Covid-19: Response and Excess Deaths

Maria Caulfield Excerpts

Thursday 18th April 2024 Commons Chamber

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

Apologies for my croaky voice. I will try to respond to all the points that I can.

I thank the hon. Member for North West Leicestershire (Andrew Bridgen) for securing this important debate. As the Opposition have rightly said, it is important that we have the debate in a measured way, because there are strong feelings on all sides. Those who have concerns about vaccines, lockdowns and the way pandemics are managed are right to raise them, but it is also right and proper that people express the view that vaccines protect people and that difficult decisions had to be made. As the hon. Member for Blackley and Broughton (Graham Stringer) highlighted, it is much easier to come to different conclusions with hindsight. It is really important that as we go forward, still living with covid, we continue our discussions in a measured debate on all sides. In recent weeks, we have seen the impact of people not being able to speak freely about their concerns regarding the Post Office or the Tavistock centre.

As I said, we have had a number of debates on this issue, including in January, when I acknowledged that the hon. Member for North West Leicestershire was correct to say that we have seen excess deaths in recent years. However, excess deaths are not new; they were happening before covid and have happened since then as well. It is important to look at the figures, because the Office for National Statistics indicates that the number of excess deaths has been reducing, year on year, since the high in 2020, when there were 66,740 excess deaths in England. I can only talk about England because health is obviously devolved and the Governments in Scotland, Wales and Northern Ireland will have their own data. In 2022, that number went down to 37,701, and in 2023, there were just 10,206 excess deaths in England. It is important to remember that every single one of those is a person, a family member, and a loved one, but it may reassure hon. Members greatly, as it does me, that the ONS has reported negative excess deaths for every week so far in 2024.

[Andrew Bridgen]

After a pandemic, which we have been out of for quite some years, we would expect a deficit in deaths, so why have we not had a deficit for the past two years, in which we have not had the covid pandemic?

[Maria Caulfield]

The hon. Gentleman may have missed my last sentence before his intervention. I said that the ONS data shows that in every week in 2024 so far, we have had negative excess deaths. That goes specifically to his point.

We are not complacent, though. As I set out in previous debates, when we have seen those rises in excess deaths—and we have seen significant excess deaths—we have looked at that data to see the cause behind it, whether it is the vaccine, covid, or other factors. We have been working so hard, and I am really pleased that we are now starting to see negative excess deaths.

Let me highlight some of the work that we have been doing in looking at those figures. We had an incident of high flu prevalence in 2022, with a peak of 31.8% of flu tests being positive. That is highly likely to be because we locked down the country for two years and people’s immune systems were not used to flu. That is why, last winter, we brought forward our flu vaccine, and extended it the year before to the over 65s; we recognised that people’s immunity to flu and respiratory illnesses was low because we had locked them down. I think that we need to be honest about that. This winter, as a result, we have seen fewer admissions and fewer deaths from flu and respiratory illnesses.

We have also seen challenges with other health conditions, such as diabetes and cardiac disease, for which people would routinely have come forward for checks. Routine treatments and access to appointments are difficult even now, given the backlog of examinations and tests that need to happen. When we looked at this, we saw that last year, the rate of deaths from cardiovascular disease was 2% higher than expected, with there having been more than 2,200 excess deaths.

That is why we are reinvesting in our NHS health check. It was on pause during covid, when people could not get their blood pressure or cholesterol checked and could not go on smoking prevention programmes. We restarted those, and as a result, excess deaths from cardiac disease are starting to fall. We want to use the opportunity to roll out our new digital health checks. We recognise that access to GPs is sometimes difficult, but this roll-out is expected to deliver an additional 1 million checks in the first four years. We also have a £10 million pilot to deliver cardiovascular checks in the workplace. Again, that is about making it as easy as possible for people to get checked. We have our Pharmacy First roll-out as well. That is all for general health purposes. We know that all these things contributed to excess death rates.

I want to touch on the crux of the matter, which is the covid vaccine; that has come through in all these debates. I was not a Health Minister at the time, so I did not have to make these difficult decisions, but the hon. Member for Blackley and Broughton is absolutely right: as the pandemic preparedness Minister, I want the findings of the inquiry. I have to make difficult decisions now about potential future pandemics that may never happen, but could happen tomorrow—we just do not know. The results of the inquiry with regard to lockdowns, face masks and vaccines will all be really useful information, and at the moment, I am not much the wiser on those results.

On module 4, I want to see any evidence about vaccine safety, because that is how we learn. I think we are all singing from the same hymn sheet. We want to do the best, but during the pandemic, when we watched TV footage from around the world, and the media were often pushing us to lock down harder, faster and longer, we had to make difficult decisions without the benefit of hindsight.

I went back to the wards during covid, and I looked after covid patients who were being treated for cancer. We lost many of them, and we lost a number of staff, too. I have seen this from both sides of the fence.

[Dr Mullan]

Of all the concerning points that the hon. Member for North West Leicestershire (Andrew Bridgen) made in his opening speech, particularly abhorrent was the suggestion that people who were not eligible for a ventilator were essentially condemned to death. That is a deeply disturbing thing to say, and it does not reflect my experience. I was privileged to volunteer on the frontline, as the Minister did, and I saw staff battling as best they could to save people, using all the medical treatments available, whatever the patient’s age. Will the Minister join me in paying tribute to those staff who worked so hard to save as many lives as they could?

