Tattoo Artists, Body Piercers and Cosmetic Clinics: Licensing

Maria Caulfield Excerpts

Tuesday 28th November 2023 Commons Chamber

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

I congratulate my hon. Friend the Member for Winchester (Steve Brine) on securing this important debate and reiterate the Government’s commitment to improving patient safety in this area. We recognise that for some time, there have been concerns about the lack of regulation of these procedures, both here and abroad, the dangers they can pose to consumers and the long-term impact when they go wrong. As my hon. Friend pointed out, we have heard many horrific stories, both in this Chamber and in Westminster Hall, about what can go wrong when procedures are done poorly or consumers or patients experience side effects that they were not expecting.

As my hon. Friend pointed out, there are existing regulations for body piercing and tattooing, which I will touch on in a moment. However, we take this area so seriously that the Health and Care Act 2022 gave the Secretary of State powers to introduce a licensing scheme for non-surgical cosmetic procedures in England. The scheme we intend to introduce in England will be more extensive than the Welsh scheme that my hon. Friend mentioned; it will cover more than the four areas outlined in the Welsh Government’s recent piece of work. Obviously, we have just held our consultation, and at the moment we are looking to see whether the scheme will also cover some of the existing powers around tattoos and piercings that are enforced by local councils.

We want the licensing scheme that we intend to introduce to support people in making an informed choice, and to ensure that when they make their choice, they experience safe care for any non-surgical cosmetic procedure. We want the scheme to address three areas, the first of which is to ensure that services are administered by suitably trained and qualified practitioners. That does not necessarily mean regulated healthcare professionals, but it does mean that anyone who undertakes procedures must be trained and qualified to do so. We also want practitioners to hold appropriate indemnity cover, so that they and the patients they are treating are covered should something go wrong, and to be operating from premises that have appropriate standards of hygiene and cleanliness.

As my hon. Friend said, we have been working closely with many professionals from a variety of backgrounds to start the process of introducing the licensing scheme. The cosmetic procedures sector includes a vast and expanding range of treatments and techniques. We want to future-proof regulation so that we cover as many emerging techniques, treatments and procedures as possible—we do not want to be revising regulations on a regular basis—and cover a wide range of practitioners and businesses. We want those businesses to thrive—they contribute to our economy and provide a very popular service—but we need to make sure that they are safe and well regulated, so that those undergoing procedures are safe and can make informed choices about treatments.

In introducing the licensing scheme, we need to make sure that we consider all eventualities. There are a number of factors to consider, from who undertakes the procedures to the types of procedures that are covered and who undertakes inspections once the regulations are introduced. Through our engagement, we have developed proposals on which treatments are to be included, who should be permitted to perform them, and whether age restrictions need to be introduced for certain procedures.

As my hon. Friend said, we rolled out an initial consultation, which closed at the end of last month. We received over 12,000 responses from across England, which is a pretty significant number of responses to a Government consultation; we do not normally get so many. To reassure my hon. Friend, 43% of those responses were from aesthetic practitioners and about 40% were from the various regulated health professionals, so there was an even mix of practitioners and regulated healthcare professionals. We received a fair balance of views, and we are working through the responses at speed. I thank everyone who responded, because the consultation will inform how the regulations are developed.

Over the next 12 months, we will work through the consultation responses and set out exactly which procedures will be covered by the regulations; the education and training standards that will be required of practitioners; the types of premises that will be allowed; the types of licence fees that will be introduced, if any; and who will enforce the regulations to ensure that they are complied with.

That will take time—we estimate that it will take most of next year—but I can assure my hon. Friend that it is crucial. Like him, I thought that we would be able to get this done pretty swiftly, but once we start to unearth which procedures should be covered, who should be doing them and the types of premises they should be operating from, it is a can of worms. It is really important that we take the time to get this right, so that we have a really robust, extensive and safe regulatory licensing scheme in operation across England.

My hon. Friend touched on tattoos and piercings. As he said, those are regulated by measures such as the Local Government (Miscellaneous Provisions) Act 1992 and the Local Government Act 2003, as well as legislation specific to geographical areas of England. The existing legislation gives local authorities the power to register practitioners and their premises, and to take enforcement action if practitioners are not abiding by byelaws. He is right that that varies across England, but the measures local authorities undertake do reduce the risk of transmission of blood-borne viruses such as HIV and hepatitis B and C. The Department has a model byelaw template—if local authorities want to introduce that in their local area, they can contact us for it—to try to get as much consistency as possible.

