaps having a cup of tea with him to learn how he is so successful.

It is both a blessing and a curse to hear the hon. Member for Newcastle-under-Lyme (Adam Jogee) make the same argument that his predecessor made about the quality of air in his constituency. I gather that it is a tip that causes a huge amount of problems there, and I hope he has success in getting the issue sorted. I also hope he takes some comfort from the fact that the previous Government passed the Environment Act 2021 to put in place legal limits to try to improve air quality and, of course, offered air-quality grants.

There is clearly an interest in respiratory conditions in both the east and west midlands, given the contribution from the hon. Member for Redditch (Chris Bloore), who is no longer in his place. Having worked over in the west midlands, I have now transferred to the clearly better east midlands.

[Adam Jogee]

I gently push back on the narrative that the previous Government made the sort of progress in tackling the issues at Walleys Quarry that the shadow Minister just implied. My constituents continue, on a daily basis, to deal with the worst effects of the hydrogen sulphide levels that the site emits. Hydrogen sulphide is a heavy gas and there are schools around the area. The impact on our children and the respiratory health of young lungs is massively underrated and fails to be part of the conversation. I invite the shadow Minister to come to Walleys Quarry and to Newcastle-under-Lyme to smell the situation for himself.

[Dr Evans]

I am grateful for that offer, and if there is a cup of tea involved that may well be a consideration too. Perhaps we could all go there as a group on a cross-party trip.

[Adam Jogee]

There has been a lot of sobriety in this debate so, rather than having a cup of tea, I will take the shadow Minister to the Waggon and Horses pub in Newcastle-under-Lyme for a slightly colder refreshment.

[Dr Evans]

I am very grateful to the hon. Gentleman for that offer.

I congratulate the hon. Member for Blaydon and Consett (Liz Twist) on her work in the APPG. She was of course right to highlight smoking as a big problem, and health inequalities are also important. We also know that people experiencing health inequalities generally struggle to access healthcare, let alone healthcare for respiratory conditions—we have not even discussed the equipment and expertise needed to deal with such conditions.

The hon. Member for Sherwood Forest (Michelle Welsh) spoke about pulmonary fibrosis, a really important condition that is not given the precedence it deserves given how debilitating it is for patients who suffer with it. I pay special tribute to her for raising that issue so powerfully and so emotionally. She is a true champion for doing something about a condition that is not thought about nearly enough.

The hon. Member for Winchester (Dr Chambers) is absolutely right about holistic approaches. They are outside the remit of this debate, but housing, environment and smoking are of course all big factors. We have not even talked about comorbidities yet. We know that people over the age of 60 are usually on several medications and may have heart problems or musculoskeletal problems as well. That will have a really big impact.

With regard to the hon. Member being a vet, I think I am right in thinking that he is still allowed to practise on humans, while I certainly am not allowed to practise on pets. That is not something for a debate today, but I think it is noteworthy; if there is a problem you should rush to him too, Mr Rosindell. What he said about antimicrobial resistance is really interwoven into everything, because there is a danger of over-prescriptions for chest infections that turn out to be viruses. That is a really problematic issue that is growing, and it is the next probable pandemic, with no easy solution. He is right to highlight that.

I thank the members of the APPG for all the work they do, led by the hon. Member for Strangford. It is really important to be able to get a debate and raise these issues, and to have the infrastructure behind the members to support the team in dealing with and producing updates.

I myself have a personal history with respiratory medicine, having ended up on the intensive care unit with bilateral pneumonia after an appendicectomy in my late 20s. It has left me, at previous times, at a brittle asthma clinic. There were many attempts to diagnose what was going on, but nothing was ever found. I had to be treated with repeated steroids and felt, full on, what it is like to suddenly not be able to breathe, not be able to exercise and have that ability taken away.

When they are listening to this debate, the key thing for the public to realise is just how important our breathing really is. A breathing condition is so seminal to everything we do. There is a reason why in an emergency it is ABCDE, or airway, breathing, circulation, disability, exposure: because breathing is quite literally life. Many people have experienced having that taken away a little bit by getting covid; that has at least made people aware of just how bad viral illnesses can be.

Turning to some of the other conditions that we have not talked about—I feel like I am back in one of my medical exams in the fifth year—we have heard about asthma and COPD, but we have not talked about pulmonary embolisms, pneumoconiosis or TB. We did hear about cystic fibrosis, but we have not heard about mesothelioma or sarcoidosis. Pneumonia is a really important one to talk about too, as is lung cancer, and there are probably some that I have missed.

Respiratory conditions are really important: they make up the third place for all deaths, so they need that attention. I was therefore pleased to see the last Government come forward with the community diagnostic centres—170 community diagnostic centres going up across the country to get better access to MRI scans, CT scans or blood tests. Those will be really important, and I was lucky to have a £24 million investment for a CDC in Hinckley, which will have MRI and CT scanners, and is being built as we speak. That will be transformative for my community when they are caught between two big centres towards Nuneaton and Leicester. I hope those measures will mean that respiratory conditions play an important part in the hospital rebuild programme and the current review, and that we will ensure we have the apparatus and equipment to support them.

