Baby Loss Certificates

Maria Caulfield Excerpts

Thursday 22nd February 2024 Written Statements

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

I wish to inform the House that the new baby loss certificate service has launched today.

As the House will be aware, the Government published the independent “Pregnancy Loss Review” in July 2023, alongside our response. The review examined the impact on families of not being able to formally register a baby or pregnancy loss before 24 weeks’ gestation.

In an interim report provided to me in 2022, the review recommended that the Government introduce a voluntary scheme to enable parents who have experienced a pre-24 weeks baby or pregnancy loss to record and receive a certificate to provide recognition of their loss. The recording and issuing of a certificate to bereaved parents who want one will provide comfort and support by validating their loss. I subsequently committed to introduce a certificate of baby loss in the women’s health strategy for England—July 2022.

Either parent is entitled to a certificate of baby loss if they have experienced a loss under 24 weeks’ gestation, are at least 16 years of age, and at least one parent was living in England at the time of the loss.

I am pleased that we are able to offer this on a retrospective basis to those who have already experienced a baby loss. Initially, this will be available to those who have experienced a loss since 1 September 2018. This will be continually assessed, and we will extend eligibility as soon as we can.

Delivering this important service highlights our continued commitment to delivering on the women’s health strategy and is an important step forward in supporting parents to provide recognition of a life lost.

[HCWS277]

JCVI Updated Advice on Covid-19 Vaccination Programme

Maria Caulfield Excerpts

Wednesday 7th February 2024 Written Statements

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

His Majesty’s Government (HMG) led the world in vaccinating our population against covid-19. We remain committed to protecting the most vulnerable as guided by the independent Joint Committee on Vaccination and Immunisation (JCVI).

The JCVI has published further advice on the covid-19 vaccination programme. The JCVI advice is that a covid-19 vaccine should be offered in spring 2024 to those at greatest risk of serious disease, who are therefore most likely to benefit from vaccination. Those eligible are:

adults aged 75 years and over;

residents in a care home for older adults; and

individuals aged 6 months and over who are immunosuppressed (as defined in tables 3 or 4

in chapter 14a of the UK Health Security Agency’s Green Book).

Throughout the pandemic, older people have been amongst those most likely to experience severe disease if infected by SARS-CoV-2 (the virus that causes covid-19). Existing data on hospital admissions in the UK are consistent with the clinical risk continuing to be higher in those aged 75 years and above.

The JCVI advice is that this further spring dose should be offered around six months after the last vaccine dose, and after a minimum gap of three months.

HMG has accepted this advice and I am informed that all four parts of the UK intend to follow the JCVI’s advice.

The JCVI has also provided advice on which vaccine products should be used as part of the spring 2024 covid-19 programme. The committee has advised that for spring 2024, the latest covid-19 XBB-variant vaccines are considered preferable; and mRNA Omicron XBB.1.5 covid-19 variant vaccines which have been pre-procured as part of the UK’s pandemic emergency response are considered the most cost-effective vaccines for use under existing circumstances.

Considerations for future covid-19 vaccination programmes

The JCVI will continue to review the optimal timing and frequency of covid-19 vaccination beyond spring 2024. The ongoing increase in population immunity permits the development of a more targeted programme aimed at those at higher risk of developing serious covid-19 disease. As the UK moves towards routine procurement and delivery of covid-19 vaccination, cost-effectiveness will become a major determining factor in future advice pertaining to the covid-19 vaccination programme. The JCVI advice indicates that, based on the most recent cost-effectiveness assessment, any autumn 2024 campaign may be smaller than previous autumn covid-19 campaigns. The JCVI will give further advice on this in due course.

Notification of liabilities

I am now updating the House on the liabilities HMG has taken on in relation to further vaccine deployment via this statement, and accompanying departmental minutes laid before Parliament containing a description of the liability undertaken. The agreement to provide indemnity with deployment of further doses increases the contingent liability of the covid-19 vaccination programme. HMG is already looking to move to vaccine market standard indemnity provisions for the procurement of future covid-19 vaccines.

I will update the House in a similar manner as appropriate, as and when any future decisions impact the contingent liability of the covid-19 vaccination programme.

[HCWS251]

Draft Human Medicines (Amendments Relating to Coronavirus and Influenza) (England and Wales and Scotland) Regulations 2024

Maria Caulfield Excerpts

Tuesday 30th January 2024 General Committees

[The Chair]

I am sure the Chairman of Ways and Means would always want to acknowledge that sort of event, so happy birthday to the Government Whip. I call the Minister to move the motion.

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

I beg to move,

That the Committee has considered the draft Human Medicines (Amendments Relating to Coronavirus and Influenza) (England and Wales and Scotland) Regulations 2024.

It is a pleasure to serve under your chairmanship, Dame Maria. I also want to pass on my best wishes to my hon. Friend the Member for Beaconsfield; it is always best to keep in with the Government Whip.

In autumn 2020, as part of the response to the covid pandemic, a number of temporary amendments were made to the Human Medicines Regulations 2012 to support the deployment of covid-19 and flu vaccinations following public consultation. This instrument looks to amend the temporary provisions in those regulations—regulations 3A, 19 and 247A—in order to maintain them and support the ongoing delivery of covid-19 and influenza vaccination.

Regulation 3A enables trained healthcare professionals or staff under the supervision of healthcare professionals to conduct the final stage of assembly, preparation and labelling of covid-19 vaccines without requiring additional marketing authorisations or manufacturer’s licences, provided that vaccines are supplied under NHS arrangements or by suppliers of medical services to His Majesty’s armed forces. Regulation 3A allows for the reformulation and reassembly of authorised covid-19 vaccines without the need for additional marketing authorisations.

Regulation 19 has enabled covid-19 and flu vaccines to be moved safely between premises at the end of the supply chain by providers operating under NHS arrangements or suppliers of medical services to His Majesty’s armed forces without the need for a wholesale dealer’s licence. Regulation 247A has provided a mechanism to expand the workforce that is legally and safely able to administer a covid-19 or flu vaccine without the input of a prescriber, using an approved protocol. Regulations 3A and 19 have sunset provisions and will cease to have effect on 1 April 2024 unless extended today. Regulation 247A is only permitted for use during a pandemic, so we want to amend it to be valid outside a pandemic for a temporary period.

The regulations continue to play a vital role in the covid-19 and flu vaccination programmes and have helped us to roll out both vaccines this autumn and winter. We are committed to protecting those who are most vulnerable, guided by the independent Joint Committee on Vaccination and Immunisation. Although for most people covid-19 is no longer a serious risk, for some it remains one and vaccines are still the first line of defence for those people. In our latest roll-out, more than 11.8 million covid vaccines have been administered by NHS England since national bookings opened on 11 September last year, and more than 17.9 million flu vaccinations were administered in England during the latest autumn campaign. That includes more than 4.5 million people who received their flu and covid-19 vaccines at the same appointment. The regulations we wish to extend today play a huge part in making that happen.

The Government have engaged a broad range of stakeholders to determine whether to retain the provisions in the 2012 regulations beyond their current period, which ends in April. That initial engagement led the Government to propose an extension, as key stakeholders, including NHS England, said that without these regulations the covid-19 and flu vaccination services would be negatively impacted. Following that engagement, the Government ran a public consultation from 7 August to 18 September 2023 on proposals to temporarily extend the regulations until 1 April 2026 while a permanent solution is developed.