[Maria Caulfield]

Absolutely, and I thank my hon. Friend for his work during those difficult times. We did not have a vaccine in those days, and we did not know how long covid was going to last. I reassure the relatives who are listening to this debate that we treated every single patient in the best way we could. If they needed a ventilator, we often had to ship them out of hospital to get them to a ventilator, but they got one. If they did not need a ventilator, we treated them. We did not leave people to die, and I reassure relatives who might think that we did that it certainly was not my experience of looking after patients.

It is important to look at the data on covid vaccinations. The Office for National Statistics published data last August showing that people who received a covid-19 vaccination had a lower mortality rate than those who had not been vaccinated. Given that 93.6% of the population has been vaccinated with either one or two doses, or multiple does, it is almost impossible to determine correlation versus causation. Vaccinated people will feature highly in excess death numbers because most people have been vaccinated, which is why we need to go through the data really carefully and not just take the first data at face value.

The covid virus continues to circulate, and we are now living with covid. Some people are still very vulnerable to covid, although the current variant is obviously less severe than the initial variant. We have just had our spring vaccine roll-out, and those who are invited should please go to get their vaccine. We know that it makes a difference to the most vulnerable. Over this winter, after both the flu and covid vaccine roll-outs, we have seen a significant reduction in hospital admissions.

[Sir Christopher Chope]

When will the immunosuppressed have access to Evusheld? Will it be this week, next week, sometime or never?

[Maria Caulfield]

That is a clinical decision, but now that we have the omicron variant, the evidence for Evusheld’s effectiveness is not as compelling.

Returning to the crux of the matter, there are risks and benefits to every single medicine when the regulator or NICE is weighing up whether to license or fund a product. If the advice coming to us is that, with omicron, the benefits of Evusheld do not outweigh the risks, we have to take that advice. People are not currently being advised to shield, but I recognise that people are very nervous, particularly when they cannot have the vaccine. We are in constant touch with NICE and the MHRA on this, but we have to respect their decision if it is felt that a product will not benefit patients.

[Andrew Bridgen]

Will the Minister give way?

[Maria Caulfield]

I will give way one more time, as I have only a few minutes left.

[Andrew Bridgen]

I thank the Minister for giving way. She is very generous.

Using her medical experience, can the Minister explain to the House—I am befuddled by this—how a systemic vaccine injected into the arm, into the blood and creating an antibody response, can stop an infection of the airways and lungs by a respiratory virus? It has never happened, and it did not happen this time either, did it? How can it do that?

[Maria Caulfield]

That is actually what antibodies do.

I will answer some of the many questions that have been asked in this debate. I reiterate that no medicine or vaccine is completely risk free. Even simple paracetamol has the potential to kill people if it is not taken properly, and people with certain conditions might not be able to take it at all. We have monitoring systems in place. The MHRA, which I know has come under criticism, took a stand when in April 2021, following concerns raised through the yellow card system, it reduced access for the under-30s and then for the under-40s. When concerns are raised, it absolutely takes action. There are now recommendations about the type of vaccine, and about whom we vaccinate, bearing in mind the current evidence.

I have said that no vaccine is 100% safe, which is why we have the vaccine damage payment scheme. I hear concerns about that, and I have met my hon. Friend the Member for Christchurch (Sir Christopher Chope) to discuss it. We took the scheme off the Department for Work and Pensions and moved it into the Department of Health and Social Care to speed it up and get claims turned around more quickly. We have had more than 4,000 claims, 170 of which have been awarded. Roughly speaking, the majority of claims are decided on within six months, and the vast majority are decided on within 12 months. Of course, we want to speed up on those. We recognise the time limit of three years, which is why we are working as hard as we can to get through as many claims as possible, so that if people have been affected by the covid vaccine, they get some help and support through that funding.

My hon. Friend the Member for South Basildon and East Thurrock (Stephen Metcalfe) raised the issue of research. We are absolutely researching the issue of covid-19 vaccines—not just future types of vaccines, but their safety. There is £110 million from the National Institute for Health and Care Research going specifically into covid-19 vaccine safety, and I encourage all Members to keep an eye on that as the evidence comes forward.

I have to give the hon. Member for North West Leicestershire a few minutes to reply, so I will just say that we take this issue extremely seriously. I know that as a Minister, I will be responsible—

[Danny Kruger]

Will the Minister give way?

[Maria Caulfield]

I will not, as I have to let the hon. Member for North West Leicestershire respond. We take this issue very seriously. I have been as open and transparent as I can be. If there are concerns, we will always look into them, but there is no doubt that covid vaccines save lives. There is no doubt that some people have experienced harm from them—we acknowledge that, and we want to help and support people who have been affected—but the vaccines did get us out of the pandemic and we need to be mindful of that as well.

[Andrew Bridgen]

With the leave of the House, Mr Deputy Speaker, let me thank all the hon. Members who have taken part in a debate that has been robust, as it should be, given the gravity of the issue. I wish this debate were not needed; I wish the experimental covid-19 vaccines were safe and effective, but they are not. The longer we go on not admitting the problem, the bigger the problem that will come, and the greater the harm that will continue to be caused. Those in this House can continue to deny that the vaccines are causing harm and deaths, and the legacy media can continue to censor all reports of vaccine harms and excess deaths, but the people know, in increasing numbers, because they are the ones who are losing their loved ones and relatives. I urge the Government: release the control-level data, and let us sort this out once and for all.