Turning to the nitty-gritty of the debate, I entirely agree with the idea of prevention. The Conservatives brought forward measures to deal with smoking. I hope that as the Government step forward with further ideas of how to tackle smoking and push for a smoke-free generation, we will be looking at that very closely.

The hon. Member for Strangford really hit on a point about data. Health policy must be driven by decent data, and the APPG’s work highlights how respiratory conditions tend to fall behind in that. I have questions for the Minister about what work is being done now only on the simple matter of how we record things, but on how we can join up that dataset. For example, in my constituency we have two boundaries; we are caught between North Warwickshire and Leicestershire when getting answers to tests. An asthmatic does not have an asthma attack directly where they live—they could be on holiday. Sharing information on what has happened with treatment and investigations is really important.

That leads me on to spirometry. Spirometry is key, but where it is and how it is achieved is too sporadic, as is the skillset to deliver it. Then, of course, we have FENO—fractional exhaled nitric oxide—which can help to aid the diagnosis of asthma. That will be key, and the Opposition look forward to seeing what the new BTS guidelines, worked up with NICE, show on dealing with asthma.

I have a couple more questions for the Minister. I appreciate that this is not her brief, so I should be grateful if she passed on any questions she cannot answer for a written response. We have heard that the likes of the RSV vaccine are really important; new vaccines are coming out to tackle this huge problem for the elderly and the young. The vaccine was introduced for those aged between 75 and 80, but it would be interesting to see whether there is scope to grow that and see who else is responsive. I gather from work done by my Opposition colleagues that there is still some debate to be had and evidence to be gathered on what that would look like. I would appreciate it if the Minister took that point away. What steps are the Government taking to increase the uptake of flu and pneumonia vaccinations? Prevention is better than cure.

Finally, it was mentioned that the last Government looked at chronic health strategies. It appears that the new Government have decided to take a different tack with chronic conditions. I appreciate that that is their prerogative, but there is a danger that we could have a lag. The data that has been gathered, the research that has been looked at and the policies that have been structured for the past five years or so could fall by the wayside, even though we have heard how much of an emergency it is to deal with respiratory conditions. Could the Minister clarify whether interested parties will need to resubmit the work they have done, or whether the work will be a continuation within the new structure that the Government are planning? Is there any timescale on what that would look like?

Clearly the Conservative Government were unable to get the long-term health strategies in place in time before the election. Time is ticking on, and we have a winter coming up. It is really important for organisations to understand where they stand. Christmas is coming up, and I well know from my time as a GP—I should declare an interest, as my wife is a GP as well—that Christmas is the busiest time, and respiratory conditions are one of the top reasons for that. If anyone out there is listening, getting vaccinated is imperative. I advise everyone to do so.

We know that the staff of these organisations will go above and beyond when they see someone struggling for breath. They will take their time to get the right history and get medication and treatment in place. We give them our greatest thanks, from the Opposition side of the House, for all the work they have done and will do in the busy Christmas period. I am sure that that sentiment is shared by the Government.

National Insurance Contributions: Healthcare

Luke Evans Excerpts

Thursday 14th November 2024 Commons Chamber

[Dr Luke Evans (Hinckley and Bosworth) (Con)]

(Urgent Question): To ask the Secretary of State for Health and Social Care if he will make a statement on the impact of changes to employer national insurance contributions on primary care providers, hospices and care homes.

[The Minister for Secondary Care (Karin Smyth)]

I am grateful to the hon. Member for asking this important question. It gives me the opportunity to say to GPs, dentists, hospices and every part of the health and care system that will be affected by changes to employer national insurance contributions that this Government understand the pressures they face and take their representations seriously. The Chancellor took into account the impact of changes to national insurance when she allocated an extra £26 billion to the Department of Health and Social Care. There are well-established processes for agreeing funding allocations across the system, and we are going through those processes now with this issue in mind.

This Government inherited a £22 billion black hole in the public finances, broken public services and a stagnant economy. Upon taking office we were told that the deficit the previous Government recklessly ran up in my Department alone would mean delivering 20,000 fewer appointments a week instead of the 40,000 more we promised. The Chancellor and my right hon. Friend the Secretary of State were not prepared to see further decline in our NHS. That is why we put in an extra £1.8 billion to stop the NHS going into reverse this year.

We built on that at the Budget, delivering the significant investment that the NHS needs to get back on its feet, backing staff with investment in modern technology, new scanners and new surgical hubs, and rebuilding our crumbling primary and secondary care estate. Alongside that, we delivered a real-terms increase in core local government spending power of around 3.2%, which will help to address the range of pressures facing the adult social care sector, including £600 million in new grant funding for social care. We are now working through exactly how that money will be allocated, as per normal processes. As the Secretary of State set out yesterday, we will ensure that every pound is invested wisely to deliver the Government’s priorities and provide value to taxpayers.

The Department will set out further details on the allocation of funding in due course, including through NHS planning guidance and the usual consultations, including on the general practice contract. As part of these processes, we will consider the impact of changes announced to employer national insurance contributions in a fair and open way over the next five months, before the changes come into force in April 2025.