In regulation 247A, condition A, which requires there to be a pandemic for it to be used, would be removed. We had 220 responses, and there was a high level of support for the change.

Eighty nine per cent of respondents agreed that regulation 3A should be extended. It is important to note that covid-19 vaccinations are not available as pre-filled syringes, so a lot of work is done when a covid vaccination clinic is running. The regulations will make that as efficient as possible. The consultation found that the flexibilities of the arrangements for safe assembly and preparation at the pace and scale required mean that our vaccination programmes are as efficient as they can be.

Again, there was a high level of support for regulation 19, with 91% agreeing that it should be extended. There was a similar level of support for the change to regulation 247A, with 82% agreeing with the proposal to remove condition A so that the regulation can be used outside a pandemic.

The regulations have played an important role in reducing workforce pressures, so we are looking at how that can be made permanent. Work is being done to see how we can use our learning from the regulations and the tools they offer to reduce workforce pressures in the future and increase our capacity to deliver hundreds of millions of covid-19 and flu vaccinations. The regulations have also released qualified healthcare professionals to deliver other care across the system.

There are a range of benefits to extending the regulations. The Government propose to temporarily extend the provisions to 1 April 2026 and, in the case of regulation 247A, to remove the requirement that there should be a pandemic or imminent pandemic when the medicine is supplied while a more permanent solution is developed. Extending the provisions will allow the Government to work with system partners to undertake a fuller consideration of longer-term mechanisms that could be deployed to better support the delivery and administration of covid-19 and flu vaccines.

In the short term, however, given the high level of support expressed in the consultation and at a time when covid-19 and flu continue to be prevalent, there is an ongoing need to support the continued safe and effective supply, distribution and administration of covid-19 and flu vaccines by maintaining the provisions to April 2026. I commend the regulations to the Committee.

--- Later in debate ---

[Maria Caulfield]

I am pleased that we have cross-party support for the regulations. They are important in ensuring that we can deliver an efficient vaccination roll-out, particularly with a potential spring roll-out coming early this year.

In answer to the questions from the hon. Member for Bury South, yes, we are working to look at a more long-term solution. We are engaging with key stakeholders such as NHS England, and proposals will be made. There will need to be a consultation, and we will set out the date of that so that everyone can engage with it. It is one thing to put temporary measures in place, but it is another thing to put in long-term, sustainable measures, so it is important that all stakeholders are consulted, particularly those in primary care.

The regulations today extend only to Great Britain. Northern Ireland is not included because health is a devolved matter and there is not a sitting Assembly, but work is going on with Northern Ireland officials and there was positive news today of the potential of the Assembly restarting. We want to make sure that Northern Ireland will be covered by the provisions once there is an Assembly.

[Christian Wakeford]

On that point, it was helpful to have the news today about the Northern Ireland Executive. If, for any reason, they take a long period for this—they have two years to catch up on—will there be a further SI to implement these provisions in Northern Ireland?

[Maria Caulfield]

Ideally, we would not want to do that, because it is for Northern Ireland to determine its own health decisions. However, I can say that Department officials have been sharing draft materials with Northern Ireland officials so, once the Assembly is up and running, that could potentially happen fairly quickly.

On the point that the hon. Member for Bury South made about vaccine hesitancy, it is absolutely true that we are seeing vaccine and immunisation hesitancy across the country. It is very unhelpful that some of these misleading claims are being made, but, when we engage with community leaders, faith leaders and primary care teams that know their communities, we are able to engage.

We had a very successful covid-19 vaccine roll-out, getting to communities that are usually under-represented in vaccination programmes. During covid, that was thanks to the work of the Equality Hub and teams such as the Office for Health Improvement and Disparities. We are now using them again, particularly in London and the west midlands, for the measles immunisation programme, and we should be able to update colleagues about progress on that fairly swiftly.

Although it is not an issue with covid-19 and flu vaccines, there is concern among the Muslim and Jewish communities, and among Seventh-day Adventists and Rastafarians, about the use of pork in some of the measles vaccines. I would just reiterate that there are non-pork-based measles vaccines available, so that should reassure communities on the alternatives. However, there is work to be done in providing reliable information, getting the confidence of communities and making that vaccine as accessible as possible. That is why we are also working with our school teams to ensure that when young children need immunisation, it is as accessible as possible.

The hon. Member touched on the availability of vaccines. We follow JCVI advice and we expect to publish the JCVI advice for the spring roll-out fairly shortly. For those not covered by NHS vaccine programmes—we did not do the over-50s this year—we are looking at the options of a private market for covid-19, as is currently the case for flu. We are having discussions with both suppliers and pharmacies to see what is possible. Again, we will support any moves towards that as much as we can.

The hon. Member’s final point, I think, was about ensuring that we can cover as many people as possible with the vaccines. It is down to the JCVI advice. We almost always follow its advice, and it looks at a range of risk factors. That will also change over time; we may move to an annual covid vaccine at some point, compared with the spring and autumn roll-outs, but that will all be guided by the JCVI advice. Obviously, if a variant of concern emerges, that will change things.

The flexibility that these regulations provide really makes a difference, and we have had a positive reception from NHS England—from primary care—about the difference that it has made to the skills mix and career progression of many who administered the vaccines, as the hon. Member pointed out. It has also been a real opportunity to develop the workforce. I hope that that answers hon. Members’ questions. I thank them for their cross-party support.

Question put and agreed to.

Measles

Maria Caulfield Excerpts

Tuesday 30th January 2024 Written Statements

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

Following my written statement of 22 January 2024, I wish to provide a further update to the House on the actions that the Government and health system are taking in response to an increase in measles cases in England, particularly in the west midlands.

The current measles outbreak

Between 1 October 2023 and 23 January 2024 there have been 347 laboratory confirmed measles cases reported in England, with 127 of these cases confirmed in January 2024. From 30 January, the UK Health Security Agency (UKHSA) will publish national laboratory confirmed measles case numbers on www.gov.uk weekly, rather than on the previous monthly cycle. This will provide more frequent and up-to-date information to support preparedness and response activity while measles cases remain raised.

Actions under way to protect the public

Measles is a vaccine preventable disease, with long-lasting immunity provided through the measles, mumps and rubella (MMR) vaccine. To support increasing the uptake of the MMR vaccine, NHS England has rapidly implemented a catch-up campaign for missed MMR vaccines as part of a major drive to protect children from becoming seriously unwell as measles continues to rise in parts of the country. From 6 February, parents and carers of unvaccinated and partially vaccinated children aged six to 11 will receive a first reminder letter, text or email inviting them to make an appointment with their child’s GP practice for their missed MMR vaccine. From 12 March, second reminders will begin to be sent.

This national campaign supplements existing measures under way to work with specific communities to boost uptake in priority areas, for example, by offering MMR pop-ups and whole-school vaccination campaigns. Extensive local engagement and communications have also been undertaken with community and faith leaders to encourage groups less likely to get their jab to come forward.

Additionally, in London and the west midlands, the first reminder invitation letters, texts or emails will be sent in February to the parents and carers of unvaccinated and partially vaccinated children aged 11 to 16 and, following that, to young people aged 16 to 25 to invite them to catch up on their missed MMR vaccinations. This will be followed by a second reminder to these age groups in March. Reminders will also be accessible for those over 16 who utilise the NHS app.