Question put and agreed to.

Resolved,

That this House has considered the covid-19 pandemic response and trends in excess deaths; and calls on the Covid-19 Inquiry to move onto its module four investigation into vaccines and therapeutics as soon as possible.

Antimicrobial Resistance

Maria Caulfield Excerpts

Wednesday 17th April 2024 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Dowd. I thank my hon. Friend the Member for Colchester (Will Quince) for securing today’s debate, for his contribution to the Department of Health and Social Care during his tenure as a Minister and, in particular, for his work on this issue.

This is a pivotal year for confronting antimicrobial resistance, because the emergence of resistant infections is relentless and, as my hon. Friend eloquently described, the pipeline for new antibiotics is running dry. The evidence is stark, not just domestically but globally: more than 1 million people die every year from infections that have become resistant to treatment. To put that number in context, that exceeds the number of people who die from HIV or malaria.

AMR is sometimes described as an ignored pandemic, but if we do not act, the cost of treating resistant infections could compare to having a pandemic such as covid-19 every five years. My hon. Friend is absolutely correct to say that, if we were to walk outside this place, many of the people we talked to would not understand what AMR is or appreciate the consequences of not dealing with it domestically or internationally. That is why we are committed to addressing antimicrobial resistance.

My hon. Friend is also right that in 2019 we published our vision for antimicrobial resistance to be contained and controlled by 2040, and that date looms ever closer. That vision recognises that it is a complex problem. There are three tiers to the way we are tackling it. First, we must lower the burden of infection in humans and—my hon. Friend touched on this slightly—in animals: if you do not get the bug, you will not need the drug.

Secondly, we must use antimicrobials only when they are absolutely needed, and we should use them correctly. That is also true for both people and animals, as I will touch on in a moment. Thirdly, we must develop new antibiotics or new technologies to treat these infections so that we have more tools in our armoury as resistance emerges.

We can all play our part. I make a public health plea to everyone: we all have a responsibility to finish courses of antibiotics prescribed to us—often, we do not finish our course, because we feel better and think there is no need to take the rest of it, but that is a key way of developing resistance—and not to self-medicate after keeping the strip, which is equally harmful. There are bad practices in other countries, but we all have a responsibility to take our antibiotics as prescribed, and not to self-medicate, should we have some antibiotics looming in our cupboards.

[Richard Foord (Tiverton and Honiton) (LD)]

I am grateful to the Minister for giving way and I pay tribute to the hon. Member for Colchester (Will Quince) for securing the debate. On a brilliant Radio 4 documentary called “Swimming in Superbugs”, Dr Anne Leonard of the University of Exeter Medical School talked about her Beach Bums project and said that people who use the sea are three times more likely to have antibiotic bacteria in their gut. Does the Minister agree that we should not import human sewage sludge to spread on farmland, given that we think traces of antibiotic resistance material might have ended up in the sea?

[Maria Caulfield]

That goes back to my first pillar of reducing and preventing infections in the first place. We need to do that domestically, but internationally we are also doing huge amounts of work in that space to improve water sanitation. With animal health, too, we have done a huge amount of work, in particular on antibiotic use in food. Among animals used in food production, the UK has reduced by 59% the amount of antibiotics going into the food chain, which has a knock-on effect.

We are also investing in innovation and capitalising on our world-leading science, including phage therapy, as my right hon. Friend the Member for Tunbridge Wells (Greg Clark) pointed out. I had not heard about the Leamington Spa facility, and I am interested to catch up with him after the debate to see what more can be done. The National Institute for Health and Care Research is investing almost £90 million in that type of research, so if there is potential to develop that further, we are always keen to hear it. Our plan is cross-sectional, a one health approach, recognising the links between the health of humans, animals and the environment, and the spread of resistance between them.

We have a national action plan, which is not limited to activity in the UK. We all know that infections do not respect borders. As my hon. Friend the Member for Colchester said, we are therefore working internationally and taking a lead in many elements of that across the global community, with our UK special envoy on antimicrobial resistance, Dame Sally Davies, spearheading some of the effort. On updating my hon. Friend on the action plan post 2024, we are working it up as we speak and hope to make an announcement soon. There is an ongoing piece of work to drive forward some of the changes across the three sectors.

We are doing our bit here and are leading internationally, but my hon. Friend also touched on what is happening in other countries. Low and middle-income countries have to be part of the change so that we can safeguard ourselves against antimicrobial resistance.

[Jim Shannon]

One of the groups that I speak to reminded me to mention—I quote—

“the need for Group B Strep screening in pregnant women during labour instead of using antibiotics for all routinely.”

The Minister is interested in that subject and has an opinion on it. Does she agree that this is a chance to raise awareness of that particular issue?

--- Later in debate ---

[Maria Caulfield]

The hon. Gentleman is absolutely right. I will touch on how much more we can do with screening to prevent some infections. This cannot just be about developing new antibiotics; it is about preventing infections and screening for them in a range of scenarios.