[Dr Evans]

I draw the House’s attention to my declaration of interests.

Many in the health sector will have been pleased to hear the announcement of the extra funding for the NHS, only for their joy to be struck down by the realisation that a manifesto promise not to raise national insurance contributions had been broken. That was compounded further by the discovery that a raft of frontline care providers—care homes, hospices, care charities, pharmacies and GPs, to name but a few—will not be exempt from the NI rise, leaving them with crippling staff bills and the threat of closures and redundancies. The hospice sector expects the cost to be £30 million—closures and redundancies. The initial assessment of the cost to GPs is £260 million—closures and redundancies, at the expense of 2.2 million appointments. For the care sector, the changes will cost £2.4 billion, dwarfing the £600 million in social care support that was announced. Does the Minister accept that it is inevitable that council tax will have to rise to support the increase in NICs?

For the first time, the National Pharmacy Association has announced collective action. Its chair said:

“The sense of anger among pharmacy owners has been intensified exponentially by the Budget, with its hike in national insurance employers’ contributions and the unfunded national living wage increase, which has tipped even more pharmacies to the brink.”

Will the Minister clarify who is exempt from NI? Will the Government admit that they got it wrong and make a change? The Prime Minister, Health Secretary and Chancellor have all said that allocations will be made “in the usual way”. Will the Minister clarify what the usual way is? Will mitigations be put in black and white to the House and the public? Is this part of the £20 billion, or new funding?

More importantly, will the Minister lay out a concrete timetable for hospices, care homes, GPs, pharmacists and all other allied health professionals, who are making decisions now? This seems to be another example of a big headline from the Labour party but no detail.

[Karin Smyth]

Well, really. I am quite dumbfounded by the hon. Gentleman’s response. I respect him for his professional practice, and he knows the state of the NHS that we inherited from the previous Government, as reported in Lord Darzi’s report. He talks about joy, but there was no joy when we inherited the mess they left back in July. He talks about people being tipped to the brink, and they absolutely were, as Lord Darzi made clear.

As I said, we will go through the allocation of additional funding in the normal process, which will be faster than under the previous Government because we are committed to giving the sector much more certainty. The normal process, as the hon. Gentleman should know from his time in government, is to go through the mandate and the planning guidance and to talk to the sector about the allocations due next April, as I said in my opening statement.

--- Later in debate ---

[Karl Turner (Kingston upon Hull East) (Lab)]

It is disappointing to put it mildly that the Opposition spokesperson was unable to mention the record funding committed in the Budget.

[Dr Luke Evans]

It was in my opening line—

[Mr Speaker]

Order! The shadow Minister has been granted an urgent question. He asks the questions; he does not answer them from the Front Bench.

Income Tax (Charge)

Luke Evans Excerpts

Tuesday 5th November 2024 Commons Chamber

[Wes Streeting]

That is a commitment that we have made and a commitment that we will keep. I am happy to ensure that the hon. Member can meet the relevant Minister and project team as we get under way on delivering that project.

I did actually go back to check the pledges made by the Conservative party in its 2024 manifesto just to see how extensive the work of fiction was, only to find that the manifesto page on its website now reads “page not found”. The truth is, had the Conservatives won the election, it would have been deleted just as quickly.

That was not all I was told when I became Secretary of State in July. Despite 18 months of strikes in the NHS, there was no funding put aside to end the junior doctors’ dispute. What is more, the previous Health Secretary had not met the resident doctors since March—the Conservatives had given up even attempting to end the strikes. People should remember that this winter. For all the challenges that the NHS will face, this will be the first winter in three years when NHS staff will be on the frontline, not the picket line. That is the difference that a Labour Budget makes.

I was told that GPs would be qualifying this year with no jobs to go into. The Government found the funding and we are hiring an extra 1,000 GPs this year. That is the difference that a Labour Budget makes.

[Dr Luke Evans (Hinckley and Bosworth) (Con)]

On the Budget, GPs, hospices and care homes have been found to be either exempt or not exempt from the national insurance contributions. Will he clarify whether hospices, care homes and primary care are exempt or not? That really matters to their costs.

[Wes Streeting]

I am grateful for that intervention for two reasons. First, it gives me an opportunity to say to GPs, hospices and other parts of the health and care system that will be affected by employers’ national insurance contribution changes that I am well aware of the pressures, we have not made allocations for the year ahead, and I will take those representations seriously.

Secondly, it gives me a chance to ask the hon. Member and the Opposition: do they support the investment or not? Are they choosing to invest in the NHS or not? They are now confronted with the hard reality of opposition. Just as when we were in opposition we had to set out how much every single one of our policies would cost and how those would be funded, they have to do that now. If they oppose the investment, they have to tell us where they would make the cuts in the NHS. If they oppose the investment, they have to tell us where they would make the cuts in school budgets. Those are the choices that we have made, and we stand by those choices. The Opposition will have to set out their choices, too.