We are looking at whether tattoos and piercings should also come under the non-surgical cosmetic procedures regulations. We are engaging with those sectors to see whether we should have one wide piece of legislation and regulation, or a dual system, because many tattoos and piercings practitioners feel that that works quite well for them right now. We have not ruled out a change, but it is important to note that, as the legislation stands, there are already regulations for tattoos and piercings, which should be being enforced by local authorities up and down the country.

I want to touch on cosmetic procedures abroad, because that is becoming more of a topical issue. As costs rise and procedures are often cheaper abroad, it is so important that we make sure that people from the UK travelling for non-surgical cosmetic procedures are informed about the risks and do their research before they travel. While excellent healthcare is available internationally, we are aware of tragic cases—even cases in which people have lost their lives—arising from treatments outside the UK. Our team are actively engaging with international partners to consider how best we can support people considering travelling abroad for such treatments. Having a safer, regulated system in England will help inform people that, if they are travelling abroad, the country involved should be operating to the same standard as the licensing scheme we are intending to introduce in England.

I absolutely understand the urgency with which my hon. Friend wants to see the licensing scheme come forward. That is why we introduced the power in the Health and Care Act, but this is a complex area. We need to decide who will undertake these procedures and which procedures will be covered, and to future-proof so that we cover as many as possible. We also need to look at the premises that practitioners are operating from and who the regulator will be. It could be the Care Quality Commission, local government, the Nursing and Midwifery Council or the General Medical Council, which all have a role to play in this. There is a lot to decide before the legislation and regulations come before us.

I can assure my hon. Friend that we will be working to respond to the consultation early in the new year, and we will then set out the framework for the legislation. We will conduct a further consultation on that before finally announcing it, because, as he said, there are concerns across the sector. There will also be an interim period so that, if we introduce mandatory training for practitioners, there is time for those operating in this space to take on qualifications and training, to upgrade their premises or to look at which procedures they undertake. We want to ensure that those who can practise safely have the time to develop their skills and upgrade their premises accordingly. I assure my hon. Friend we will consult again so people will be fully aware of the changes coming through.

I look forward to working with my hon. Friend and his Select Committee to make sure that we have an extensive scheme of regulation across England as quickly as possible, but also that it is robust and meets the needs, most importantly of patients, but of the sector as well.

Question put and agreed to.

Draft Health Protection (Coronavirus, Testing Requirements and Standards) (England) (Amendment and Transitional Provision) Regulations 2023

Maria Caulfield Excerpts

Wednesday 22nd November 2023 General Committees

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

I beg to move,

That the Committee has considered the draft Health Protection (Coronavirus, Testing Requirements and Standards) (England) (Amendment and Transitional Provision) Regulations 2023.

It is a pleasure to serve under your chairmanship, Mr Paisley. I will begin by setting out the policy context for the regulations, and then explain the effects of the proposed changes. We all remember that during the covid-19 pandemic the Health Protection (Coronavirus, Testing Requirements and Standards) (England) Regulations 2020 focused on enabling providers who met appropriate quality standards to rapidly enter the private covid-19 testing market. At the time, the right balance was struck between protecting public health and growing the market quickly, both of which were necessary public health outcomes. Now that the threat of covid-19 is reduced and there is no longer an urgent need to grow the testing market quickly, the Department has reviewed the 2020 regulations and proposes that all private providers must be now be fully accredited before they provide testing services.

The 2020 regulations introduced a three-stage accredit- ation process for organisations providing covid-19 testing commercially, to speed up entry to the market. Stage 1 required a private provider to make an application to the United Kingdom Accreditation Service for accreditation, and to make a declaration to the Department that it met and would continue to meet certain minimum standards. Stage 2 required an applicant to demonstrate within four weeks of applying for accreditation that it met the requirements published by UKAS. Between January and June 2021, stage 3 required providers to complete their application within four months.

In June 2021, we passed legislation to update stage 3, thereby requiring applicants to achieve a positive recommendation from UKAS within four months of completing stage 2. As long as a provider received that recommendation, it then had a further two months to achieve accreditation. Providers that failed to meet those deadlines, or failed to satisfy UKAS that they met the relevant standards, had to stop supplying tests. At the time, our approach ensured that enough providers were able to enter the market to meet the public’s demand for covid-19 testing, while still putting providers through an appropriate approvals process.