In the west midlands, strategic partnership groups are in place in three of six NHSE integrated care board areas to oversee planning, delivery and response across the health system. The other three integrated care boards also work on a multi-agency basis to assess preparedness and response activities.

UKHSA West Midlands and regional Department for Education colleagues hosted a webinar for education and early years settings last week with over 650 attendees. This focused on describing the signs and symptoms of measles, what schools need to know and how they can access more support. In addition, UKHSA West Midlands and NHS Midlands hosted a webinar for clinicians and frontline staff in maternity services with over 280 attendees, and significant work across the region to promote MMR vaccination continues through a range of mechanisms, including social media and community engagement at a local level.

I will also be chairing a regular measles ministerial co-ordination board, bringing together local and national actors to bring the current outbreak under control.

Work also continues at pace across England’s regions, particularly in London, to prepare for the possibility of further cases and outbreaks, learning from the west midlands experience. This preparation includes a multi-agency planning exercise led by UKHSA that was focused on a potential outbreak in London and exercising the response to that.

Correction to written statement UIN HCWS200

I would like to amend the written statement I gave the House on 22 January 2024 and an answer I gave to the House on the same day in response to an urgent question from the hon. Member for Birmingham, Edgbaston (Preet Kaur Gill).

In the written statement and at the urgent question, I stated that an existing MMR vaccination campaign by NHS England had resulted in a 10% increase in vaccine uptake compared to the previous year. I would like to clarify that this 10% increase is not an overall figure but rather refers to the proportion of children aged one to five who came forward for their MMR jab as a result of having been identified as eligible for and or missing one or both doses and contacted proactively by the NHS between 22 September and 23 February last year to get the jab. The figure I quoted was from a published NHS England press release, which was corrected on 23 January 2024.

[HCWS224]

Children’s Mental Health Week 2024

Maria Caulfield Excerpts

Tuesday 30th January 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 Pritchard. I am grateful to the hon. Member for Tooting (Dr Allin-Khan) for securing this debate ahead of Children’s Mental Health Week. I thank all hon. and right hon. Members for their thoughtful contributions, and I will try to answer as many points as I can in the time that I have.

It is absolutely clear that we face a challenge in ensuring timely support is available for children and young people’s mental health. Two factors are proving the greatest challenges. The first, as was pointed out by a number of speakers today, is the historic underinvestment in mental health services in this country. No other Government before us had tackled this, trying to introduce a parity in esteem between mental and physical health. The Government are investing £2.3 billion extra a year—I know the hon. Member for Tooting is tired of this figure —in mental health services. That is making a difference.

I just want to correct one figure that the hon. Member raised, about only 8% of funding going to children and young people’s mental health services. Actually, 1.63 million people were in contact with mental health services in November last year, and 31% of those were children aged between nought and 18. That shows that children are making up a large proportion of those benefiting from the funding. The extra £2.3 billion a year is going into projects such as our capital investment programme to eradicate mental health dormitories, and is being invested in our crisis centres, our crisis cafés, and 27,000 additional staff. We are seeing evidence that that is making a difference already. Our crisis cafés are associated with an 8% lower admission rate and our crisis telephone services with a 12% lower admission rate, and detentions under the Mental Health Act 1983 are 15% lower.

Our second challenge is the sheer scale of demand for services in the past few years. Even though we are investing more than ever before in children and young people’s mental health services, as the hon. Member for Tooting pointed out, one in five children now suffers with a mental health problem, compared with one in nine in 2017. There were 743,000 new referrals to children and young people’s mental health services in 2022, up 41% from just the year before. We recognise that we have to put in more funding. We are doing that, but it is difficult to meet the sheer demand for the support that children and young people need.

This is true across all four nations of the United Kingdom and not just here in England, where the Government are responsible for health. In Cardiff, for example, where Labour runs the health service, 83% of CAMHS are not on target for seeing children and young people. The Welsh Labour Government target of 80% of children and young people being assessed within 28 days had not been met for the five years up to 2021, the dates covered by the latest figures. I was quite surprised by the contribution from the SNP spokesperson, the hon. Member for East Dunbartonshire (Amy Callaghan), as Scotland have been missing their national targets. Under some health boards, children and young people have been waiting for more than 1,000 days for services. In Northern Ireland, 60% of those targets have not been met, either. All four nations of the United Kingdom are facing exactly the same pressures.

In England, however, we have a plan, and I can assure hon. Members that it is far from just warm words. While our spending on children and young people’s mental health services has increased from £841 million in 2020 to just over £1 billion in 2022-23, it is not just about how much we spend, but about how we spend it. An additional 345,000 children and young people are getting the mental health support they need. As of August last year, 703,000 children and young people aged under 18 were being supported through NHS-funded mental health services. That is a 13.1% increase on the year before.

[Amy Callaghan]

I recognise what the Minister is saying. Things are not perfect, but we in Scotland are investing more in the NHS and mental health services than they are in England. We recognise the problem, but we are doing something about it. That is more than can be said for down here.

[Maria Caulfield]

Let me point out what we are doing with our funding. We have introduced two waiting time standards for children and young people. The first is for 95% of children up to 19 with an eating disorder to receive treatment within one week for urgent cases and four weeks for more routine cases. I can showcase for the hon. Member for Tooting figures from her local integrated care board for eating disorders: 82% of children and young people under 19 are seen within four weeks. That is not 95%, so we are not where we want to be, but a significant proportion are being seen according to our new target. Our extra funding to children and young people’s services for eating disorders will rise to £54 million in the coming financial year, creating more capacity, but we absolutely acknowledge that there is more to do.

The second waiting time standard we have introduced is for 50% of patients of all ages, including children and young people, experiencing a first episode of psychosis to receive treatment within two weeks of being referred. That target is being met across the country.

Our plan for children and young people is cross-Government, because this is not just a health and social care problem. Mental health is everyone’s business. That is why we are working with the Department for Education to implement proposals from the children and young people’s mental health Green Paper.

[Dr Allin-Khan]

If the Government are interested in implementing cross-party proposals, why on earth have they scrapped the Mental Health Bill?

[Maria Caulfield]

I will touch on what we are doing and come back to the hon. Lady on that point.

Last week we met the Education Secretary and the chief executive of the NHS to discuss how we can better support school attendance, because we know that children with mental health problems are the most likely not to attend school. I do not think there was a single proposal from any of the Labour MPs, apart from on mental health support teams in schools, which we are already rolling out. We have rolled out 400 mental health support teams, covering 3.4 million pupils in England—something that Labour has not started to do in Wales, where it runs the health service. Our original ambition was to cover 25% of pupils, but we have done that a year earlier than expected; we are now on track in March this year to cover just under 50% of pupils with a mental health support team. We will also have 13,800 schools and colleges with a trained senior mental health lead, including seven in 10 state-funded schools in England.

We are already doing what Labour says it plans to do if it ever gets into government, and our evidence shows that that is making a difference across the country. In addition, in October we announced £4.92 million of new funding to develop new mental health and wellbeing support hubs for young people across all of England. We will be announcing in the next few weeks the successful hubs and where they will be based. That clearly shows that the work we are doing is on track and amounts to far more than just the warm words we have been accused of.