I was told that because the Conservatives had run up huge deficits in NHS finances, I would not be able to deliver the 40,000 extra appointments a week that we had promised. In fact, I was told that we would have to cut 20,000 appointments a week instead. The Chancellor and I were not prepared to see waiting lists rise further. She put the funding in, and an extra 40,000 patients will be treated by the NHS each week. That is the difference that a Labour Budget makes.

Access to Primary Healthcare

Luke Evans Excerpts

Wednesday 16th October 2024 Commons Chamber

[Karin Smyth]

I am tempted, but I know that many of the hon. Lady’s colleagues want to speak, and I am sure she is on the list.

Fixing the NHS will take years of discipline and hard work, and we are in this for the long haul. However, we must first clean up the mess we inherited, and that work has begun in earnest. We have found the funding to recruit an extra 1,000 GPs this year as our first step towards fixing the NHS’s front door and making the system more flexible.

[Dr Luke Evans (Hinckley and Bosworth) (Con)]

Will the Minister give way?

[Karin Smyth]

Yes, as that will be one from each side of the aisle.

--- Later in debate ---

[Dr Evans]

One of the keys to delivery is the GP partnership model, which is the mechanism by which they are set up. The Secretary of State, who is now in his place, said in 2023 that he wanted to phase out the GP partnership model, although he later reneged on that position. It would be interesting to hear what the Government now perceive to be the best model for delivering primary care, as that is really important for GP partners.

[Karin Smyth]

I wish the hon. Gentleman well with his own access to a GP at the moment. We are committed to working with the profession on the best way to organise primary care. The critical point is that primary care, however it is organised in neighbourhoods, is there for our constituents when they need it. It is not there now. The model is not working and has not worked over a period of time. It has merits, as we have said, and we are continuing to talk to people. I have worked in the sector for a number of years, so I understand the point the hon. Gentleman makes.

--- Later in debate ---

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

The challenges facing the NHS are no secret. In my new role as Chair of the Select Committee, I have begun to meet key stakeholders. The list of things that we need to consider is enormous. I pay credit to those who stood for the Committee, and welcome those who made it on. I understand that Conservative members have been chosen, but I do not yet know who they are—I ask them to forgive me if they are here. I look forward to cracking on.

I will start by highlighting to Ministers a few of the reports by the previous Committee, which I urge them to look at. One is on dentistry and another on pharmacies —and they are from 2023 and 2024, so they are extremely current. There is a note of frustration in the dentistry report as it points out that it makes the same recommendations that the Committee had made 15 years prior. I hope that this Government will take our Committee’s recommendations extremely seriously. Such cross-party recommendations are made thoughtfully—we are here to help.

Today, I will focus on the GP crisis. Another Committee report from October 2022, for which I take no credit—it was done by the previous Committee, so credit should go to its previous Chairs and members—points out what we already know: GPs are overstretched and patients are frustrated. The British Medical Association reports that a single GP now manages an average of 2,282 patients, a significant increase on 2015 figures. I know that there are even more acute numbers across the country. That has led to longer waiting times and difficulty in accessing care. One of my constituents wrote to me about his wife, who was struggling to book a GP appointment. The surgery does not even take phone calls—or at least that was what she thought. It opens an online form for a few minutes at 8 am, and as soon as the appointments are gone, it closes the form. We then called the practice, which pointed out that patients could ring, although it seems that that message is not getting across to those patients.

That experience is being felt across the country, but I do not blame the GPs, because they are trying their very best. The Royal College of General Practitioners found that over 40% of GPs might leave within the next five years, with stress being a key factor, and the crisis in general practice affects the entire NHS. When patients cannot see a GP, they often turn to A&E, worsening pressures on emergency departments. GPs play a vital role in managing long-term conditions and co-ordinating social care at both ends of that flow of patients. Without a functioning general practice system, the entire healthcare ecosystem suffers.

So what can be done? The Committee made four main proposals, which I hope Ministers will include in their 10-year plan. First, we need to urgently increase the number of fully qualified GPs in the system. That means more than just training them: retention is also key. Secondly, we must embrace and improve digital health solutions, undertaking a full review of all primary care IT systems from the point of view of clinicians and patients. We also have to accept that for some people, digital just does not work.

[Dr Luke Evans]

I was a member of that Committee and helped to author that report. One of the key things that we want to see from the clinical perspective is the ability to join up the IT side, so having a place to share technology is really important. For example, every GP practice suffers with the question of how to set up its appointment system, yet bizarrely, if I wanted to set up as a GP on my own, there is no centre of excellence to say what is the best way to do so. Does the Chair of the Health and Social Care Committee agree that it would be valuable if we had a single point of expertise that each practice could ask, “What’s the best solution that you’ve seen elsewhere in the country?”

[Layla Moran]

I thank the hon. Gentleman for his work on the previous Committee. The GPs I have spoken to point to that report as describing what they would like to see done, so all credit is due to the ideas that have come out of it.

The third area I wish to mention is prevention, which is at the heart of the Darzi report. That report makes it clear that focusing on prevention and early intervention will relieve pressure on the NHS in the long run.