However, we are now more than three years on from the start of the pandemic, the living with covid strategy has been in place for over a year and the World Health Organisation has declared that covid-19 is no longer a public health emergency of international concern. It is, therefore, the right opportunity to review and update covid-19 legislation on private providers to bring in requirements and standards to strengthen consistency, safety and high-quality covid-19 testing services.

The proposed changes will empower consumers to choose a private testing service with confidence, while continuing to improve safety and quality.

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

I notice that there is no impact assessment associated with the regulations—why is that? Will the changes to the regulations take into account the investigation into Immensa and the errors that resulted in 39,000 covid tests being inaccurately assessed as negative? Will the Minister reassure us that that will be the case, and explain why there was no impact assessment?

[Maria Caulfield]

Certainly. I will come in a moment to the standards we are changing to meet those concerns.

First, under the new regulations, from 1 January 2024, in order to enter the private covid testing market private providers will have to achieve accreditation against the appropriate ISO standard by a signatory of the international laboratory accreditation co-operation mutual recognition agreement. That should give Members confidence that providers will now have to meet an internationally recognised standard. There will be consistent testing standards across the board that meet the ISO standard and are accredited by a signatory of that mutual recognition agreement. The new requirements will replace the three-stage accreditation process required under the existing regulations, which I just outlined, to make sure that providers meet a certain standard.

Secondly, we are removing the requirement for providers to get sign-off from the Department at the start of the application process, because they will have to be accredited before they can enter the market; thirdly, we are shifting the legal responsibility for clinical services to the clinical organisation, rather than it resting with customer-facing organisations; and finally, we are removing the duplicative provision for the validation of testing and ensuring that the regulations reflect the publication of the updated ISO standard, which is 15189:2022.

The changes in the regulations are forward-looking and do not affect private providers that have applied for accreditation before the instrument comes into force. Those providers will still need to complete the application process but can do so using the current staged accreditation system.

On the point made by the hon. Member for Oldham East and Saddleworth, we are moving to a system in which accreditation will have to be achieved against the new ISO standard, and that will apply across the board and be comparable to other countries. We will move away from the three-stage process that we used during the emergency phase of the pandemic, when we had to balance risks and benefits. The risk at that time related to the need to get as much testing out to the public as possible, but that has now reduced, so it is important to set high standards so that people have confidence in the tests they get done.

The regulations will reduce the bureaucracy involved in applying for accreditation while still delivering the rigorous accreditation requirements that are important for public health. I therefore commend the regulations to the Committee.

--- Later in debate ---

[Maria Caulfield]

Let me respond to the questions from the shadow Minister. Currently, we have enough testing capability. Testing providers that are already accredited by the current system will not have to reapply, and those currently undergoing accreditation will be able to continue as planned. The new regulations are for providers that want to enter the market.

More than 100 providers currently hold accreditation, and 18 of them were reporting results to UKHSA as of September. A significant number of providers is currently accredited, so we do not anticipate a huge number coming through the new system, but we will keep an eye on that. Since January we have had very few applications, if any, which shows that the current capacity reflects the demand.

If covid numbers took off or there was a variant of concern, the balance of risk and benefit that I talked about earlier would have to be re-looked at and we would look at the accreditation process in that light. Assuming that the living with covid policy continues as it is, we are confident that the regulations will be appropriate to meet the demand of those wanting to join the private market testing sector. We will keep that under constant review, along with the resources needed to manage the accreditation process.

The shadow Minister touched on the specific issue of the testing at Immensa laboratories. As she said, the UKHSA, the arm’s length organisation responsible for that, looked at the issue and published a public statement in November last year on the serious incident investigation. It found that

“no singular action or process implemented by NHS Test and Trace could have prevented the errors within the Immensa laboratory arising”.

However, although Immensa was going through the three-stage accreditation process, when problems were identified and it failed to achieve a positive recommendation at stage 3, it was not allowed to continue, and neither of the relevant organisations has rejoined the private testing market. So it was identified at the time and the UKHSA, the organisation that oversees testing, looked into it.

Lessons will be learned from the covid experience, which is why an independent inquiry is ongoing. I reassure the shadow Minister that we will do everything we can to learn lessons from that. This is exactly why we have the regulations in front of us: at that time there was pressure to get as much testing out to the public as possible, and the three-stage accreditation process was introduced to do that. That is not the case now, so we are able to take a much more robust approach to assessing organisations that want to take on testing. I hope that gives the shadow Minister some reassurance and that I have demonstrated why the regulations need to come into force now. I hope I have answered the questions. I commend the regulations to the Committee.