To touch on some of the high prevalence internationally, 89% of all antimicrobial resistance deaths occur in Africa and Asia, so we have responsibility to ensure that we help out in those countries that struggle most with the issue. We must continue to ensure that people around the world have access to the antibiotics they need, which is why the £40 million in innovative research through the global AMR innovation fund that my hon. Friend the Member for Colchester mentioned is so crucial. It enabled the development of a new antibiotic for drug-resistant gonorrhoea, the first in 30 years.

The hon. Member for Tiverton and Honiton (Richard Foord) touched on the role of water, which requires an international effort. Sanitation is often a leading cause of infection in other countries. That is why we are working hard with other countries and the WHO to improve water sanitation and hygiene to reduce infections occurring in the first place.

In 2022, we made a further £210 million commitment for the second phase of the Fleming Fund to strengthen our surveillance systems. As the hon. Member for Strangford (Jim Shannon) said, it is not just about treatment, but about picking up infections and trends and trying to prevent them in the first place. The Fleming Fund is having an impact. Since 2015, over 240 laboratories have been upgraded with state-of-the-art equipment, training and new systems, and over 75 national action plans on AMR have been developed in Africa and Asia to try to get the death toll from antibiotic resistance down. The Fleming Fund leverages UK expertise, with over 3,000 healthcare workers being trained in antimicrobial surveillance principles through a partnership with the NHS.

Looking ahead, we recognise the risks. We are not being complacent either domestically or internationally. Through the hard work of my hon. Friend the Member for Colchester, we have put some good building blocks in place, but we need to look to the future. Our next five-year antimicrobial resistance national action plan will be published later this year.

[Greg Clark]

I am grateful to the Minister for what she said about phages. She knows that UK science is world-leading, especially in this area. In Imperial College alone, there are 180 researchers working on AMR. One such researcher, Professor Jonathan Cook, has noted the real benefits of point-of-care testing and the fact that other countries, including the Netherlands, have managed to make a big impact. Can the Minister say whether we have plans to accelerate the availability of such testing in this country?

[Maria Caulfield]

My right hon. Friend makes a good point, which I will take away and follow up on. There are some really good examples in primary care where some testing is done. Primary care nurses particularly will do point-of-care testing to see whether someone’s infection will be sensitive to antibiotics or not. I believe there is more we can do in that space, both in primary and secondary care, so I am happy to write to him about how we can roll that out nationally. Importantly, that testing helps to maintain patients’ expectations. I cannot remember who, but someone said that people go along to GPs and expect to be given antibiotics. Point-of-care testing will be able to reassure them that they either do or do not need antibiotics and tell them which type is best suited to their type of infection. That is crucial.

Our plan will set out an ambitious programme of work, learning from covid-19 in testing, surveillance and treatment to prepare for infections of the future. I can reassure my hon. Friend the Member for Colchester that we will continue to collaborate internationally with organisations such as the WHO and use our soft power to help to support in particular African and Asian nations, which are suffering greatly from the mortality of antimicrobial resistance. This is a hidden pandemic that will have consequences for us all if we do not deal with it.

Question put and agreed to.

Duty of Candour in Health and Social Care: Review

Maria Caulfield Excerpts

Tuesday 16th April 2024 Written Statements

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

On 6 December 2023, I informed the House that the Department of Health and Social Care will lead a review into the effectiveness of the statutory duty of candour for health and social care providers in England.

The duty of candour is set out in regulation 20 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. It has been in place for NHS trusts and NHS foundation trusts since 2014 and for all other providers regulated by the Care Quality Commission since 2015.

The duty of candour is a crucial instrument for promoting an open and transparent culture in health and social care, ensuring patients and service users or their families receive a full account of events, and a meaningful, timely apology when things go wrong during the provision of health and care services. Providers must also provide those affected with reasonable support and details of further enquiries or investigations that need to be made. The duty is about providers taking reasonable steps to ensure they communicate with those affected in a way that is as accessible and supportive as possible.

Today, I wish to inform the House that we are publishing a call for evidence as part of the review. A call for evidence will allow my Department to capture and consider a wide range of views, including expert opinions, about how the duty is being honoured, monitored and enforced, and the extent to which the policy has met its objectives.

The call for evidence will run for six weeks and close on 29 May 2024.

We will consider all responses to the call for evidence and use them to inform our recommendations for better meeting the policy objectives of the duty of candour.

The call for evidence will be published on www.gov.uk and a copy will be deposited in the Libraries of both Houses.

[HCWS408]

Death Certification Reform: Introduction of Medical Examiners

Maria Caulfield Excerpts

Monday 15th April 2024 Written Statements

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

I wish to inform the House that the Government will today lay before Parliament regulations which will reform death certification in England and Wales. Under these reforms all deaths will legally become subject to either a medical examiner’s scrutiny or a coroner’s investigation. The changes coming into force on 9 September 2024 will put all the medical examiner system’s obligations, duties and responsibilities on a statutory footing, and ensure they are recognised by law.

The changes will provide greater transparency on the circumstances surrounding a death. Medical examiners will always offer a conversation to the bereaved, providing an opportunity for them to raise questions or concerns with a senior doctor not involved in the care of the deceased. This will help deter criminal activity, improve practice and ensure the right deaths are referred to coroners for further investigation.