Finally, I want to talk about continuity of care, which was a key theme—indeed, an entire chapter—in the Darzi report. It makes it clear that seeing the same GP over a long period leads to fewer hospital visits, lower mortality and less cost to the NHS. This is not about some sort of nostalgic harking back to the way things used to be: if we want to solve what is, in my view, the biggest thesis question in the NHS today—the productivity issue—we need to be looking at interventions such as that. Continuity of care within GP practices, understanding the whole person and the whole family, is one of the ways the report identified of making GPs’ time more productive.

The challenges are immense, but not insurmountable. We owe it to our healthcare professionals and, most importantly, the patients to fix this crisis, and I look forward to working collaboratively with my new Committee members to help the Government do so.

Mental Health Support

Luke Evans Excerpts

Thursday 10th October 2024 Westminster Hall

[Dr Luke Evans (Hinckley and Bosworth) (Con)]

Thank you, Mr Dowd, for allowing me to take off my neck brace to speak. I congratulate the hon. Member for Ashford (Sojan Joseph) on speaking so powerfully on this topic. I was a doctor before I came to this House, so for me the topic is important. There is a clear distinction when we debate this topic between mental wellbeing and mental health. Lockdown proved that everyone’s mental wellbeing gets punished, but not everyone has a mental health issue. That is important when we are trying to segregate services: how do we supply the correct services to the people who need them the most?

I have spent the last five years in Parliament campaigning around body image and for a men’s health Minister, particularly with regard to suicide. But I turn my attention to something close to my heart that is really important: the issue of adolescent mental health, because I am deeply concerned by the increase in children who are suffering. It is not just things such as eating disorders; we are seeing attention deficit hyperactivity disorder, we are seeing anxiety and we are seeing autism.

I plead with the new Minister to think radically, in a positive way, when it comes to the NHS. In my area of Leicestershire, 40% of child and adolescent mental health services is taken up by dealing with ADHD and autism. That takes a lot of attention away from the kids who are self-harming, or have eating disorders or significant serious depression or psychosis. There is a radical solution: pull out education and health and pool those services as specialisms. That would build on the work that the last Conservative Government did on placing representatives and mental health workers in school, and would allow GPs and CAMHS the freedom to concentrate on what they need to deal with.

[John Glen (Salisbury) (Con)]

On that point, may I draw my hon. Friend’s attention to the role of care co-ordinators with adolescents, and the problems and challenges of the transition to adult care? That moment can be critical in securing a pathway to an effective outcome. Often, the confusion over where responsibilities are delineated and begin has been a difficulty for my constituents.

[Dr Evans]

My hon. Friend is absolutely spot on. The cliff edges that exist in the NHS—and education and social services—cause a real problem, particularly for families, because at 18 someone does not just lose their diagnosis.

It is important to pool those areas because it allows us to stratify the way that we use our limited resources, and we know that health costs will continue to go up and spiral. I urge the Minister to have a think about potentially creating almost a national special educational needs and disabilities service, which would pool education and health experts together, releasing schools and relieving GPs’ primary care and secondary care with specialists. Now we have the set-up of ICBs, there is scope to do that regionally across the 42 areas.

It is well worth thinking about pooling those resources together, because it would be possible to give specialist help; and as the hon. Member for Ashford said, identifying people early means that they will not end up in a crisis. That brings us back to preventive care, to identify those who are having problems with wellbeing or who have mental health issues. For me, that is the crux of what we need to do: how do we pool the resources in a way that is sustainable for the taxpayer and, most importantly, service users and providers—the children and adolescents, and the staff who have to cope with some of the most difficult problems? I leave the Minister with that thought.

--- Later in debate ---

[Dr Ben Spencer (Runnymede and Weybridge) (Con)]

It is a pleasure to serve under your chairmanship, Mr Dowd. I start by declaring that I am a former consultant psychiatrist and that a family member is a consultant psychiatrist.

Listening to this debate has been a mixed experience. It has been great to hear the wealth of talent and expertise that we have in the House, but at times it has been harrowing to hear people speak about their personal experiences or those of their constituents. That is a reminder to us all of just how substantial the impact of mental illness can be on people—our families and friends. The tone in which this very sensitive debate has been conducted is fantastic.

I thank the hon. Member for Ashford (Sojan Joseph) for bringing forward this debate, for the wealth of experience—22 years—that he brings to this place, and for a very balanced speech in which he acknowledged the catchment investments under the previous Government and raised the importance of waiting lists. When I was first elected, I brought up targets for mental health in a private Member’s Bill, which did not end up going anywhere, on waiting times for getting an in-patient bed when one is requested for somebody with a mental disorder. Of course, we all want improvements in mental health care and treatment, and there need to be improvements in mental health care and treatment. I am sure there will be no disagreement across the House about that.

The hon. Member for Ashford was absolutely spot on to mention housing, work and benefits. It is a testament to his experiences in psychiatric nursing that he went on to mention the surrounding holistic care. One of the challenges of debates on improving mental health services is that we must acknowledge that that involves many other areas of public policy, public provision and cultural factors, and try to broaden that as much as possible.