Question put and agreed to.

International Men's Day

Maria Caulfield Excerpts

Tuesday 21st November 2023 Westminster Hall

[The Minister for Women (Maria Caulfield)]

It is a pleasure to serve under your chairmanship, Mr Davies. May I start by saying how pleased I am to participate in today’s debate? The theme of this year’s International Men’s Day is “zero male suicide”, which was touched on in many contributions today and is something that I am passionate about in my role as mental health Minister. I will touch on the groundbreaking work that we are introducing in that space, which is absolutely a priority area for this Government.

I thank my hon. Friend the Member for Don Valley (Nick Fletcher) for securing the debate and for his tireless campaigning. He has held my feet to the fire to get men’s health recognised in a way that has not happened before, and pushed the Government to make this a priority area.

We are clear that more needs to be done to improve outcomes across the board for men, particularly in relation to health. That includes men and boys, whose place in society, as we have heard today, is integral to equality for all, because when men thrive, we all thrive. We all have fathers, brothers, friends, husbands, partners and colleagues. When we improve care for women, that impacts society, but that is equally true when we improve care for men. That is why, as part of International Men’s Day, we have made some significant announcements, which I will touch on.

My hon. Friend highlighted really well that improving outcomes for men is everybody’s business, and I absolutely agree. Whether in relation to economic prosperity for society, delivering education to the next generation, or even politics—or, of course, our own families—it is really important that we support men in every way, and International Men’s Day is an opportunity to highlight the issues that they face.

My hon. Friend the Member for Truro and Falmouth (Cherilyn Mackrory) spoke about the impact of supporting men, particularly around the loss of a child; my hon. Friend the Member for Don Valley gave the example of “Tommy” and talked about how many Tommies there are across the country facing those very issues today; my right hon. Friend the Member for Basingstoke (Dame Maria Miller) touched on life expectancy differences for men; and the hon. Member for Strangford (Jim Shannon) touched on the issues facing veterans. Alongside the NHS, we are rolling out Op Courage for veterans, service leavers and reservists across England, and there is different support in different regions, but I will absolutely take up with the veterans Minister what we can do to help support a similar scheme in Northern Ireland.

The theme of this year’s International Men’s Day is zero male suicide. The latest data we have from the Office for National Statistics tells us that men account for around three quarters of all deaths by suicide. As many Members have said, that is the biggest cause of premature death in men under 35, but middle-aged men are also a significant risk group, and that is why they are a priority group in our recently published suicide prevention strategy. Over 4,500 men die by suicide in England alone every year. My hon. Friend the Member for Don Valley noted that is 13 deaths a day. Every suicide is a tragedy, and we know about the ripple effect that it has for family and friends. We have heard from campaigners what a devastating loss it can be.

Achieving zero male suicide is an ambitious target. In our suicide prevention strategy, we have addressed men as a priority group and addressed the many issues that they face, including alcohol addiction, financial pressures and relationship breakdown. Those are all key drivers of male suicide, so we want to tackle them and put better support systems in place.

Male suicide is everyone’s business. About two thirds of men who take their own lives are in contact with a frontline service, such as primary care, in the three months leading up to their suicide. That is why every Department—whether it is the Department for Work and Pensions, the Department for Environment, Food and Rural Affairs, the Ministry of Defence or the Ministry of Justice—has a role to play in our suicide prevention strategy. We are bringing those Departments together to make suicide everyone’s business, and we want to see a difference—a reduction—in two and a half years.

I do not have a huge amount of time, because my hon. Friend the Member for Don Valley has to respond to the debate, but I want to touch on the announcement we made on International Men’s Day of £16 million funding for a new prostate cancer screening trial. On my right hon. Friend the Member for Basingstoke’s point about life expectancy, we know that cancer is a significant driver of that. That is why we have rolled out our “man’s van” for lung cancer checks, to target men who have previously smoked and perhaps are not as good as they should be in coming forward to get checks done. That is enabling us to detect around 80% of lung cancers at stage 1, rather than at stage 3 and 4 as was the case previously. The prostate research will dramatically change outcomes for men. On the point made by the hon. Member for Strangford, we can look at that on a UK-wide basis, and we will have discussions with the devolved Administrations before that is rolled out in the spring.