The introduction of medical examiners is part of a broader set of reforms to death certification, coronial and registration processes which will allow for the efficient flow of information between medical practitioners, medical examiners, coroners and registrars in the new system.

This is the most significant set of reforms to death certification in 70 years and we have allowed additional time to prepare for implementation. We are working closely with our partners in government, local registration services, coronial services and the health service to ensure that the appropriate operational processes are in place to deliver these changes in September 2024. There will be further communication regarding legislative changes and operational guidance between now and September 2024.

[HCWS395]

Managing Covid-19: Updated Guidance

Maria Caulfield Excerpts

Monday 25th March 2024 Written Statements

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

On 21 February 2022, the Government published the “Covid-19 Response: Living with Covid-19” guidance, which set out a plan to live with covid-19, while protecting people at higher risk of serious illness. In March 2023, the Government announced further changes towards managing covid-19 like other respiratory illnesses. New changes from 1 April 2024 are the next stage in delivering this approach.

The latest changes are an important milestone in our journey to living with covid-19. After several years of dedicated resources and focus, covid-19 is now recognised as an established and ongoing health issue in the UK, and the approach to managing it will now be even further aligned with other established respiratory pathogens. Protecting people at higher risk remains the Government’s priority.

Vaccines for those at higher risk of serious outcomes from covid-19 remain central to the Government’s approach. Last autumn’s covid-19 vaccination campaign saw over 70% of all people aged over 65 years living in England receive a covid-19 booster. In care homes, over 80% of residents received a booster, providing vital protection over the winter months. Today, due to a combination of immunity acquired from natural infection or vaccination, covid-19 is now a relatively mild disease for the vast majority of people.

This spring, a covid-19 vaccine will again be offered to those most at risk of serious illness, in line with advice from the Joint Committee on Vaccination and Immunisation. The NHS will also offer more people access to covid-19 treatments, expanding the eligible cohort from the existing 3.9 million people to an additional 1.4 million people at the highest risk of severe illness.

The continued effectiveness of vaccines and treatments to protect people at high risk means that we can transition to an approach where covid-19 is managed in line with other respiratory illnesses, such as flu. From 1 April 2024, changes will be made to covid-19 testing to align with other respiratory infectious diseases.

Testing from 1 April 2024

While the virus causing covid-19 continues to evolve, new variants have not required a return to large-scale public testing. Given the high levels of vaccination among groups at higher risk, wider access to treatments and the reduced impact of outbreaks, the Government are now able to remove some of the highly targeted testing that remains in place from the height of the pandemic.

From 1 April 2024, routine provision of free covid-19 lateral flow device (LFD) tests for the management of outbreaks in higher risk settings will come to an end in England. However, free testing to determine the cause of an acute respiratory infection outbreak, where deemed appropriate by a local UK Health Security Agency (UKHSA) health protection team, in higher risk settings will remain to test for a wide range of respiratory viruses.

Routine asymptomatic covid-19 LFD testing on discharge from hospital into care or hospice settings will also end to align with the approach for other respiratory illnesses, though NHS trusts will have local discretion to re-introduce this or other forms of testing as clinically appropriate following risk assessment, involving local authority public health teams, UKHSA health protection teams and care providers as necessary in decision making.

Acute health providers should have trusted processes in place with local care home and hospice providers to facilitate safe discharges, as set out in the hospital discharge and community support guidance. Together with the care home or hospice, hospitals should assess the risk in the period before planned discharge, seeking advice on proposed changes to testing arrangements from local authority public health teams or UKHSA health protection teams if needed.

Care providers and hospices will also continue to have the ability to discuss and raise any concerns about discharge arrangements through existing local mechanisms. Where a care provider or hospice is providing services commissioned by a local authority or the NHS and has concerns about a planned discharge that cannot be resolved with the acute hospital provider, this includes the ability to contact the relevant commissioner.

Limited testing, including symptomatic testing of staff working on in-patient wards focused on treating profoundly immuno-compromised individuals, will continue in line with locally derived protocols to protect those most at risk. Symptomatic testing of patient-facing hospice staff who work closely with people who are at high risk from severe outcomes if suffering from covid-19 will also continue as outlined in guidance, in line with similar NHS settings.

The cohort of people eligible for covid-19 treatments can continue to access free covid-19 LFDs from their local pharmacy. These people, who are at highest risk of becoming seriously ill, are encouraged to test in order to gain timely access to treatments. A full list of those who are eligible, and information on how to access tests, is available on the NHS website.

Guidance on a range of infection prevention and control measures in adult social care has now been combined with acute respiratory infection guidance and has been updated to reflect these changes. This guidance, as well as guidance for hospices and other non-clinical settings, has been updated to reflect the latest evidence and expert consensus. It is technical guidance to support settings in operationalising the changes to the services they are directly responsible for from 1 April 2024.

Guidance published on 1 April 2022 for individuals in the community with symptoms of covid-19 or respiratory illness continues to set out the actions we can all take to help reduce the risk of catching covid-19 and passing it on to others.

