Coronavirus

Luke Evans Excerpts

Wednesday 11th March 2020 Commons Chamber

[Matt Hancock]

It is for Public Health England to make advice available and to give guidance. We will always follow the scientific advice on what makes the biggest impact. It is interesting, listening to the scientists, that sometimes the things that we, as lay people, may feel intuitively will have the biggest impact do not in fact have the biggest impact. The measures that we are taking and proposing to take include, for instance, looking at asking people who have symptoms, however mild, to stay at home. We are aiming to do the things that have the biggest impact. There are some things that feel right but do not have an impact at all. That is why it is so important to follow the science and what Public Health England says.

[Dr Luke Evans (Bosworth) (Con)]

Primary care clinicians are expected to collect quality and outcomes framework data, which can be-time consuming and take them away from their clinical work. Will the Secretary of State consider suspending QOF data?

[Matt Hancock]

We are looking to reduce bureaucratic burdens on primary care and GPs—we were looking at it anyway, but we have accelerated that work because of this outbreak. We have moved to a principle of “digital first” in primary care and with out-patients: unless there are clinical or practical reasons, all consultations should be done by telemedicine.

Oral Answers to Questions

Luke Evans Excerpts

Tuesday 10th March 2020 Commons Chamber

[Helen Whately]

I am well aware that my hon. Friend is very keen on that particular approach. He has hopefully received a letter from the Secretary of State, inviting colleagues to come to talk to us about the proposals and options for fixing our social care crisis, and I hope he will take that up.

[Dr Luke Evans (Bosworth) (Con)]

Will the Minister consider waiving the NHS surcharge for overseas staff who want to come to work in our NHS?

[Helen Whately]

I am well aware of concerns about the surcharge. Many overseas nurses coming to work in the NHS do not have to pay the surcharge, as it is covered by their employer.

Coronavirus

Luke Evans Excerpts

Monday 9th March 2020 Commons Chamber

[Matt Hancock]

I urge all companies, especially the large companies that, as the hon. Lady said, use an awful lot of self-employed workers to deliver their services, to look at what Hermes has done and appreciate that their part of the national effort is to help everybody to make sure that they can go home and stay at home if they need to stay at home to keep themselves and others safe.

[Dr Luke Evans (Bosworth) (Con)]

I have a practical question for the Secretary of State. Many of my colleagues who work in the health service are keen to come forward and do their best. Their big concern is: should schools close, who would care for their children when they run forward to help in the NHS? Are the Government considering any plans to support frontline workers?

[Matt Hancock]

We absolutely are, not only in terms of any measures that we take and how they might have to be amended for key workers, but also because, critically, when it comes to school closures, one reason why closing schools is not a cost-free option is that it takes away some of the very staff whom we need to be able to respond to the crisis.

Health Inequalities

Luke Evans Excerpts

Wednesday 4th March 2020 Commons Chamber

[Dr Luke Evans (Bosworth) (Con)]

Does my hon. Friend agree that patient behaviour around rurality is different from those in the city? They have to make a decision when they are on their own whether to trouble the GP, to go out, to face the weather, to go to the hospital. When they really need to go, they leave it to the last minute. That creates an inequality that is not captured in the data.

[Anne Marie Morris]

My hon. Friend is totally right. There are some very big consequentials relating to the geography of our area and to the demographic profile. We tend to export young people and import older people. In consequence, we need more geriatricians. We do not need a lot of specialists; we need doctors who can cope with complex co-morbidities. We do not have doctors like that.

We need also more funding for primary care. Much of the funding is skewed towards accident and emergency. Why? Because that is where the measures are. We also need to look at how we overcome the infrastructure barriers. Road and rail, bad; 5G, great. But we do not have it. We ought to be a priority because that would be a real plus in trying to solve this rural problem.

We also need to train and recruit people who understand rural communities. If we do not train them in rural areas, they will not want to come and stay. Nurses working in hospitals and in social care need to be trained in a similar way and they need to be interchangeable, otherwise we cannot cope with the demand in social care. On mental health, as I think has already been mentioned, isolation and loneliness in rural areas mean that we have a very high level—I think the highest level—of suicide. We have lots of lone workers and lone livers. That is a real challenge.