We are appointing a men’s health ambassador—work will start on that soon—and we are launching a men’s health taskforce to join up all the dots. In a similar way to what we have done on the menopause taskforce, my hon. Friend the Member for Don Valley, as chair of the APPG, will be invited to that meeting. We will also improve the information on the NHS UK website, to make it easier for men to access help and support. Men often find it difficult to ask for help, but if it is available on the website, they can do that in the privacy of their own home and know that the information is reliable.

We are also now rolling out the HPV vaccine to boys. While we hope that vaccine will help us eradicate cervical cancer, we know that some male cancers—particularly oral cancers—are related to HPV, so rolling out the vaccine to boys will also have an impact on future cancers in men. We also have our major conditions strategy, which will look at things such as heart disease. There is a huge amount of work going on in this space.

I hope that in my whistle-stop tour—

[Karl MᶜCartney]

Will my hon. Friend give way?

[Maria Caulfield]

I will not, because my hon. Friend the Member for Don Valley needs time to respond.

I hope that, in showcasing some of the work we are doing, I have demonstrated how seriously we take this issue. Once again, I thank my hon. Friend for his work in this space.

Equality and Human Rights Monitor Report

Maria Caulfield Excerpts

Thursday 16th November 2023 Written Statements

[The Minister for Women (Maria Caulfield)]

Today the Equality and Human Rights Commission (EHRC) has published its report, “The Equality and Human Rights Monitor 2023.”

The report can be found on the EHRC website later today. The EHRC has a statutory duty—under Section 12 of the Equality Act 2006—to monitor progress on equality and human rights in Britain and publish its findings every 5 years. “The Equality and Human Rights Monitor 2023” outlines the changes the Commission has observed in equality and human rights in England, Scotland and Wales over the last five years, since its last report, “Is Britain Fairer?” (2018).

Based on the Commission’s comprehensive measurement framework, this report analyses outcomes in all aspects of life in Britain, across all nine protected characteristics. It is based on their own robust statistical analyses, a systematic review of research evidence and the responses to a public call for evidence, as well as input from a broad programme of stakeholder engagement.

I would like to thank Baroness Falkner and the Commission for their work on this report.

The report has been published on gov.uk and will be laid in Parliament on Monday 20 November, once the House of Lords returns.

[HCWS42]

Long-term Segregation in Hospital: Baroness Hollins’ Report

Maria Caulfield Excerpts

Wednesday 8th November 2023 Written Statements

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

Today we have published our response to Baroness Hollins’ final report as chair of the Independent Care (Education) and Treatment Review (IC(E)TR) Oversight Panel. This follows the completion of the second phase of the IC(E)TR programme, which Baroness Hollins has overseen, in order to reduce the use of long-term segregation for people with a learning disability and autistic people. Baroness Hollins’ final report includes recommendations for Government. A copy of both the report and our response will be deposited in in the Libraries of both Houses.

We warmly welcome Baroness Hollins’ report and the work of the oversight panel. The report and the examples of poor care reported are sobering. I continue to be deeply concerned by the examples of unacceptable treatment of people with a learning disability and autistic people in long-term segregation in hospital. The use of long-term segregation must be significantly and urgently reduced. Where it is used, it should only ever be in a way that respects human rights, and all treatment plans should aim to end long-term segregation.

The recommendations made in the report are critical in informing our work to reduce the use of long-term segregation for people with a learning disability and autistic people. They are also aligned with our wider work to reduce the numbers of people with a learning disability and autistic people in mental health hospitals, with more people living ordinary lives in the community.

In our response, we highlight some of the work being undertaken now to reduce the use of long-term segregation in people with a learning disability and autistic people. In particular, I am pleased to be able to confirm that in the very near term IC(E)TRs will continue, now led by CQC, to preserve regulatory oversight and understanding of long-term segregation for people with a learning disability and autistic people and crucially to support people to less restrictive settings and discharge to the community. We will also seek changes to the CQC regulations (subject to parliamentary approval) to improve reporting and notifications by providers to CQC on use of restrictive practices. Once in place, this will provide a better flow of information, supporting CQC to convene an IC(E)TR as soon as possible where someone is moved into LTS to scrutinise the care provided and protect rights.

We will also use Baroness Hollins’ recommendations to inform our longer term work. For example, using the report and accompanying framework code of practice to inform updates to the “Mental Health Act 1983: Code of Practice” when it is next reviewed. Work is ongoing on a number of recommendations as outlined in the report.

I am extremely grateful to Baroness Hollins and the oversight panel for their expertise and commitment to this work over a number of years. Their report will play a critical role in tackling the unacceptably high levels of long-term segregation and in supporting people with a learning disability and autistic people to receive high quality care that is right for them. It is essential that Baroness Hollins’ report and recommendations drive that change.