The future approach to pandemic preparedness

The covid-19 pandemic has highlighted the public health and economic risks posed by pandemics. The Government are continuing to work closely with partners to reduce the impact of a future pandemic. Together, UKHSA and the Department of Health and Social Care are developing plans to prevent and/or respond efficiently and effectively in the event of a pandemic.

These plans will build on learning from covid-19, and the findings of the covid-19 inquiry, once published. The exact nature of a future pandemic may vary, and so preparedness is considering all modes of transmission and tackling “Disease X” in readiness for unknown future threats.

The Government have already taken steps to prepare and develop capacity to respond, including through the Moderna-UK strategic partnership and the Vaccines Development and Evaluation Centre. Through UKHSA, we retain strong surveillance systems, world-leading genomic sequencing capabilities, and stronger baseline data and analysis functions that will help detect and characterise pandemic threats.

[HCWS376]

Kettering General Hospital: Redevelopment

Maria Caulfield Excerpts

Friday 22nd March 2024 Commons Chamber

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

I congratulate my hon. Friend the Member for Kettering (Mr Hollobone) on securing this important debate. He tirelessly campaigns for Kettering, particularly for the new hospital there, and firmly holds Ministers’ feet to the fire on this issue.

I reassure my hon. Friend that the Government remain absolutely committed to a new hospital for Kettering, and that a number of milestones are being met. As he pointed out, the trust is currently developing its refreshed strategic outline business case, supported by the new hospital programme team, to make sure that it aligns with our national approach of standardising all our new hospitals to the Hospital 2.0 model. We expect a submission to the Department for the wider hospital work later this year.

[Mr Hollobone]

I thank the Minister for the start of her response, which has been very constructive. I support the Hospital 2.0 programme and its standardised design of the 40 new hospitals—that is great. Kettering General Hospital has already submitted its first two business cases for the main scheme. Instead of having to resubmit them all over again, please could it simply submit an addendum, so that it does not have to reinvent the wheel?

[Maria Caulfield]

I absolutely take my hon. Friend’s point, particularly given the issue he raised about RAAC being discovered on the maternity and gynae floors. I will take that point to the Hospitals Minister in the other place and the team, and I will put in his request to meet the Minister to discuss this. I understand the frustration that comes when some work has been done already, and that it takes time for the trust, which urgently wants to get on and construct the new hospital. I will certainly take that away after the debate.

I reassure my hon. Friend, his constituents, the patients who use Kettering General Hospital and the staff who work there that the new hospital will be in place as soon as possible and will meet the 2030 deadline. I recognise the urgency. As part of the works, the energy centre is crucial to the development of the wider hospital scheme. We heard very eloquently from my hon. Friend this afternoon—he has also explained this to me and other Ministers—that this is not just a crucial part of the new hospital plans, but that the current system was only ever meant to be a temporary measure; he described how fragile it is, so I recognise the urgency of starting work on the new energy centre.

My hon. Friend will know that early works have commenced on site. Ground clearance and site surveys are under way to prepare for the cabling that is needed to provide the energy centre’s power once it is completed. Hoardings will shortly go up to allow more extensive works to start on site. I can reassure my hon. Friend that his constituents will start to see progress on that very shortly. The trust has made progress, recently reaching a new connection agreement with National Grid and agreeing the reserve capacity needed for the energy centre. That is a vital step in securing the new hospital’s energy requirements for the future and in dealing with the imminent problem of the temporary energy facility that is keeping the hospital going.

The final piece of the jigsaw to get the construction of the energy centre under way is the full business case that the trust needs to submit. I can reassure my hon. Friend that that we are working with the new hospital programme team on this. We expect the case to be submitted in June. The Hospitals Minister has committed that, subject to it meeting the cost threshold and certain criteria, we can estimate a turnaround time for approval of two weeks, so hopefully we will start to see the construction of the energy centre this summer. I hope that gives my hon. Friend and his constituents reassurance.

[Mr Hollobone]

I thank the Minister for her reassurance. The purpose of these debates is to put pressure on the Government—that is the way Parliament works—but would she join me in applying gentle pressure on the trust? The sooner it can get the full business case in, the sooner the thing can be approved and the funds can start to flow.

[Maria Caulfield]

Absolutely. I have spoken to the Hospitals Minister on the specific issue of Kettering, and he is in agreement; if the trust can keep us updated with the timeline and let Ministers know as soon as it submits the business case, he has given the commitment to try to turn it around within a couple of weeks. I would gently say to the trust that it is in its interest to get the case to us as soon as possible.

[Mr Hollobone]

I thank both my hon. Friend and the Hospitals Minister for their involvement. It is right, is it not, that this two-week turnaround is a novel feature of the new hospital programme? It is a groundbreaking approval process that will turn the application round that quickly. Where Kettering leads, others surely will follow.

[Maria Caulfield]

Absolutely. I take hon. and right hon. Members’ feedback about their frustration at how clearing the red tape in this process sometimes takes longer than the construction. My hon. Friend is right: this will be a novel way forward and could open the door for other trusts that are proactive in securing approval for their business cases in a more timely manner.

In addition to the energy centre, the Government are releasing funds to support the trust overall for the new hospital that we wish to build at Kettering, both for the development of the business case more widely and for some early critical works to prepare the site for main construction. By the end of this financial year—which is early next week—the scheme will have received over £5 million in development funding. That includes the release of over £1.9 million in fees to support with the design, planning permission and a business case for a new multi-storey car park. Further funding has also been released to support the development of business cases for the reprovision of accommodation, which will be needed during construction, the data centre and construction area and access roads, which will also be required.