[Dr Allin-Khan]

Let me point out two things. First, 12,140 children are on waiting lists at my ICB, an increase of 18.15% on last year. Secondly, the Minister spoke about 1.63 million people accessing mental health services and said that 38% of them were children, but that is actually up on the 25% that I cited. She used that figure in her argument about the amount of money that has been spent on children’s mental health services. She was incorrect, and all she did was highlight that the situation is getting worse, rather than arguing against my point that only 8% is being spent on children. She did not address that point.

[Maria Caulfield]

The hon. Lady is making my argument for me. We are seeing a significant increase in demand, and that is why we are spending more on rolling out these services. She did not welcome the progress we are making on mental health support teams across our schools, or the fact that we are set to announce new mental health support hubs across England.

Last year we published our new suicide prevention strategy; my hon. Friend the Member for Penrith and The Border (Dr Hudson) talked about 3 Dads Walking, who I was pleased to meet. We are also rolling out mental health and wellbeing support in our school curriculum, teaching young people what good mental health looks like and about support mechanisms. Our strategy sets out over 100 actions to help reduce suicide and to ensure that young people in particular, who are identified as a high-risk group in the strategy, are getting the support they need. That includes making mental health and wellbeing part of the school curriculum.

[Jim Shannon]

Has the Minister had the opportunity to look at how to ensure that young people have some church activity and pastoral care, which is very important?

[Maria Caulfield]

The hon. Gentleman is absolutely right. Part of that can be done in our schools. With the increase in mental health support teams, which will now cover 4.2 million pupils, there will be different levels of support, from pastoral support right through to acute help for those with more acute mental health needs. It is really important that we ensure that those teams are rolled out as we are planning. Our hubs in local areas will also be able to provide more bespoke services for the communities they represent, which is crucial. I would like to thank Dr Alex George, the Government’s youth mental health ambassador, who has been leading much of this work, particularly on the suicide prevention strategy and making children and young people a priority group.

I reiterate my thanks to everyone who has contributed to the debate. The Government have a plan to improve mental health services for children and young people by investing in services, with capital projects to improve infrastructure in order to provide the care that is needed, from crisis centres right through to the 27,000 extra mental health workers; rolling out mental health support teams in schools and our new children and young people’s mental health hubs, which will be announced shortly; and dealing with the sheer tsunami of demand, whether it is due to the fallout of covid or the fact that people are coming forward because we are encouraging them to talk about their mental health and ask for support.

Our plan is making a difference. I am hopeful that, with the investment we are putting in to tackle the lack of investment for decades under many Governments, we are providing the building blocks to improve the mental health of our young people in this country.

[Dr Allin-Khan]

I thank all Members, including the Minister and my hon. Friend the shadow Minister, for their contributions. Disappointingly, I have not heard anything about the scrapping of the Mental Health Bill, which the Minister conveniently avoided.

[Maria Caulfield]

Will the hon. Lady give way?

[Dr Allin-Khan]

No, I will continue. The Minister had ample opportunity to respond to a direct intervention, and she chose not to. That Bill was a great piece of cross-party work that would have improved the lives and outcomes of so many people in our country, particularly minority groups. The Minister did not address the fact that only 8% of funding is spent on children’s mental health services, but she highlighted that the need is greater than ever.

The £2.3 billion was promised before covid. We have heard multiple arguments today that the situation has got worse post covid. There has been no money to make up for the increased need related to covid, and no assessment of how we are going to deal with the fact that adverse childhood experiences and poverty are contributing so greatly to our nation’s mental ill health.

The Minister talked about the fact that there are many new referrals. There are many new referrals, but she did not mention that in so many parts of this country, and even in parts of this city, it is a postcode lottery. In some places, up to 50% of referrals are closed before the person has even been seen. While I welcome the fact that efforts are being made—it would be churlish of me to suggest that they are not—the fact remains that they are not good enough, they do not reach far enough and they are not ambitious enough. Even on the £2.3 billion, I know for a fact that the head of mental health services in the NHS asked for more, and that was before covid.

I thank everyone for being here and for their contributions. Although we are all on the same page in the sense that this is an issue we all care about, regardless of how we vote, where we live or what our socioeconomic background is, this Government still lack ambition for children in this country and for their mental health. Let me again, on the record, thank all the organisations that work so tirelessly in this space.

Question put and agreed to.

Resolved,

That this House has considered Children’s Mental Health Week 2024.

Measles

Maria Caulfield Excerpts

Monday 22nd January 2024 Written Statements

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

I wish to update the House on an increase in measles cases across England and the actions that the Government and health system are taking to control the disease’s spread.

The current measles outbreak

Following an increase in measles cases across England, the UK Health Security Agency raised its incident response level to a national standard incident on 8 January 2024. There are three categories of incident: routine, standard and enhanced.

In 2023, there was an increase in confirmed measles cases, on which the UKHSA publishes statistics monthly. As of 18 January 2024, there have been 216 confirmed cases in the west midlands since 1 October 2023. NHS figures show that more than 3.4 million children under the age of 16 are unprotected and at risk of catching this serious and completely preventable disease. In response to this and the slow decline in measles, mumps and rubella vaccine uptake, the NHS carried out catch-up efforts in 2023, contacting parents and carers of unvaccinated children aged five and younger. This resulted in a 10% increase in MMR vaccine uptake compared with the previous year.

Measles is a highly infectious illness that can easily be spread between unvaccinated people. Complications from measles can be potentially life changing and include blindness, deafness and swelling of the brain, or encephalitis.

Analysis shows that one infected child in a classroom can infect up to nine other unvaccinated children, making it one of the most infectious diseases worldwide, and more infectious than covid-19. One in five children with measles will need to be admitted to a hospital for treatment—which could put additional pressure on the NHS.

Measles is not just a childhood disease and can be serious at any age. If caught during pregnancy, it can be very serious, causing stillbirth, miscarriage and low birth weight.

Actions under way to protect the public

Measles is a vaccine-preventable disease, with long-lasting immunity provided through the measles, mumps and rubella vaccine. Ninety-five per cent of the population must be vaccinated to provide sufficient population immunity. In some parts of the country, vaccination levels are below this threshold, allowing measles to spread rapidly through communities.

Data shows that the MMR vaccine is safe and very effective. After two doses:

around 99% of people will be protected against measles and rubella

around 88% of people will be protected against mumps

Two doses of the safe and effective MMR vaccine are needed for maximum life-long protection, with the first dose given around the child’s first birthday and the second dose given at around three years and four months old. However, anyone can catch up at any age on any missed doses. It is never too late to protect yourself, and everyone eligible for the MMR vaccination who has not yet taken up the offer should get vaccinated.

To support increasing the uptake of the MMR vaccine, NHS England announced on Friday 19 January a catch-up campaign from February for missed MMR vaccines, as part of a major new drive to protect children from becoming seriously unwell as measles continues to rise across the country. The campaign:

Will be targeted at parents and carers of unvaccinated and partially vaccinated children aged six to 11, encouraging them to make an appointment with their child’s GP practice for their missed MMR vaccine.

Builds on the work already done to contact parents of children aged nought to five for vaccination—a campaign which saw a 10% increase in the number of MMR vaccinations compared with the previous year, with two million texts, emails and letters sent to parents between September 2022 and February 2023.

Will target places with low uptake of the vaccine. Initial priority areas are London and the west midlands, with the NHS acting quickly to contact almost 1 million more people, including parents and carers of those aged six to 18, and young people aged 18 to 25, to invite them to catch up on their missed MMR vaccinations.