[HCWS12]

Health and Social Care

Maria Caulfield Excerpts

Tuesday 7th November 2023 Ministerial Corrections

The following is an extract from the Backbench Business debate on Baby Loss Awareness Week on 19 October 2023.

[Maria Caulfield]

We announced in July that we would be rolling out baby loss certificates. They will be retrospective. There is no time limit on applying for them.

[Official Report, 19 October 2023, Vol. 738, c. 472.]

Letter of correction from the Under-Secretary of State for Health and Social Care, the hon. Member for Lewes (Maria Caulfield):

An error has been identified in my response to the debate on Baby Loss Awareness Week. The correct information is as follows:

[Maria Caulfield]

We announced in July that we would be rolling out baby loss certificates. They will be retrospective. Initially, only those who have experienced a loss since 1 September 2018 and are currently living in England will be eligible to apply for them.

Training of NHS Staff

The following is an extract from Health and Social Care questions on 17 October 2023.

[Theo Clarke]

What steps are the Government taking to increase the recruitment of midwives, given the closure of Stafford County Hospital’s freestanding midwifery birthing unit due to shortages, and how is the Secretary of State going to ensure that all midwives are trained to deal with birth injuries to reduce risk?

Menopause

Maria Caulfield Excerpts

Thursday 26th October 2023 Commons Chamber

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

I congratulate the hon. Member for Swansea East (Carolyn Harris) on securing this debate, and I am sad she is not here to join us this afternoon because we have held this debate on almost an annual basis and have made huge progress in achieving some of her asks. She is a tireless voice for women in this place, always raising awareness and inspiring action, and I am very proud to be working with her as co-chair of the menopause taskforce. One key piece of work by the Government has been to respond to one of her asks and reduce the cost of NHS prescriptions for HRT. Of course, there is much to be done. Our women’s health strategy has made the menopause a key priority area. For far too long, women’s health was a secondary consideration. This Government have put it top of the agenda—menopause, fertility, baby loss, dementia and osteoporosis are now priority areas for this Government—and we are the first Government to do so.

There has been a menopause revolution here this morning. I really thank the hon. Member for Bootle (Peter Dowd) for presenting the debate. We have heard from four male colleagues—the hon. Members for Merthyr Tydfil and Rhymney (Gerald Jones) and for Bootle, my hon. Friend the Member for Walsall North (Eddie Hughes) and the hon. Member for Strangford (Jim Shannon)—which is twice the number of women Back Benchers contributing. It is absolutely positive news that we have made so much progress that the menopause matters to men as much as it does to women. In my own Department, to mark World Menopause Day we organised a session during which officials tried on the world’s first menopause simulator, so that men could experience some of the side effects. It was a great success, and many male colleagues went away with an enhanced appreciation of women’s experience of the menopause. I also thank the all-party parliamentary group for its important work. It does a huge amount to shine a light on the issues, particularly with its manifesto for menopause.

I hope the House will give me some time to update it on the progress we have made since our last debate in the Chamber. First, a number of Members have mentioned the HRT prepayment certificate. It has been rolled out since April, and women can pay less than £20 a year for all their HRT prescriptions for 12 months. Many women are on multiple products—they are often on dual hormones—and each of those has a prescription cost. However, just to reassure colleagues, about 89% of all prescriptions are not paid for and there are no charges, and for HRT about 60% pay no prescription charges at all. For those who do, the £20 a year absolutely makes a difference, and it could save women hundreds of pounds on the cost of their HRT. In the spring, we launched a successful campaign to alert women to these changes, and I am really pleased to say that, as of the end of September, well over 400,000 women in England had purchased a HRT prescription prepayment certificate. For anyone who has not got one yet, they can be purchased online, but they can also be purchased in some pharmacies.

The shadow Minister, the hon. Member for Erith and Thamesmead (Abena Oppong-Asare), mentioned HRT supply, which has been an issue over recent months. We have seen a huge wave of women coming forward asking for HRT from their GP, and GPs have been much more comfortable in prescribing HRT, which did put pressure on supplies. There are over 70 products available in the United Kingdom, and in fact the majority of them remain in good supply. We have held six roundtables with suppliers, wholesalers and community pharmacists to discuss the challenges they were facing, and these have delivered results. Since April last year, there were 23 serious shortage protocols for HRT—relevant to 23 products—but as of today only one of those remains in place. That means that at the moment there is only one product for which there is a serious shortage protocol, meaning alternative dispensing or reduced dispensing occurs. We are holding a seventh roundtable later this month, and manufacturers are confident that, in producing and securing more, there will be supplies to be used. That is a real success story, and when women have their prescription, they can be confident that their prescription will be available at their pharmacy.