I hope I have reassured my hon. Friend that we are doing extra work, in addition to the energy centre. We expect to receive the full business case and submissions over the course of this year. Again, we urge the trust to be as swift as it can with that, so that we can make some assessments and decisions as quickly as possible. Of course we will keep my hon. Friend updated as the scheme progresses and as further funding is released to the project, because we want to stay on track to complete the main construction of the new hospital by 2030.

In the short time I have, I want to update the House on the wider hospitals programme, because I know that hon. Members are often interested in the progress we are making. I am pleased to say that four of our new hospitals are now open to patients: the Northern Centre for Cancer Care in Newcastle, the Royal Liverpool Hospital, the Louisa Martindale, also known as the 3Ts hospital, in Brighton, and the Northgate and Ferndene Hospitals in Northumberland. A further four hospitals are expected to be open by the end of the next financial year: Salford Royal major trauma centre, the Dyson cancer centre in Bath, the national rehabilitation centre in Loughborough, and the Midland Metropolitan University Hospital. A further 18 hospitals are in construction or well under way towards completion. We also have other capital programmes, including over 100 rapid diagnostic centres that are open, 100 new surgical hubs that are either open or in construction, and 160 mental health crisis centres—all capital projects that will transform healthcare up and down England.

In conclusion, I again thank my hon. Friend the Member for Kettering. He has raised this issue, quite rightly, to hold our feet to the fire. He is fighting tooth and nail for his constituents to get the new hospital up and running by 2030. The energy centre will be the first major part of that construction. If the trust can get us the business case by June, the Hospitals Minister has committed to try to turn that round within a couple of weeks. That will be the start of the wider programme for the new hospital at Kettering. We will absolutely keep my hon. Friend updated, and the new hospital programme team will continue to do all it can to meet the challenges of delivering such a large infrastructure project, to ensure that staff and patients have world-class facilities in Kettering.

Question put and agreed to.

Down Syndrome Act 2022: Progress on Implementation

Maria Caulfield Excerpts

Thursday 21st March 2024 Written Statements

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

Today, on World Down Syndrome Day, I am pleased to provide an update on the Government progress on implementation of the Down Syndrome Act 2022. The Act seeks to improve life outcomes for people with Down syndrome and imposes a duty on the Secretary of State for Health and Social Care to give guidance to relevant authorities about how to meet their needs.

On 18 March 2024, we formally commenced the Down Syndrome Act 2022 by way of regulations, which bring into force all the provisions of the Act and is a necessary step towards the publication of guidance. This progress follows over 1,500 responses to our call for evidence from people with Down syndrome, their families and carers, professionals, and organisations, and we will be publishing our summary of these findings shortly. We have created easy-read and accessible content to ensure everyone can fully engage and be a part of the process to develop the statutory guidance.

This year’s global World Down Syndrome Day theme is to “End the stereotypes”. Working with people with personal experience, voluntary sector organisations and other experts to develop the guidance has brought a wealth of information to better understand the needs of people with Down syndrome and how we can address those needs. By raising awareness and understanding of the needs of people with Down syndrome, we can help to ensure every person with Down syndrome has the opportunity to live full and fulfilling lives.

Engagement with people, professionals and organisations representing different genetic conditions has been an important consideration in developing the guidance, particularly identifying where tailored services and support for people with Down syndrome would benefit those with similar needs. We have also worked closely with the Department of Education on adding a question in relation to Down syndrome to the school census to provide helpful information to support implementation of the Act and facilitate better planning for local authorities.

I would like to thank all those people with personal experience, national and local charities, integrated care board leads for Down syndrome and others that have fed in their views and informed our work to develop the guidance. I am grateful to my right hon. Friend for North Somerset (Sir Liam Fox MP) for introducing his private Members’ Bill which is now the Down Syndrome Act, and to hon. Members for their continued support for this work.

We look forward to issuing the draft statutory guidance for public consultation later this year.

[HCWS363]

Mental Health: Government Responses to Reports

Maria Caulfield Excerpts

Thursday 21st March 2024 Written Statements

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

Today the Government have laid before Parliament their response to the Joint Committee on the Draft Mental Health Bill.

The Government would like to thank the Joint Committee on the Draft Mental Health Bill, its Chair Baroness Buscombe, its members from both Houses, and staff, for its careful and considered work scrutinising the draft Bill. We are also grateful to all the stakeholders who gave or provided oral or written evidence, and many experts by experience and members of the public who have so generously given their time.

We have carefully considered the Joint Committee’s report and the Government response addresses each of the Committee’s recommendations in turn. We welcome the Committee’s support for the draft Bill and will consider some amendments to the draft Bill, as well as further steps that can be taken without the need for primary legislation, in response to the Committee’s recommendations.

It remains our intention to bring forward a Mental Health Bill when parliamentary time allows, and the Government continue to take forward non-legislative commitments to improve the care and treatment of people detained under the Act.

We are continuing to pilot models of culturally appropriate advocacy, investing up to £1.5 million to provide tailored support to hundreds of people from ethnic minorities to better understand their rights when they are detained under the Mental Health Act.