The consequence of all that is that in Devon we find ourselves with some of the worst financial performance results and some of the worst results in terms of meeting targets. Why? Because we are being funded for the wrong thing in the wrong way. Nobody seems to notice that many in our community do not ever get ambulances. You try north Devon and parts of Cornwall—it is just not going to happen. The effect is that we are now in special measures. What does that do? Do we get help? Actually we get told to spend less. If that is not health inequality, I do not know what is. I hope the Minister will not tell me that people in rural areas live longer. It is not great to live longer if you are not in great health and the quality of your health really does not cut it.

This situation can change and it has to change. The Government need to accept that one size does not fit all. If the Government are willing to listen and to change, it can all happen.

I invite the Minister to come and listen to the evidence I am gathering while chairing a national inquiry into rural health and care. We are unpicking the issues. We are looking at evidence not only from across the United Kingdom, but from abroad—from New Zealand, Australia and America—of what good care looks like. We hope to provide the Minister with a toolkit for a good result. Thank you for listening.

Coronavirus

Luke Evans Excerpts

Tuesday 3rd March 2020 Commons Chamber

[Mr Speaker]

Order. I will let this statement run for about an hour, so let us help each other.

[Dr Luke Evans (Bosworth) (Con)]

With regard to the impact that coronavirus can have, the Secretary of State is right to balance the difference of health and the economy and I welcome his caution in that regard. I want to raise a point about small businesses. If coronavirus does become a more significant problem, are the Government considering making emergency loans available to otherwise good businesses? If not, will he ask other Departments whether they might consider that?

[Matt Hancock]

We are considering that; it is being led by the Department for Business, Energy and Industrial Strategy, in conjunction with the Treasury. The Chancellor will be making a statement today, ahead of the Budget on 11 March.

Medicines and Medical Devices Bill

Luke Evans Excerpts

2nd reading & 2nd reading: House of Commons & Money resolution & Money resolution: House of Commons & Programme motion & Programme motion: House of Commons & Ways and Means resolution & Ways and Means resolution: House of Commons
Monday 2nd March 2020 Commons Chamber

[Jonathan Ashworth]

That is a welcome clarification, but I am sure the Secretary of State will agree that it is important that decisions made in this field are properly scrutinised through the usual procedures. We are keen to ensure that by tabling an appropriate amendment in Committee.

We are leaving the EU, but Labour Members consider it essential that we stay closely aligned with it on medicine regulation. With that in mind, the Government should clarify their attitude to new EU regulations such as the in vitro diagnostic medical devices regulation, which is due to be implemented in 2022. As I understand it, that regulation will not automatically apply to the UK. Is it the Government’s intention to align with it? The EU tissue and cells directive is being reviewed. Do the Government intend us to align with it? To ensure that the UK remains a world leader in scientific research and discovery, it is vital that we align with guidelines on clinical trials. Otherwise, patients could miss out on participating in trials and the UK could find it harder to access funding.

Effective joint working with our European partners has been vital for the NHS over recent years on everything from infectious disease control to the licensing, sale and regulation of medicines. Patients in the UK can access EU-wide trials for new treatments and the UK has the highest number of phase 1 clinical trials across the EU, as well as the highest number of trials for rare and childhood diseases. It is vital for improving health outcomes in the UK and EU that the UK continues to access those networks. Otherwise, we run the high risk of patients with rare diseases being adversely impacted.

The Bill contains provisions to extend the range of professions that can prescribe medicines, thereby allowing additional health care practitioners such as paramedics and midwives to be given restricted prescribing rights. We welcome those provisions and, assuming that their competencies have been assessed in the same way as those of other prescribers and that equal safeguards are in place, we support that sensible and timely reform. Will there also be plans for a consultation on the future prescribing rights of physician associates and surgical care practitioners?

I will not say too much about part 2 of the Bill, other than to confirm that any measures that help in the battle against anti-microbial resistance have Labour’s support. Part 3 is about medical devices. I have already commented on the use of delegated powers, and as I said at the outset, patient safety must be the priority and we will look to strengthen regulation in that area. Unlike medicines and drugs, many surgical innovations can be introduced without clinical trial data or centrally held evidence. That is a clear risk to patient safety, and it undermines public confidence. Manufacturers are often in charge of testing their own products after faults have developed and they can shop around for approval to market their products without declaring any refusals.

Two years ago, freedom of information requests to the Medicines and Healthcare Products Regulatory Agency revealed 62,000 adverse incident reports that were linked to medical devices between 2015 and 2018, and more than 1,000 had resulted in death. Most devices are cleared through a pathway that allows new products to inherit the approval status of “substantially equivalent” products already on the market. In some cases, after lengthy chains of equivalence-based approvals, the new devices scarcely resemble the original version. Indeed, a study in The BMJ in 2017 found that the family tree of 61 surgical mesh products related to two original devices that were approved in 1985 and 1996. Unless we fix that and put patient safety at the heart of the regulatory framework, patients will suffer and lack confidence.