A key part of our menopause taskforce has been talking about research into the menopause and management of the menopause. The National Institute for Health and Care Research has conducted an exercise to identify research priorities, which concluded in January. I cannot remember which hon. Member mentioned testosterone, but research into how testosterone can alleviate menopausal symptoms has been identified as a gap. It is not licensed for use in the menopause because there is not currently the evidence base for the Medicines and Healthcare products Regulatory Agency to allow a licence. Having that research into testosterone and the improvements it could bring is a crucial step towards any licensing of that hormone. That is why it requested bids for organisations to come forward with research proposals in this area, and we expect an update in December. I am also pleased to update that between April last year and July this year, the NIHR has invested £53 million to support women’s health. On World Menopause Day, it funded the James Lind Alliance to launch its menopause priority-setting partnership. That is crucial in developing the evidence base for better management of the menopause.

I will just touch on a number of other points that were raised. First, on health checks, I have asked the NHS health check advisory group to review the case for including the menopause in the NHS health check alongside its broader future considerations on the health check, following the delivery of the digital check next spring. I will keep the House updated on that work, particularly the hon. Member for Swansea East, as co-chair of the menopause taskforce, because it is crucial that it is included.

We have started the process to set up women’s health hubs across every ICB in the country, because our ambition is for women and girls to access services for women’s health more generally in the places where they live. That is why we are investing £25 million to expand women’s health hubs across England. Hubs will deliver a range of healthcare experiences, but we would expect the menopause and advice on it to be covered by women’s health hubs. We are meeting ICBs shortly to get an update on progress.

One other point raised was about conducting a review into specialist menopause care. It is important to remember that specialist menopause care is not funded by central Government, but is commissioned by integrated care boards and implemented at a local level. They have a statutory responsibility to commission healthcare that meets the needs of whole populations, including for the menopause, but we know that is not always happening on the ground.

[Nick Smith]

I acknowledge that the Government are making good progress on this topic, and I thank the Minister for that. Having said that, my hon. Friend the Member for Erith and Thamesmead (Abena Oppong-Asare) spoke from the Labour Front Bench about training and development for GPs on supporting women with menopause symptoms. Can I press the Minister to tell us more about the Government’s plans to boost training and development for clinicians to help women experiencing the menopause?

[Maria Caulfield]

The hon. Gentleman makes a valid point, and I will come on to that in a moment, because we are making huge progress there. If I may, I will touch on specialist support for the menopause. We will be working with ICBs, and when we meet shortly to ask for updates, we will be looking at the progress being made at the local level in providing that support. We have tried to ensure that information for women is as accessible as possible. We launched our dedicated women’s health area on the NHS website recently, where there is advice and support on the menopause, as well as for other health conditions. That will be updated regularly. Women now have a trusted source to go to for healthcare and advice. That includes a new HRT medicines hub, providing information about the different types of HRT and other options, because HRT does not work for every woman, and sometimes women have to try several types to get one that works for them.

Workplace support has also come up. As Employment Minister, my hon. Friend the Member for Mid Sussex (Mims Davies) has made huge progress. In March, we appointed Helen Tomlinson, who is the menopause employment champion. This month, she published a report with a four-point plan to improve menopause support in the workplace. Organisations such as Wellbeing of Women offer support to businesses, small and large, on how to improve their offer to women. Many of the suggestions that have been made in this place are being taken up, and they do make a difference. We hear from women all the time about the difference they make. This month we launched a new space for guidance on the helptogrow.campaign.gov.uk website. Large or small, businesses can get advice there about the difference they can make in the workplace not only in retaining women, but in having open conversations in the workplace. Flexible working is a key part of that.

To touch on the GP point, we are looking this year to consult on the future of the quality and outcomes framework, which is one of the measures used to look at health conditions, to see whether the menopause should be included. We fully recognise the importance of ensuring that GPs ask the right questions so that women get the right support. We intend to have those conversations with GPs about the QOF framework.