[Dr Evans]

The former Member for Doncaster, who is now sadly not in this House, was a significant champion for men’s and boys’ health—suicide in particular, which has been mentioned here, is such a problem. My hon. Friend stated the case for mental health being a pan-Government policy area—does he believe that strengthens the argument for having a Minister for men and boys to go across Government and think about all these issues, especially as suicide is the leading cause of death for young men under the age of 45?

[Dr Spencer]

My hon. Friend is absolutely right to point out that, sadly, suicide is the No.1 cause of death among young men. My understanding, although the stats change all the time, is that below the age of 45, suicide is the No.1 cause of death among both men and women. It is absolutely right that we look at sex-specific approaches to intervention. Factors affecting health in men will be different from factors affecting health in women.

I want to go back to the social elements of mental health care, which the hon. Member for Ashford mentioned, and a smoke-free society and banning tobacco. Certainly when I was practising, 50% of tobacco was consumed by people with a severe mental illness. That raises a whole host of concerns and issues about what is happening with tobacco consumption and people with a mental disorder.

My hon. Friend the Member for Hinckley and Bosworth (Dr Evans) was absolutely right, given his experience, about something he has mentioned many times in the House: the importance of delineating mental wellbeing and mental illness. I tend to think about it in this way: we all have mental health, but we need to separate mental wellbeing from mental illness. The two are different and need different approaches, as was echoed by my right hon. Friend the Member for Salisbury (John Glen) and the new hon. Member for Stroud (Dr Opher), who gave rise to a very fertile discussion on his views on the area. The hon. Member for Leicester South (Shockat Adam), who is no longer in his place, rightly pointed out inequalities in detention and outcomes for those from minority ethnic backgrounds. That is a very important issue.

That brings me on to our record in Government over the past 14 years; there are a few things I want to pick out. One is that we set parity of esteem in law through the Health and Social Care Act 2012, which was a big step forward. We still need parity of esteem in outcomes, but nevertheless that was a very important step. We expanded access to psychological therapies and I am particularly pleased by the expansion of individual placement and support, which has been shown to help people get into work, particularly those with a chronic and enduring mental illness. We have seen more people take up maternity care, and we also invested in the mental health estate.

In fact, in my own constituency, we have a new mental health hospital. The Abraham Cowley Unit is being rebuilt, which will provide world-class care for people living in my patch. Perhaps most important of all, given the conversation that we have had today, is the decrease in in-patient and out-patient suicide that we have seen over the years. Of course, I recognise that there are a variety of factors driving that but we should be pleased that things are moving in the right direction on suicides, although there is more to be done.

Today is World Mental Health day and it is a very broad topic, but in my time I would like to focus specifically on one area that, as it certainly was in my former career, is often neglected—psychosis. It particularly affects people suffering from schizophrenia or bipolar affective disorder. It can be a very disabling illness and has been responsible for quite a degree of disability and health concern in the UK. Often debates such as these, and debates in the media, do not focus on psychosis and I think a big part of that comes from the stigma attached to it. People who work in the sector, and those with expertise here, will know that it is an area of great need both in terms of community mental health teams and in-patient settings. The hon. Member for Stroud was absolutely right and I am glad he pointed this out: the 10 to 15 years of life lost following a diagnosis of psychosis is something that we have to fix.

I believe that we also need to improve access to treatments such as clozapine, which is an excellent treatment for schizophrenia. I am pleased to have previously worked with Clozapine Support Group UK in its campaign to try to get more access to clozapine for people for whom it is indicated. We have also seen the reform of the Mental Health Act 1983, which the former Prime Minister Theresa May kicked off with the Wessely review. I was part of the working groups on the Wessely review, particularly looking at helping with the tribunal system, and I was on the pre-legislative scrutiny committee as well. How we look after people detained for treatment in the absence of consent is very important, and I am pleased that this Government have committed to take forward the work on reviewing that Act.

I thank everyone who works in the care and treatment of people with mental illness. As we have heard today, that is a very broad sector; it is not only people who work in the NHS but those who work in the third sector in a variety of organisations and institutions. That is very important work.

--- Later in debate ---

[Andrew Gwynne]

The right hon. Gentleman is absolutely right. That will be one of the big challenges with the prevention agenda more generally, because often the investment we have to make today does not pay dividends immediately and there is a bit of a punt. Having been a Treasury Minister, he will know the challenges that that can present to the Treasury orthodoxy, but we have to push on this agenda.

I always say that being an MP and a GP is only one letter apart. We are often dealing with the same people who present with the same problems but from a different angle. We go away as Members of Parliament trying to fix the issue as they have presented it to us, and the GP will write a prescription and send them off having sorted out the issue as it was presented to them. However, the beauty of social prescribing is that there is an opportunity to deal with the whole issue in the round. The argument has been won with almost everybody, and any tips from the right hon. Member for Salisbury (John Glen) so we can get this over the line with the Treasury will be welcome.

I should mention my hon. Friend the Member for Darlington (Lola McEvoy), and welcome the hon. Members for Winchester (Dr Chambers) and for Runnymede and Weybridge (Dr Spencer) to their Front-Bench positions.