We know the Secretary of State is a great champion of and has promoted many health-based apps. We need a robust and sophisticated mechanism to evaluate app-based healthcare for use in the NHS, and in Committee we will look to strengthen the regulation of that. We welcome what appear to be plans for a devices register, and I took note of what the Secretary of State said in his interaction with my hon. Friend the Member for Birmingham, Selly Oak (Steve McCabe). We believe, however, that such a register must provide comprehensive data on who, where, how and why devices were implanted, and by whom, so that any recall could be quickly enacted.

To achieve that, we encourage Ministers to strengthen the Bill by reflecting provisions in existing EU regulation and to ensure there are unique device identifiers, such as serial numbers on medical devices that are labelled with tracking information, as well as the power to track the use of those devices, so that the NHS can find and notify affected patients if and when problems arise. By the same token, the Government must reassure us that with such a register it is practically possible to cover all devices, including everything from implants to bone screws, software, apps, mesh, medical cannulas, pacemakers and so on. That is an extensive list of different devices, and I would be keen to hear how such a register could be implemented practically.

[Dr Luke Evans (Bosworth) (Con)]

The hon. Gentleman’s point about “why?” is important. As a doctor, I know that things move on, and when someone leaves medical school 50% of what they have learned is out of date. With devices that are likely to exist for 10, 20, 30 or 40 years, looking back it can be difficult to work out exactly why something was implanted. I would like the Bill to request an explanation from the clinician at the time to say what the thinking was. In the future, that would inform people who needed to deal with someone who had something implanted in their heart 20 years ago, for example, by which time the history might be exactly that—history.

[Jonathan Ashworth]

It has taken me some time, but let me welcome the hon. Gentleman to his place, particularly as a fellow Leicestershire MP. His contribution is well made, and I look forward to working constructively with him on health matters, as well as on various Leicestershire matters. I hope the Minister will reflect on his contribution and answer it when responding to the debate.

The Opposition will not seek to divide the House. We want the Bill to proceed to Committee, and we will work constructively with the Government to improve and strengthen it. It is up to Ministers to allay concerns about patient safety and about the UK’s ability to develop medicines rapidly for NHS patients in the future, and we look forward to a constructive debate on the Bill.

--- Later in debate ---

[Chris Green]

That is an incredibly important point. We need confidence that when data is taken, it is secure, protected and anonymised in the appropriate way, and that only the right organisations have access to it. I believe that data is a key area for the NHS and what it ought to be able to deliver. The NHS should be a huge repository of data, and universities, charities and businesses, with the appropriate controls, ought to be able to use it. As we move on—perhaps a particular aspect relates to rare conditions—the size of population needed in order to gather and analyse that data will increase. I hope my hon. Friend Minister will take note of this point and perhaps elaborate on it at the end of the debate. We need to ensure that our relationship with the EU will enable us to continue to collaborate on clinical trials and that data transmission across the European Union, and across Europe more widely, is efficient and effective.

[Dr Luke Evans]

My hon. Friend talks wisely about big data. Big data can be used to empower patients as individuals. Providing them with more data to understand and interpret, if it is provided in the right way, can empower them to make better choices. After all, the biggest under-utilised resource we have in healthcare is our patients. Healthcare is very doctor-heavy and nurse-heavy. Empowering patients helps them to make better choices. For example, patients with diabetes can monitor their own blood sugar. That has revolutionised the way in which people care for themselves. I would like my hon. Friend’s thoughts on whether he thinks we should explore this area further.

[Chris Green]

That is a vital and well-made point. Data can empower the individual. They can have more detailed access to their own records and their own data. The data generated by someone wearing a device day in, day out, week in, week out can be transmitted to a consultant, who can call a patient more promptly if there is anything a little worrying. If there is a heart murmur or someone feels a bit dizzy, the person can register that concern at that moment. That is useful information for the clinician, who will be able to recognise when someone’s lifestyle has aggravated a condition. There are many ways that the data can be used. I think we are in relatively early days. I am not sure I would include Fitbits and that kind of technology—there is far more interesting and advanced technology—but it is important that people are increasingly engaged.