People who are unvaccinated can get catch-up jabs at MMR pop-ups in schools and other convenient places, including GP surgeries, asylum hotels and libraries.

GPs, teachers, and trusted community leaders are encouraging groups less likely to get their jab to come forward. NHS England, UKHSA and local health partners are also working together to deliver immunisation programmes tailored to the needs of under-vaccinated communities. For example, in the west midlands, MMR pop-up clinics are running in outbreak settings, and whole-school vaccination campaigns will be run in areas with the highest number of at-risk individuals. GP practices are also being supported to improve MMR uptake through convenient, tailored appointments and proactive conversations with concerned parents.

Longer-term actions

The recently published NHS vaccine strategy builds on the success of the NHS’s world-leading covid-19 vaccine programme, when local teams found innovative ways to reach people during the pandemic. It reflects views sought from a wide range of stakeholders and delivery partners, including the public, those who work in our health services, community and charity leaders, and colleagues in local government. This strategy will maximise convenience, with more vaccination services at locations that the public can easily access, such as libraries, leisure centres, social clubs or sports grounds, family hubs, support services and places of worship, or at local cultural and community events; with flexible opening hours; and with booking options.

Parents and carers can find out more about the different vaccines their child should have and when by visiting www.nhs.uk and searching for “NHS vaccinations and when to have them”.

It is vitally important that everyone takes up the vaccinations they are entitled to. The MMR vaccine is highly effective, safe and the best way to prevent the spread of measles and to protect children from becoming seriously unwell from the disease.

[HCWS200]

Measles

Maria Caulfield Excerpts

Monday 22nd January 2024 Commons Chamber

[Preet Kaur Gill (Birmingham, Edgbaston) (Lab/Co-op)]

(Urgent Question): To ask the Secretary of State for Health and Social Care to make a statement on the declaration of a national incident in response to the recent surge in measles cases.

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

I thank the hon. Lady for giving me the chance to update the House on this important matter, further to the written ministerial statement that we will publish later today.

The UK Health Security Agency announced last week that it has declared a national standard incident in response to an increase in confirmed cases of measles. In order for our measles, mumps and rubella vaccine to work, the World Health Organisation recommends at least 95% coverage to maintain population coverage. At the moment, our MMR reach is 89.3% for the first dose at 24 months, and 84.5% for the second dose at five years.

This is not a new issue. There has been a gradual decline in coverage over 10 years because of a number of factors, ranging from the Wakefield generation, when Dr Andrew Wakefield published his discredited paper on the risks of MMR, through to covid, when routine vaccinations were missed, and there has been a drop since then. There have also been concerns in particular communities, such as the Jewish and Muslim communities, about the type of vaccine used. We have not been waiting: the NHS has carried out a catch-up effort over the past 12 months, proactively contacting parents and carers of unvaccinated children aged five and younger, and we have seen a 10% increase in vaccination compared to the previous year.

However, that is not enough. NHS figures show that almost 3.5 million children under the age of 16 are unprotected and at risk of catching this serious and preventable disease. Measles is so infectious that one infected child in a classroom can infect up to nine other unvaccinated children, making it one of the most infectious diseases worldwide. While for most it will be a mild illness, one in five children with measles will need to be admitted to hospital for treatment, putting additional pressure on the NHS.

I want to stress that this is not just a childhood disease; for adults who have not been vaccinated it can be a serious and potentially life-changing event. My message to mums and dads with children who are currently unvaccinated is to come forward. We have a range of measures in place. One million letters are going out to the parents of unvaccinated children across London and the midlands.

We have extra clinics being set up by GPs, pop-up clinics in schools and vaccine buses targeting communities with low vaccination rates. We have held two MP briefing sessions, on 12 and 19 January: one for the west midlands and one for London. Today we have sent out information to MPs so that they can help us get the message out to their constituents to come forward. It is not too late. There is no age limit. Anybody who has not had their vaccination can come forward. The first vaccine will provide roughly 92% protection, and the second will provide 98%. The message is to come forward and get vaccinated.

[Preet Kaur Gill]

Thank you for granting this urgent question, Mr Speaker.

The declaration of a national incident due to the rise in measles cases by the UK Health Security Agency on Friday is concerning. Measles can be serious and it is extremely infectious, with a reproduction rate five times that of covid. However, it is also entirely preventable. The Minister is right to emphasise the importance of getting vaccinated. The MMR vaccine is safe, effective and the best way to protect ourselves and our loved ones against measles. There is no age cut-off for getting an MMR vaccine. There are alternatives available for those who do not touch pork products. Once a person has had it, the vaccine can provide protection within two weeks. I urge anyone watching this who has not been vaccinated to contact their GP.

Mr Speaker, we are in agreement that this issue is serious. I thank the Minister for outlining some of the steps that she is taking. However, we should never have got to this point. The UK was deemed by the World Health Organisation to have eradicated measles just five years ago. Since then, MMR vaccination rates have plummeted, leaving tens of thousands of children completely unprotected, which means that now one in five children is not protected with two doses by the age of five. Cases have also risen consistently over the years, and by 120% in the past year alone, so the warning signs could have been seen from space. What steps are being taken to get a grip on this crisis before it becomes a national outbreak? How will the Minister rectify her Department’s failure to maintain child vaccination rates for contagious diseases? Is this not another instance of Government complacency when it comes to protecting our children’s health?

For the record, Mr Speaker, my team attended a briefing with the Minister and her officials on this issue on 12 January, which she has mentioned. I requested some more information and communications materials that I could use in my capacity as a local MP, given the rise in cases in Birmingham. It took until this morning—some 10 days later—to be sent that information, but only after a national incident had been declared. Have the Government been asleep? Have no lessons been learned from the pandemic that, with highly transmissible diseases, the sooner we act, the better?

We saw how much children suffered and lost out during the pandemic, so the re-emergence of serious childhood illnesses that we have vaccines for and that we know how to prevent is unacceptable. When 80 countries across the world are measles-free, it is a badge of shame that this Government have lost the UK that status on their watch.

[Maria Caulfield]

I remind the hon. Lady that health is a devolved matter across the United Kingdom. When she refers to the United Kingdom’s lower MMR vaccination rate, does she include Labour-run Wales? Wales has also not met the WHO threshold, and neither has Scotland, Northern Ireland or England. It is a real shame to play politics with this issue. This is an issue of the utmost importance.

As I have set out, this Government have been working over the past 12 months to get vaccination rates up in England, and we have seen a 10% increase. There are a range of reasons why we are seeing certain parts of the country and some communities not coming forward. The hon. Lady touched on the concerns of the Jewish and Muslim communities that a wide range of MMR vaccines are porcine vaccines. We do have non-porcine vaccines available. Priorix is not just available on request; following a meeting that we had with west midlands MPs, we proactively pushed Priorix out to communities. The help of local MPs to get that message out to communities would be extremely valuable. There is also a halal vaccine available. Again, we need to get that message out, so that people do not have to request it; it would be routinely offered to them.

We are also undoing much of the damage done to the Wakefield cohort of young adults, who were born between 1998 and 2004, when Dr Andrew Wakefield’s discredited paper on the risks of MMR led to a drop in the numbers coming forward for the vaccine. Those young adults are eligible for vaccines right now to try to prevent the spread of measles.