In the minutes I have left, I want to say to the House that many of the issues raised by Members during the debate are symptomatic of a struggling NHS. If we look at the figures, the challenges facing the NHS are sobering. In 2023, one in five children and young people aged eight to 25 had a mental health problem, which is a rise from one in eight in 2017. The covid-19 pandemic has exacerbated need, with analysis showing that 1.5 million children and young people under the age of 18 could need new or increased mental health support following the pandemic.

[Dr Luke Evans]

I want to raise an issue as the Minister is the Minister responsible for prevention. One of the biggest and most shocking things we saw during the pandemic was the increase in eating disorders, which is a very difficult topic for any Government around the world to try to break down. We know that the impact of eating disorders lives with people for the rest of their life and can cause them to lose their life, so will the Minister ensure that they are looked at as a priority? There was previously a roundtable; will he look into doing something similar again to bring experts together?

[Andrew Gwynne]

I am reluctant to commit Ministers to roundtables when I am covering another portfolio, because then they will do the same when they cover me in Westminster Hall debates, but I will say that we take this agenda incredibly seriously. When we were in opposition we gave support to the then Government, and I assure the hon. Gentleman that we will do everything we can to support people who have eating disorders and to get the right provision and support at the right time to the people who need it.

As I was saying, the covid-19 pandemic has exacerbated the need for mental health support. Around 345,000 children and young people were on a mental health waiting list at the end of July this year, with more than 10% of them having waited for more than two years. Some groups of children and young people are disproportionately impacted by mental health problems largely driven by a complex interplay of social and environmental determinants of poor mental health, as we heard in the debate.

We are committed to reforming the NHS to ensure that we give mental health the same attention and focus as physical health. It is unacceptable that too many children, young people and adults do not receive the mental health- care that they need, and we know that waits for mental health services are far too long. We are determined to change that, which is why we will recruit 8,500 additional mental health workers across child and adolescent mental health services. We will also introduce a specialist mental health professional in every school and roll out Young Futures hubs. We are working with our colleagues at NHS England and in the Department for Education as we plan the delivery of those commitments.

Early intervention on mental health issues is vital if we want to prevent young people from reaching crisis point. Schools and colleges play an important role in early support, which is why we have committed to providing a mental health professional in every school. However, it is not enough to provide access to a mental health professional when young people are struggling; we want the education system to set young people up to thrive, and we know that schools and colleges can have a profound impact on the promotion of good mental health and wellbeing. Doing this will require a holistic approach, drawing in many aspects of the school or college’s provision. I know there are many schools that already do this work, and my Department is working alongside the DFE to understand how we can support best practice across the sector.

As I have said, our manifesto commits us to rolling out Young Futures hubs. This national network will bring local services together and deliver support for teenagers who are at risk of being drawn into crime or who face mental health challenges. The hubs will provide open-access mental health support for children and young people in every community.

On other aspects of our plans, the mental health Bill announced in the King’s Speech will deliver the Government’s manifesto commitment to modernise the Mental Health Act 1983. It will give patients greater choice, autonomy, enhanced rights and support, and it will ensure that everyone is treated with dignity and respect throughout their medical treatment. It is important that we get the balance right to ensure that people receive the support and treatment they need when necessary for their own protection and that of others. The Bill will make the Mental Health Act 1983 fit for the 21st century, redressing the balance of power from the system to the patient and ensuring that people with the most severe mental health conditions get better and more personalised care. It will also limit the scope to detain people with a learning disability and autistic people under the 1983 Act.

Finally, Lord Darzi’s report identified circumstances in which mental health patients are being accommodated in Victorian-era cells that are infested with vermin, with 17 men sharing two showers. We will ensure that everyone is treated with dignity and respect throughout their treatment in a mental health hospital, and we will fix the broken system to ensure that we give mental health the same attention as physical health.

If I have not answered Members’ questions, those Members will be written to by the relevant Minister. I again congratulate my hon. Friend the Member for Ashford on securing the debate.

NHS Performance: Darzi Investigation

Luke Evans Excerpts

Monday 7th October 2024 Commons Chamber

[Victoria Atkins]

I will finish this point. That transition must begin with the language that the Secretary of State is choosing to use about the NHS. Interestingly, we have heard a little bit of nuance for the first time tonight, perhaps because health leaders are raising concerns that his “broken” narrative is damaging public confidence and will lead to people not coming forward for care, as was reported on the day that the right hon. Gentleman gave his speech to conference. That narrative is hurting the morale of staff who are working tirelessly for their patients. As the confected doom and gloom of the new Chancellor damages business confidence, so too does the Health Secretary’s relentlessly negative language risk consequences in real life.

Let me say what the Health Secretary refuses to acknowledge: the NHS is here for us and is ready to help. Its dedicated staff look after 1.6 million people per day, a 25% increase from the days of the last Labour Government. That is why I am always a little concerned whenever the right hon. Gentleman harks back so far; I do not think he has quite understood the change in capacity and scale of the national health service since we inherited it from the last Labour Government. The majority of those 1.6 million people will receive good care. [Interruption.] These are just facts, but I know the Health Secretary finds them difficult to receive.