There is a concern about the embrace of technology, devices and data, and the streamlining of processes in hospitals. The contribution of individuals, GPs and consultants provides an opportunity to consider a more engaged approach to hospital and GP services in a way that could reduce the number of appointments that are necessary. Some hospital trusts have a chief innovation officer on their board. I think there are about 20 across the country, which is a relatively small proportion. It may be worth considering what the Minister can do to promote that. Ideally, we need the early adoption of approved medicines in the system. This is where the register ought to help. If we can have people in hospital trusts leading and championing the adoption of new technologies, providing information and insight, perhaps we can give more confidence to chairmen and boards as a whole. We could then have more trusts adopting technologies. We could therefore support the industry and patients, and get them the medical treatment they need earlier.

--- Later in debate ---

[Dr Luke Evans (Bosworth) (Con)]

I congratulate the hon. Member for Central Ayrshire (Dr Whitford), who has made me feel rather nostalgic. Listening to her speech gave me a flashback to when I used to go to Grand Ronde and hear someone speak so eminently plausibly in many a debate of which I had very little understanding.

Let me make this declaration now: I am a simple GP. When I entered the House, I always said that I would speak about the coalface and what really affected me at that point, and that is why I felt that I needed to speak about the Bill today. I welcome it because I approve of the emphasis on the creation of a world-leading research-driven, standards-based clinical care framework that can drive the UK forward, but two aspects have struck me in particular. The first is prescribing, and the second is trials and tests.

Members on both sides of the House have broadly welcomed the provision for new prescribers, and the flexibility for that within the framework. As the workforce and the demand grow and as the roles change, that new prescription will be necessary. I agree about the importance of ensuring that those prescribers have the necessary due diligence, training and registration, which, after all, will provide the safeguards and the accountability that are needed when it comes to writing a prescription. However, I think that the Bill has missed the issue of prescription waste, or waste medication. On numerous home visits doctors see piles of unused medication, and that does not apply only to their patients: there is a crossover in hospitals and, of course, in care homes. Some of it is purely coincidental as people are taken into hospital or from hospital into a care home, but there is a huge amount of it, and, anecdotally, doctors see it all the time. I have seen patients hand in up to 100 boxes of, say, warfarin, and that cannot be right.

When I consulted the House of Commons Library, it came up with a figure of £300 million a year in losses from 2011 on the basis of only one study. That suggests to me that, over a decade, it is hard to find sufficient information. Last week I spoke in the debate on the Environment Bill, one of whose first principles is that any other legislation should consider environmental impacts. I think that this Bill would do well to take account of prescription waste, which it could do that in a couple of ways.

Pharmacies and, indeed, any dispensers could be asked to legally collect the statistics on returns. That would allow us to see how big the problem actually is, and allow us to create solutions. It might sound strange for someone who has worked in the workforce and had lots of paperwork to be suggesting more paperwork, but at least if we open up the statistics, I am confident that my medical colleagues would look at them and see a way to resolve this.

I would also argue that we should review the charitable donation of medications. I freely admit that there are issues over their storage and over how to check the safety of this practice. However, the problem is not insurmountable if the medications are returned in their original state. If the Government do not address the matter in this Bill, I suggest that they might want to consider it going forward. We could, however, consider a more severe statutory obligation on pharmacies, care homes and dispensers to be far more vigorous in the way in which they dispense their medications and follow up, particularly for repeat prescriptions. Things such as emollients, moisturisers and day-to-day painkillers often pile up and end up on repeat prescriptions, and it is quite hard to monitor them. As someone who has written hundreds of prescriptions in a day, I know that it is very easy to sign them off rather than check them, and if there is no obligation for me to check whether the patient actually needs the medication, who does that responsibility fall to? It is arguably the patient, but if that is not happening, and if there is as much waste as we think there is, I suggest that the Government might want to consider that issue.

[Jim Shannon]

I recognise the fact that the hon. Gentleman is a GP. I declare an interest, in that I am a type 2 diabetic. At my surgery, my doctors and those who are in charge check my prescription every time to make sure that I am not over-ordering or getting more than I should be getting. Some GPs are doing that already and thereby controlling what medications people get.