We also know that covid disrupted the routine vaccination programme. Again, that is a key reason why all four nations of the United Kingdom are not meeting the WHO recommended coverage. As I have set out, letters are going out to the parents of unvaccinated children, because we recognise that rates have been lower than we would wish. One million have gone out across London and the west midlands. Of all parts of the United Kingdom, it is the west midlands that we are most concerned about.

To give the House some context, last year there were more than 209 laboratory-confirmed measles cases in England, over three quarters of which were from the west midlands, predominantly Birmingham and Coventry, so there is a particular push in the west midlands. That is why nearly two weeks ago we gave a briefing to local MPs and local directors of public health, who are doing an outstanding job at the coalface, rolling out pop-up clinics in schools and going out on community buses to reach communities that may struggle to be reached through traditional routes. GPs are putting on extra clinics, but we have to get the message out. It is not through a lack of vaccines or a lack of messaging, but we still have vaccine hesitancy. We all have a role to play in getting communities to come forward.

[Mr Speaker]

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

[Steve Brine (Winchester) (Con)]

In April last year, the UK Health Security Agency told the Health and Social Care Committee that it was

“expecting measles to come back”,

while the Joint Committee on Vaccination and Immunisation told us that the threat was “very real”. Last summer, as the Minister knows, we published a vaccination report as part of our prevention inquiry. We were pleased that, in answer to a recommendation, NHS England published its vaccination strategy just before Christmas. Can the Minister say more about how she will inject more urgency into the roll-out, and will she commit, as we also asked, to a much more flexible delivery model for vaccinations, including through pharmacy?

[Maria Caulfield]

The Chair of the Health and Social Care Committee is right. That is why we have met with both the west midlands and the London teams to hear from those on the ground what resources they need in order to become more nimble in the vaccine roll-out. The communities that are not coming forward are the ones that are not engaging with the routine MMR vaccine programme, so we need to be more nimble, which is why we are hearing from those vaccinating on the ground about vaccine buses going into communities, pop-up clinics in schools, and GPs putting on extra vaccine clinics. From our data, we have a list of the children who are unvaccinated, and more than a million letters have gone out to their parents to urge them to come forward.

My hon. Friend is right about using pharmacy, with Pharmacy First as a model, to make it even easier for people to come forward, but the real barrier is people’s reluctance to get vaccinated for a variety of reasons, whether it is vaccine fatigue through covid or because they missed their routine appointments and find it difficult to come forward at an extra clinic. We are engaging with local authorities and the Department for Education to try to make it as easy as possible for children and adults to get vaccinated.

[Debbie Abrahams (Oldham East and Saddleworth) (Lab)]

There are clear inequalities in vaccination uptake, including MMR, which reflect various socioeconomic inequalities. What extra support is being given to those areas, and to places such as mine, and why, as the Chair of the Health and Social Care Committee suggests, was the risk assessment of the UK Health Security Agency seemingly ignored by the Government?

[Maria Caulfield]

I can assure the hon. Lady that it was not ignored by the Government. Over the past 12 months, we have been pushing vaccinations to those who have not come forward, and to communities that struggle with vaccination uptake, which is why in the past 12 months there has been a 10% increase. As I say, that is not enough. There are still people who need to come forward for vaccination who have not done so. I emphasise to the House that this is an acute outbreak of measles. If someone has their first dose of the measles vaccine today, within two weeks they will have roughly 92% immunity. If they go on to have the second vaccine, they will have roughly 98% immunity, which will be lifelong.

[Sir Desmond Swayne (New Forest West) (Con)]

Might vaccination rates benefit from a much more generous compensation scheme for the very small number of severe adverse reactions?

[Maria Caulfield]

We have a vaccine damage payment scheme, which provides a one-off payment of £120,000. That is accessible for any vaccine that someone takes up, but I have to say that part of the problem is misleading information about the safety of vaccines. The measles vaccine is safe. At one point, we had eliminated measles in this country. Most children will be fine, with a mild illness, but we have had episodes of children getting encephalitis, which is a swelling of the brain that has lifelong consequences. We must move away from the narrative that vaccines are not safe. The measles vaccine is one of the safest vaccines people can have. I really do not think that that messaging is helpful.

[Daisy Cooper (St Albans) (LD)]

During the covid pandemic, my constituency of St Albans had one of the highest rates of vaccination. That was, in part, because of the work of our GPs and pharmacists, but we were also incredibly proactive at recruiting community champions, who could have those vital conversations to tackle hesitancy within particular pockets of our community. The Minister has mentioned pop-up clinics and vans, but she has not mentioned the role of community champions. Will she work with and support the directors of public health to recruit those community champions, who can have those vital conversations so that people can put their questions to people they know and trust?

[Maria Caulfield]

The hon. Lady is right that we used community champions during covid. We had some particularly effective campaigns for those communities that do not traditionally come forward for vaccinations, and that was done by using community leaders, faith leaders and trusted organisations within communities. We are doing that in the west midlands, in London and across the country.

Those people tell us that one of the key things that prevents Jewish and Muslim communities in particular from coming forward is their fear about the porcine vaccine. Just to reiterate, we have two types of MMR vaccine. Priorix does not contain gelatine and is safe and effective as an MMR vaccine. It is available on request, but we are also pushing out its availability so that people do not have to request it and it is offered up front. It is important that people know we have sufficient supply of the gelatine-free MMR product, and faith leaders, community groups and organisations are trying to get that message out to those two particular groups.

[Maggie Throup (Erewash) (Con)]

My hon. Friend has an important message today because, after clean water, vaccines are the most impactful public health measure we have and, without a doubt, they save lives. One of the lessons we learned through the pandemic was that the most effective way to reach hard-to-reach communities is through faith and community leaders and to take the vaccines to those communities, whether that is to mosques or temples. Will she do whatever she can to ensure that we employ the same measures this time and take the vaccines to the communities and not expect the communities to go to the vaccines? Will she also consider reaching out to those fantastic vaccinators we had during the covid pandemic, who are highly trained to deliver vaccines to all age groups, and getting them on board to get the MMR vaccinations carried out as quickly as possible?

[Maria Caulfield]

My hon. Friend is absolutely right. I pay tribute to the work she did during the covid pandemic to roll out the vaccine programme to those community groups. That had such an effective reach for something we were struggling with previously, and she worked hard on that. That is exactly what we are trying to replicate with this roll-out, and we are working with community groups and faith leaders, but also taking the vaccine out to communities. I was on the call with the London teams on Friday, and they have a vaccine bus that they are taking out to community centres and faith groups so that people do not have to book an appointment to get the vaccine. It is important to say that this is not just for children. If an adult has not had their vaccine, it is never too late to get the MMR vaccine to protect themselves against measles.

[Clive Efford (Eltham) (Lab)]

Does the Minister accept that the reduction in the number of health professionals who support parents has contributed to the reduction in the number of parents presenting their children for the MMR vaccine, and that that is one of the lessons we should learn from this situation?

[Maria Caulfield]

I would not agree with the hon. Gentleman. We have plenty of vaccine—that is one of the messages we want to get out—and that is both the traditional MMR vaccine and the non-porcine vaccine. We also have plenty of vaccination spaces. We have spaces at GP clinics and pharmacies, and the school roll-out programme has spaces, but we still do not have people coming forward. We really need the help of all hon. Members in this place to get the message out that people should come forward for their MMR vaccine to protect against measles.