NHS England has also launched the patient and carer race equality framework, for all NHS mental health trusts to embed across England. This mandatory framework will support trusts and providers to work with their local communities, patients and carers to agree and implement concrete actions to reduce racial inequalities within their services.

Today I am also announcing the publication of our Government response to the rapid review into data on mental health inpatient settings.

On 23 January 2023, the Government launched a “rapid review” into mental health patient safety, chaired by an independent expert, Dr Geraldine Strathdee.

This review was commissioned in response to significant concerns about the treatment and safety of patients at a number of mental health inpatient settings. It considered how data and information can provide early alerts and be improved to identify risks in order to prevent patient safety incidents and support efforts to improve care in mental health inpatient settings. The review’s report and recommendations were published on 28 June 2023. I would like to thank Dr Geraldine Strathdee for her extensive work and valuable contribution in leading the review.

We have carefully considered the recommendations and have today published the Government response to the report, setting out how we are taking forward each recommendation. There has already been good progress towards implementation of a number of the recommendations and I have established a steering group, co-chaired with an external expert Professor Sir Louis Appleby, to work with healthcare system partners to take forward the key deliverables for each recommendation. We intend to provide an update on progress by July 2024.

The Government response to the review has been published on gov.uk.

[HCWS368]

Clinical Indemnities Reform

Maria Caulfield Excerpts

Thursday 7th March 2024 Written Statements

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

In December 2022, I reported on the steps we are taking to respond to the findings of the inquiry into the issues raised by disgraced surgeon, Ian Paterson. Today, I am reporting further progress on recommendation 10 of the inquiry report, which identified shortcomings in the clinical negligence cover system.

Clinical negligence cover is the system that enables patients to receive compensation if they are harmed during treatment through the cover held by regulated healthcare professionals such as doctors, nurses and dentists. The inquiry highlighted that Paterson’s private patients were unable to access compensation for the harm caused by his actions due to gaps in clinical negligence cover in the independent sector. These gaps do not occur in the NHS where cover is via a state scheme.

The Government’s implementation update on the inquiry’s recommendations included proposed policy options for recommendation 10. One of the policy options was to make the system more transparent through safeguards, such as the introduction of a code of practice for medical defence organisations which provide a particular type of clinical negligence cover called discretionary indemnity that many healthcare professionals purchase. Unlike regulated insurance, where terms and conditions are set out contractually, discretionary indemnity allows for discretion to be applied to accept or refuse claims.

Following engagement with patients and the wider sector last year, I am pleased that medical defence organisations propose to implement a sector-led code of practice by end of 2024. The aim of this code is to provide greater transparency around this system of discretionary indemnity.

For example, there will be more information on how decisions are made to assist healthcare professionals to pay patients compensation. The code will include an escalation procedure with an independent review of disputed claims assistance decisions. Importantly, the code will now offer healthcare professionals information on the basis of any decisions to decline claims.

We welcome the code as a meaningful step forward. The Department of Health and Social Care will evaluate its implementation, including the long-term impact on patients and healthcare professionals, to determine whether further intervention is required. I will provide an update on further steps to reform the clinical negligence cover system, such as addressing cover for criminal acts or when a healthcare professional has otherwise worked outside the terms of their cover, in due course.

Alongside this update, the report on a survey that the Government commissioned IFF Research to carry out into healthcare professionals’ clinical indemnity arrangements will also be published. A copy of the report will be placed in the Library of both Houses.

[HCWS318]

Suicide Prevention Grant Fund

Maria Caulfield Excerpts

Monday 4th March 2024 Written Statements

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

On 25 August 2023, my Department launched a £10 million suicide prevention grant fund to support voluntary, community and social enterprise organisations in delivering suicide prevention activity in England.

I am pleased to today confirm the 79 successful organisations which have been awarded funding from the scheme. I would like to put on the record my thanks to all those organisations that applied, and for all the suicide prevention activity that is delivered on a daily basis, up and down the country.

The list of provisional awardees was published today at https://www.gov.uk/government/publications/suicide-prevention-grant-fund-2023-to-2025 and can be found below.

The commitment is part of this Government’s plan to make health and care services faster, simpler and fairer.

I look forward to seeing the important and innovative activities that will follow as a result of this funding, in some of the most at-risk regions in England and to the groups who most need it. This is an important milestone in delivering the new “Suicide prevention strategy for England: 2023 to 2028” which we published in September 2023 and can be found at https://www.gov.uk/government/publications/suicide-prevention-strategy-for-england-2023-to-2028/suicide-prevention-in-england-5-year-cross-sector-strategy

The voluntary, community and social enterprise sector plays a critical role in providing support to people experiencing suicidal thoughts or approaching a mental health crisis, as well as intervening early to prevent people reaching these points. Ultimately, their work saves countless lives and this grant will help ensure that they can keep doing that.

This grant builds on the record sums of money this Government have invested to transform and expand NHS mental health services as well as the successes of a previous grant fund of £5.4 million in 2021-22. That fund supported over 100 voluntary, community and social enterprise organisations, with overwhelmingly positive results, including helping to address demand after the covid-19 pandemic, improving access to services for people in need, and helping identify those in need, quicker.