[Dr Evans]

Absolutely, and I agree with the hon. Gentleman that that is exactly what a GP should be doing. However, when a GP is dealing with hundreds of requests for repeat prescriptions, it is unlikely that they will have time to phone every single one of those patients to say, “Is this what you need? Have you already got it?” That has been the role of clinical pharmacists, particularly in relation to people who have multiple prescriptions for four, five or six medications, at the time of their medication review, which I entirely agree with. A GP will indeed look at a medication review, but when someone asks for a repeat prescription, they usually do it either electronically or by making a simple mark or cross on a piece of paper that they take to the GP surgery. It is unlikely, if the prescription has already been set for six or 12 months, that there would be a review of the prescription each month. That is the whole idea of having an annual review. In the old days, people could be on medications for months, if not years, without ever being checked. The reason for doing that was convenience. If a patient had to come in to see their GP every month to justify why they wanted their medication when their condition, say diabetes, was stable, that system would not be sustainable, given the current pressures on the NHS.

My second point relates to trials and tests. For me, another element that is missing from the Bill is a duty of care. I would like to give an example of a patient who came to see me who had had her genome sequenced. She came in with a report, and she said, “Dr Evans, I have been told I have a 50% chance of having cardiovascular issues and an 80% chance of having Parkinson’s disease. Please can you help me out?” That was very difficult to deal with. First, there is as yet very little we can do to influence Parkinson’s. Secondly, at that point I had had no training on counselling someone who had had genomic testing. The cardiovascular side was easier: we know some remits, and we can make a difference with cholesterol, exercise and lifestyle advice. But this is just the tip of the iceberg, and as the tests become more advanced and more people have them, I would like to see emphasis being put on ensuring that those doing the tests have a duty of care to ensure that there is follow-up and comeback for the person who has the test.

[Dr Whitford]

Does the hon. Gentleman therefore agree that it was completely wrong last year when the NHS in England tried to offer genomic testing for £500 or £600, provided that people were willing to allow the data from their genomic testing to be used in research, without any thought of the outcome that that would generate for general practices right across the country?

[Dr Evans]

The hon. Lady makes a good point. I have no problem with that, provided that those doing the tests are also doing the follow-up and ensuring that the patient who has had the test has had counselling before, during and after it.

[Dr Whitford]

If the hon. Gentleman thinks that genomic testing for completely asymptomatic people without any family history is a benefit, does he then support the idea that it would only be the better-off people who could afford £500 or £600 who would have the test? Would that not widen health inequalities, which we will be debating on Wednesday?

[Dr Evans]

I am grateful for the hon. Lady’s point, but I would simply say that the NHS is going that way and will be providing those tests. My simple point is that whoever goes through such a test must have counselling afterwards to tell them what to do with the information. We could put that in law. It does not matter if the testing is done by the NHS or by a private testing facility. If an individual makes the choice to have the test, it must be incumbent on the person doing the test to inform them completely and counsel them throughout the test and of course afterwards when they are given the result. That duty should fall on the NHS, if the NHS has done the test, and on the private provider if the private provider has done it.

[Ben Everitt]

This is a brave new world for medical science and for the NHS, and we should not let ideology get in the way of getting the data that we need or of trialling things and accepting good ideas when they come our way, while of course taking on board what my hon. Friend is saying about getting it right at the GP end and ensuring that we look after the people who are involved in this pioneering work.

--- Later in debate ---

[Dr Evans]

Absolutely, and I am grateful to my hon. Friend for pointing that out. As I said at the start of my speech, this is about creating a framework that can be built on, and that framework should have standards and safety, but I would argue that a third strand that is needed is communication. That is the angle that is missing at this point.

That leads me on to my final point. When it comes to some medical devices, I use the term “device” in a slightly quizzical manner. For example, is lip filler a medical device? I would argue that it is probably not, but in the context of this Bill it might well fall into that category, and it probably should. Many people have cosmetic surgery. They have lip fillers, and all too often, I as a GP have had to pick up the pieces when something has gone wrong. My hon. Friend the Member for Sevenoaks (Laura Trott) is not here today, but she is bringing forward a private Member’s Bill to try to address some of these issues. This illustrates the point that now is the time to enshrine in legislation a duty of care to talk to people and to inform them, categorically, before, during and after any test or medical intervention. After all, that is the duty of a good health professional.

I support the Bill. I believe that it is about responsible research, medical provision and future-proofing medicines and medical devices, and I hope that in considering my points on prescribing, tests and trials, the Government will provide a framework that helps to strengthen our world-leading position on health.

Social Care

Luke Evans Excerpts

Tuesday 25th February 2020 Commons Chamber

[Paul Bristow]

I accept what the hon. Gentleman says —pay is indeed a factor in the recruitment and retention of social care staff, but I also agree that it is not the only factor. Terms such as “low-skilled worker” are far too commonly used in relation to care staff. That language and perception need to be challenged. We need a greater emphasis on professional structures, career development and appropriate reward.