[Florence Eshalomi (Vauxhall) (Lab/Co-op)]

Every time my six-year-old comes home coughing, I get a bit scared because, obviously, measles is highly contagious. It is important that we get the message out about the way it is passed on through coughs, sneezes and high fevers. The Minister has outlined a range of areas where the Government are trying to get that message out, but the fact is that they are fighting against a system where a number of the hesitancy messages are shared in closed groups—groups that are getting that message out to parents and carers who will not come forward. Will the Minister outline what the Government are doing to counter that and to give people an informed choice on the vaccine, so that they come forward with their children?

[Maria Caulfield]

The hon. Lady is quite right that there is vaccine hesitancy, and that is a key reason why uptake has dropped so significantly across all groups, but more in some groups than in others. That is why NHS England and the UK Health Security Agency have written to more than 1 million parents in the west midlands and London to highlight the benefits of having the MMR vaccine. As more cases of measles break out, we are seeing more people come forward to take up the vaccine, because they are balancing for themselves the risk of having the vaccine, which is very minimal, against the risk of having measles. Any help that hon. Members can give is welcome and we are very willing to hear any suggestions they have for helpful messages in their own particular communities.

[Alex Davies-Jones (Pontypridd) (Lab)]

The Minister is right to point out that one reason for the decline in people coming forward to take up the MMR vaccine is the rise of dis- and misinformation about the vaccine—not just online, but, sadly, perpetrated in this House. The Online Safety Act 2023 does very little to tackle online dis- and misinformation and to keep people safe. What is the purpose of the Government’s counter disinformation unit? Why is there no transparency on what that unit is supposedly doing, and when will the Government stand up to the social media platforms and stop them proliferating this dis- and misinformation and profiting from something that is causing real-world harm?

[Maria Caulfield]

The hon. Lady has a point that part of the vaccine hesitancy is due to misinformation about vaccines more generally. That is why we are trying to use the message of immunisation rather than vaccination, because it is a much more positive message. We are also providing positive messages and social media graphics for communities and Members of this House to roll out to counter some of that misinformation. It is really important that we get that message out. There is a problem with misinformation, and I want to reiterate that measles is a highly infectious disease that can be eliminated by vaccination alone.

[Jim Shannon (Strangford) (DUP)]

I thank the Minister very much for her positive response to this urgent question. You and I are of similar vintage, Mr Speaker, and I recall getting my measles vaccination at Ballywalter Primary School in the early ’60s—so not yesterday, but a long time ago. There was a system where vaccination happened in schools, and I think that is where it should happen.

The Northern Ireland Audit Office reports that the number of pre-school vaccinations has been steadily declining and the rate of children getting the MMR vaccine at two years of age has fallen from 96% in 2012 to 90% in 2022—a significant drop in Northern Ireland, with a population of 1.95 million. There is clearly a crisis emerging not just in England, but across the whole of the United Kingdom, in particular in Northern Ireland. Does the Minister agree it would be helpful to have a joint approach across the whole United Kingdom of Great Britain and Northern Ireland, to ensure that children are vaccinated and, more importantly, protected against this awful disease? It is always better to do it together; that is my suggestion to the Minister.

[Mr Speaker]

I think that was the Adjournment debate on measles. [Laughter.]

[Maria Caulfield]

The hon. Gentleman is absolutely right and I want to work with all four corners of the United Kingdom, because none of us is meeting the World Health Organisation coverage for MMR. Northern Ireland has similar rates to England at 89%. A joined-up approach, so that we have better coverage for MMR across the UK and can get back on top of breakouts and eradicate measles once again, would be very welcome.

Excess Death Trends

Maria Caulfield Excerpts

Tuesday 16th January 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, Sir Gary. I thank the hon. Member for North West Leicestershire (Andrew Bridgen) for securing this important debate. We have had a number of debates; I responded very briefly to his Adjournment debate in October. I acknowledge that he is absolutely correct that there is an increase in excess deaths. We take that very seriously; I take that seriously as a Minister, and from the point of view of my clinical background.

To echo the thoughts of many hon. Members around lessons to be learned from the covid period, I too, as Minister with responsibility for pandemic preparedness, would like answers and advice on the impacts of lockdowns, face masks and the timings of vaccine roll-outs, so that those can be taken into consideration for any future pandemic. Although the inquiry is independent, a focus on those issues would be extremely helpful to me, as Minister.

[Paul Girvan]

Will the Minister give way?

[Maria Caulfield]

Not for the moment; let me respond to as many points from hon. Members as I can.

There is an increase in excess deaths. A number of factors contribute to that. We take that seriously, and monitor it constantly. Looking at the past year, for example, there was a high flu prevalence last winter, when there were still ongoing challenges relating to instances of covid-19 and a strep A outbreak, particularly among children. Those had an impact. Statistics from the Office for Health Improvement and Disparities showed that last year, there were almost 26,400 excess deaths in England, and of those excess deaths, 7,300 were due to acute respiratory infections, including flu and pneumonia.

Last winter, the number of positive tests for flu peaked at 31.8%—the highest figure in the last six years. There are schools of thought on that; one is that when people were locked down, they were not exposed to flu for a couple of years, so their immune systems struggle to cope. We have learned those lessons, and that is why, this year, we have brought forward our flu vaccination programme. We have successfully vaccinated over 17.6 million people since the campaign started in September. It is still early in the winter season, but—touch wood—we are seeing fewer admissions from flu and covid than we did last year. We are learning lessons from those excess deaths.

There are also excess deaths from cardiovascular diseases; that was pointed out during the debate. The figure is 6% higher than expected in England, with almost 13,500 excess deaths attributed to cardiovascular disease. Lockdown did have an impact on that. We know that people were not getting their cholesterol tested or their blood pressure checked, and were still smoking. Antihypertensives and statins were not being prescribed. Again, we have taken action. As my hon. Friend the Member for South West Bedfordshire (Andrew Selous) pointed out, we are supporting local authorities to resume normal NHS healthcare checks; between April and June last year, the highest number of checks were offered since the programme began in 2013. We are investing £17 million in innovative new digital health checks, to be rolled out this spring, that will deliver an additional 1 million checks in the first four years. We have a £10 million pilot to deliver up to 150,000 cardiovascular disease checks in the workplace, with free blood pressure checks being rolled out in community pharmacies to people over 40, and we are investing £645 million to include blood pressure checks in our community pharmacy facilities. That is in addition to the work the Prime Minister announced on a smoke-free generation, which will be debated further, through which we want to see smoking rates further reduce.

I turn to the elephant in the room—covid vaccines—because the hon. Member for North West Leicestershire and other hon. Members have raised concerns about their safety. It is true that Office for National Statistics data, published only in August, shows that people who have had a covid-19 vaccine have a lower mortality rate than those who have not been vaccinated. My hon. Friend the Member for Bosworth (Dr Evans) and the hon. Member for North West Leicestershire are absolutely correct that a high number of people who were vaccinated appear in the excess death population, but when 93.6% of the population have had at least one dose of a covid vaccine, there will be a high number of vaccinated people in the excess death numbers. That is prevalence, not causality. It is important that we look at the causes of excess deaths and tackle them.

[Dr Caroline Johnson]

The Minister is saying that the number of people dying who are vaccinated is higher than the number of people who are not. That is to be expected because they are more likely to be older and frailer. Does she have any data that are adjusted for age and frailty—to say whether the vaccinated population are more or less likely to die?