[Dr Luke Evans (Hinckley and Bosworth) (Con)]

Will my right hon. Friend give way?

[Victoria Atkins]

In one moment.

Of course, it is important that we focus relentlessly on those patients who do not receive good care, but that will not be achieved by writing off the 1.5 million people who work in the NHS. In fact, the NHS has more doctors, nurses and investment than at any point in its history. It is delivering millions more outpatient appointments and diagnostic tests and procedures for patients than in 2010, and NHS mental health services are supporting 3.6 million people a year, a 10% increase in one year alone.

[Dr Evans]

rose—

[Peter Prinsley (Bury St Edmunds and Stowmarket) (Lab)]

rose—

[Victoria Atkins]

I will give way to the doctor behind me, and then I will give way again.

[Dr Evans]

It is interesting that Lord Darzi chose 2010, because there were some good points in what the Labour Government put in place, but there was also the problem of Mid Staffs. We had the Medical Training Application Service fiasco around medical careers, for which Patricia Hewitt had to apologise, and we had the £11 billion IT project that was put in place and has now failed as well. These things shape the NHS, and when we are trying to come up with solutions, they impact on the way that doctors, leaders and politicians come together. Does my right hon. Friend have suggestions for how we can take the politics out of this debate, enabling us to have a sensible debate on reform, which I think both sides of this House would like to see?

[Victoria Atkins]

I thank my hon. Friend, who brings his clinical experience and expertise to this debate. I say frankly to the Secretary of State that I wish he had taken the approach of the Defence Secretary, who has set up a cross-party commission on defence spending. Indeed, he has invited my former colleagues to sit on that review, because he understands that we bring an enormous amount of knowledge, experience, and—dare I say it?—some hard knocks from working in those massively complex Departments.

The right hon. Gentleman knows me. We have done good-humoured battle over the Dispatch Boxes for a long time now, and had he come to me and asked me to help him, I genuinely would have. [Interruption.] The public are hearing this. They want politicians to cut all the flim-flam and the bluster and work together, and had the right hon. Gentleman been serious about the Darzi report, he would have done exactly as his colleague around the Cabinet table has done and conducted a cross-party review of the NHS to ensure that we can make real progress. It is interesting that the Health Secretary does not appear to agree with the approach that his Cabinet colleague has taken.

--- Later in debate ---

[Dr Luke Evans (Hinckley and Bosworth) (Con)]

Thank you, Madam Deputy Speaker. I have removed my neck collar, which I am allowed to do, but if Members see my head wobbling, I ask them to intervene and I will put it straight back on. I welcome the hon. Member for South Norfolk (Ben Goldsborough) to his place. With the respect that he talks about and commands, I am sure he will be an asset to the House.

I come to the debate with a slightly unique perspective, and three minutes is very little time to make my point. I have been a doctor since 2007; I sat on the Health and Social Care Committee for three years; and, most recently—and probably most obviously—I recently had spinal surgery on my neck. However, that is not my only foray into the NHS: I have had both knees and my shoulder operated on and my appendix out, and I ended up in intensive care with bilateral pneumonia after that, so I have seen a fair amount of it.

[Gregory Stafford (Farnham and Bordon) (Con)]

The bionic man.

[Dr Evans]

Absolutely. In this debate, health is a political football. It always strikes me that there is a rising tide across the western world, and at the four points of the nation. In Scotland, the NHS is run by the SNP; in Wales, it is run by Labour; in Northern Ireland, it is also separate; and we had the Conservatives, who have now handed it over to Labour. All of them are struggling, and we would do well to remember that. I came into politics not to change the world but to solve that—that sounds cheesy. In my last two minutes I have a set of suggestions—as any good doctor would do, I will look at the short term, the mid term and the long term—to try to improve it.

We could start with a root and branch review into prescribing, which is one of the most wasteful things in the NHS. On top of that, it is worth looking at the European working time directive, which hampers doctors when they study. Overnight, that could increase the ability to see more patients by a couple of percentage points. I spent nine months waiting for my operation, and there were a number of appointment letters. I had the ability to understand them and work my way through them, but a root and branch review of communications—the simple bread and butter of the NHS—would be very welcome. Comparable data across the nations, to see what goes on, is so important.

For the medium term, I would like statementing when people go into the NHS. Everyone knows how much it costs when they go to America—£40,000 for a ski accident. It costs that much here, and people would do well to remember that when they do not turn up to their appointments. On the IT system, we focus a lot on patients but I would like more focus on the staff and how they can use IT. I would like capping of GP lists—a sensible way, now that we have a workforce plan in place, to grow our staffing.

Finally, for the long term, in the 20 seconds I have I suggest a national service for SEND, taking education and health together to deal with mental health. Some 40% of the child and adolescent mental health services referrals in Leicestershire relate to autism and ADHD. That is a real problem that could easily be solved. In my final five seconds, I suggest an NHS centre for clinical excellence to share best practice. It is not good enough.