We also need to celebrate these roles and show how rewarding and fulfilling they can be. After all, this is about looking after people. These people are our grandparents, our fathers, our mothers, our uncles, our aunts and, in some cases, our children. One day it is likely to be us. I will never forget a constituent telling me about his job in social care. He said that each and every day, he got to look after, talk to and listen to people who became his friends, and he felt he was almost cheating by calling it work.

[Dr Luke Evans (Bosworth) (Con)]

I agree with the hon. Gentleman in my professional capacity as a GP. It is invaluable to have people who know those they care for: they can pick up when there are problems, and they can inform professionals. Does he agree that we need this kind of relationship—people who understand the people they are caring for—because it saves the NHS money? That is not in any statistic that we may see, but that professionalism, dedication and care make the real difference not only to the person but for the wider NHS.

[Paul Bristow]

I agree entirely with my hon. Friend. Those social care staff and the relationships they have with the people they care for can save our service money.

Don’t get me wrong. Social care is hard, sometimes literally requiring heavy lifting and involving emotional distress, yet it is a career that can be rewarding. The Government are keen to build the same consensus on social care that already exists on our national health service, and that is the right thing to do. I hope that we can build parity of esteem for our social care workers.

Of course, there are millions who undertake social care roles without any pay. I listened with great interest to some hon. Members’ comments about unpaid carers. The 2011 census—obviously some time ago—identified that one in 10 residents in England and Wales, or 5.8 million people, are spending at least part of their week caring for disabled, sick or older relatives and friends. As with careers in social care, carers can often enjoy their work and it can be positive and rewarding. There are, however, a lot of reasons why carers need support. Carers’ own health and wellbeing problems are often exacerbated or caused by their caring role. Carers are entitled to a social care assessment of their own needs, and subsequently support, if the assessment shows that they need it; but not enough carers are being identified and subsequently assessed, and that means that they are going without support for their needs, putting their own health and wellbeing at risk. Support for carers should be embedded in funding for social care, and evidence shows that supporting carers can save money in adult social care services and the NHS, while improving the life of the carer and the person with care needs.

I would like to make a quick mention, if I may, of the social care work that goes on in my constituency. Some of the most enjoyable time I spent on the campaign trail was at two hustings that were organised in Peterborough. One was the general election hustings for adults with learning and social disabilities. I found it one of the most rewarding aspects of that campaign, because I learned a huge amount about the experiences of those particular constituents and of those who care for them. I would like to pay tribute to Klayr Lynch, the facilitator of Club 73, and her team for all the hard work they undertake each and every day for some of my most vulnerable constituents. They do a truly brilliant job. The same can be said of the disability hustings organised by Disability Peterborough and the Cambridgeshire Deaf Association, organised by my old school friend Andrew Palmer.

Colleagues will learn much about social care from their own constituencies. In this place we rightly often talk about hard-working doctors and nurses. Understanding the crucial work that those in social care undertake, may I make a plea that hon. Members, especially my right hon. Friends on the Front Bench, remember to include a reference to social care workers when they talk about hard-working doctors and nurses.

Wuhan Coronavirus

Luke Evans Excerpts

Monday 3rd February 2020 Commons Chamber

[Matt Hancock]

I agree with the hon. Lady that through experiencing a challenge such as this, when things are moving fast and information flows very quickly, we can always improve the way in which those flows occur. The Minister leading on this will be happy to meet the hon. Lady to discuss these matters because, as she rightly identifies, we must constantly seek improvement. I pay tribute to the approach she has taken, given that the two cases identified in England so far involve residents of her constituency.

[Dr Luke Evans (Bosworth) (Con)]

I thank the Health Secretary for updating the House today. As one who has worked on the frontline in primary care, I know that the people working there often bear the brunt of these events, dealing with both the people who are scared when they come in to talk and those who actually suffer from the virus. My colleagues back in practice will be pleased that my right hon. Friend has directed people towards the 111 service, but what has he done to tell colleagues in GP practices or health centres where they should signpost people who turn up in those locations? If the situation worsens and becomes more sinister and widespread, will any funding be made available?

[Matt Hancock]

We have clearly communicated advice to all GPs and published it. I will not repeat it here, because what matters is that people follow the precise clinical guidelines set out by the medical leaders of the NHS and the chief medical officer.