--- Later in debate ---

[Maria Caulfield]

I do not have those figures on me, but I will be very happy to write to the hon. Lady with them. I am not saying that the rate is higher if people are vaccinated but that a high number of vaccinated people appear in the excess death figures because 93.6% of the population were vaccinated. That does not link to causality; it shows a high prevalence instead.

[Paul Girvan]

On that very point, during the public inquiry, should greater importance not have been placed on investigating the excess deaths, as opposed to delaying that part of the inquiry?

[Maria Caulfield]

The public inquiry is independent, and the Government are under heavy scrutiny from it. It is not for me to say how the inquiry should be conducted. As a Government, we are looking at the causes of excess deaths and introducing, where we can, urgent measures to reverse that increase as quickly as possible.

No vaccine or medicine—even simple paracetamol—is completely risk free, but we have systems in place to continually monitor the safety of our medicines. For example, in April 2021, following concerns raised through the yellow card system or by GPs or clinicians, the MHRA reacted to rare cases of concurrent thrombosis and thrombocytopenia following the AZ vaccine. That resulted in actions, with adults under 30 not offered the vaccine any further. In May of that year, that was extended to adults under 40. Where there is concern, we will take action and take recommendations from bodies like the MHRA to make sure that those vaccines are as safe as they can be.

[Neale Hanvey]

The Minister knows as well as I do that the yellow card scheme sits at the heart of safe clinical care, but allegations are circulating that the MHRA is sitting on 50 times more yellow cards related to the covid-19 vaccine than those related to any other vaccine that have been reported to it. Will she commit to asking the MHRA to account for that and to taking urgent action if, indeed, it is sitting on the yellow card system reports?

[Sir Gary Streeter (in the Chair)]

Minister, please leave some time for the Member in charge to wind up.

[Maria Caulfield]

Thank you, Sir Gary, for reminding me that I have two minutes left.

I absolutely take the hon. Gentleman’s point. If people have concerns, I am more than happy to raise them with organisations or to provide hon. and right hon. Members with answers. Although we have had over 8,000 claims to the vaccine damage payment scheme so far, 4,000 of them have been rejected on the grounds of causation or not meeting the severity threshold, and 159 have been awarded—156 for the AZ vaccine, two for Pfizer and one for Moderna. As well as the information that the MHRA is collecting, we are analysing the vaccine damage payment scheme to keep constantly reviewing the safety of the vaccines.

We must be careful with the language we use. We have a measles outbreak at the moment that is affecting young children, with particularly high outbreaks in London and the west midlands. Thankfully, it is mild in most cases, but children can die or have long-term side effects, and there is a danger if we are not careful with the language we use. We should absolutely scrutinise the safety of vaccines, but we need to make sure that we are not deterring parents from coming forward. We nearly eradicated measles, and we are now seeing outbreaks because of concerns about vaccinations. Although we have concerns, we also have responsibilities.

I do not have much time left, so I will make one quick point. If clinicians and experts have concerns, we should point them to the funding that we have made available for the National Institute for Health and Care Research. Some £110 million has been allocated for covid-19 vaccine research, and I encourage them to make use of that fund to develop our knowledge further.

I reassure colleagues that we absolutely acknowledge that there is a risk of excess deaths. We are working towards how we reduce that as quickly as possible, but the lockdowns have had a negative effect in many cases. We are also mindful of the safety of vaccinations, and have taken action when safety concerns have been raised.

My hon. Friend the Member for Watford (Dean Russell) mentioned coronial delays. That is a matter for the Ministry of Justice, but if he wants to write to me with the details of his case, I would be happy to take it up with that Department.

I thank my hon. Friend the Member for North West Leicestershire for bringing forward this issue. My door is open, and I am very happy to continue the discussion with him on it.

[Sir Gary Streeter (in the Chair)]

Andrew Bridgen will have the final say.

Medical Examiner and Death Certification Reforms

Maria Caulfield Excerpts

Thursday 14th December 2023 Written Statements

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

I wish to update the House on the Government plan to introduce secondary legislation to reform death certification in England and Wales, from April 2024. Under the reforms, all deaths will become legally subject to either a medical examiner’s scrutiny or a coroner’s investigation. Medical examiners are senior medical doctors that independently scrutinise the causes of death. Since 2019, NHS trusts have appointed medical examiners to scrutinise most deaths in acute healthcare settings and some community settings on a non-statutory basis. From April 2024, it will become a requirement that all deaths in any health setting that are not referred to the coroner in the first instance are subject to medical examiner scrutiny.

The changes will mean that families will have greater transparency on the circumstances surrounding the death of a loved one. 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 poor practice and ensure the right deaths are referred to coroners for further investigation.

The relevant primary legislation for these reforms was commenced on 1 October 2023 and today the Government are publishing three sets of draft regulations under powers in the Coroners and Justice Act 2009 that will be laid shortly when parliamentary time allows. These will be published on gov.uk.

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 doctors, medical examiners, coroners and registrars in the new system. We are working closely with our partners in Government and the health service to ensure that the appropriate operational processes are in place to deliver these changes from April 2024.

[HCWS131]

NHS Vaccination and Immunisation Services

Maria Caulfield Excerpts

Wednesday 13th December 2023 Written Statements

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

In 2019 the Government’s manifesto committed to continue to promote the uptake of vaccines via a national vaccination strategy. I am pleased to announce that on Wednesday 13 December NHS England published that strategy.

Vaccination saves lives and protects people’s health. It ranks second only to clean water as the most effective public health intervention to prevent disease. Through vaccination, diseases that were previously common are now rare, and millions of people each year are protected from severe illness and death.



Building on the success of our world-leading NHS covid-19 vaccination programme, which has delivered over 150 million vaccinations to date, and learning from many decades of successful immunisation delivery, NHS England, in collaboration with the Department of Health and Social Care, the UK Health Security Agency and other partners, has developed a strategic direction for the delivery of vaccination services, focused on improving uptake and coverage of all vaccinations across the whole population while reducing disparities of uptake in under-served communities. To do so, the strategy aims to:



Simplify and streamline access to vaccinations, including extending online booking capability;

improve access for people who are currently under-served by offering vaccination through community-based, targeted approaches; and

deliver vaccination through flexible, integrated, neighbourhood teams that can deliver other preventative interventions alongside vaccination.

The strategy proposes that integrated care boards have the responsibility and flexibility to deliver these aims through local vaccination delivery networks that are tailored to the needs of local people. These local networks will be underpinned by timely, accurate data flows and responsive vaccine supply chains. Local systems will have a robust plan for managing disease outbreaks and surge responses, collaboratively developed with partners including local government, and setting out clear roles and responsibilities.



In developing this strategy, NHS England has sought the views of a wide range of stakeholders, including service users via a public survey, GPs, community pharmacy, NHS trusts and directors of public health. Stakeholder input has been invaluable in developing an ambitious plan for the future of vaccination delivery, as well as describing what should be retained, improved and adapted from the current approach to ensure that it meets everyone’s needs.



The strategy supports NHS England’s ambition to eliminate cervical cancer by 2040, with England among the first places in the world to set this ambition within the next two decades, by making it as easy as possible for people to get the lifesaving human papillomavirus (HPV) vaccination and increasing cervical screening uptake.



A copy of the strategy will be deposited in the Libraries of both Houses.

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