We are also, rightly, looking at staff training and developing education and training materials for healthcare professionals across the board, not just GPs, so that healthcare professionals have better awareness of the menopause. My hon. Friend the Member for Walsall North and the hon. Member for Strangford pointed out that women often go and ask for help, but their signs and symptoms are not recognised as being related to the menopause. Our women’s health ambassador, Professor Dame Lesley Regan, is doing crucial work on engagement in this place. We are also ensuring that GPs are assessed on menopause as a measure in their training. From next year, all medical students will have to complete a module that includes menopause so that doctors, whether GPs in primary care or in secondary care, have better awareness of the signs and symptoms and management of the menopause, so that when women approach for help, they will be better supported.

I thank all hon. Members for their contributions to the debate. We have taken great strides in the last 12 months in supply of HRT and reducing the cost, rolling out women’s health hubs, but I know that there is more work to be done. I know also that the hon. Member for Swansea East will be back to hold my feet to the fire, and I look forward to working with her as co-chair of the menopause taskforce.

IVF Provision

Maria Caulfield Excerpts

Tuesday 24th October 2023 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 Robertson. I thank the hon. Member for Jarrow (Kate Osborne) for tabling this important debate, and all Members across the Chamber for their contributions. It has been a positive debate—a good example of putting politics aside and debating how to do the right thing. While I am not denying the challenges for the LGBT+ community raised by the hon. Member, I want to highlight that the Government have brought in major changes over the years with the introduction of same-sex marriage, and the transformation of the management of HIV with the roll-out of opt-out testing and PrEP treatment.

I am pleased to announce that, following the advice from the Advisory Committee on the Safety of Blood, Tissues and Organs, the Government will be introducing secondary legislation to allow the donation of gametes by people with HIV who have an undetectable viral load; we will be introducing that as soon as we can. We will also be addressing the current discriminatory definitions of partner donation, which result in additional screening costs for female same-sex couples undergoing reciprocal IVF; again, amendments through statutory instruments will be introduced as soon as possible.

Those are some of the measures that we have been working on, but I absolutely understand from what I have heard today that there are many issues still to be dealt with, and I welcome the hon. Member for Jarrow holding my feet to the fire to deliver change. Hopefully some of these updates will provide reassurance. This is a priority area, which is why IVF, fertility, and particularly same-sex access to IVF, were in the first year of the women’s health strategy, and it is why we are not going to wait for the 10 years of the strategy to introduce the changes.

To be clear, the Government are implementing a policy that no form of self-financed or self-arranged insemination is to be required for same-sex couples to access fertility treatment. I acknowledge that is taking a little while to be rolled out across the country. Hon. Members, especially the hon. Member for Pontypridd (Alex Davies-Jones), have spoken about infertility a lot. We absolutely recognise that it has a serious effect on individuals and couples, which is why it is a priority—particularly for the women’s health strategy.

As the hon. Members for Strangford (Jim Shannon) and for Livingston (Hannah Bardell) pointed out, I can only speak on the provision of IVF in England, but I am very happy to work with colleagues in the devolved nations of Scotland, Wales and Northern Ireland to achieve a consistent approach. Although we are dealing with the inconsistencies in England, if we are a United Kingdom, these matters need to be addressed across all four nations and I am not precious about stealing best practice from other parts of the UK.

In our call for evidence for the women’s health strategy, women told us time and again that fertility was a key issue and that they felt very frustrated about the provision of, and access to, fertility treatment. Colleagues have made a number of important points which I will respond to in turn, but it has been recognised that there has been unequal access to IVF in England since the treatment was introduced; that is why this is such an important issue. There is resistance in some parts of the country to the changes the Government want to make, but I think we will be able to make progress on them.

NICE is reviewing its fertility guidelines, taking account of the latest evidence of clinical effectiveness. These will be published next year and we will be working with NHS England to implement these guidelines in England quickly and fairly. I am told that they will end regional variation and create a compassionate and consistent fertility service across England, but that does not mean that we cannot improve services in the meantime.

As has been set out, integrated care boards are now responsible for delivering IVF services. They were previously determined by CCGs, but from July last year the 42 ICBs across England are now responsible. Since the ICBs were created, we have seen a levelling up of IVF provision in many. Where CCGs have come together, ICBs have often adopted the higher rate of provision, rather than the lowest level. That is to be welcomed, but by no means does it mean that the level of provision is where we want it to be. Some, but by no means all, ICBs, including in north-east London and Sussex—I declare an interest as a Sussex MP—are now fully compliant with the current NICE guidelines and the provision of three cycles. Others are improving their integrated offer, but some ICBs have kept their pre-existing local offer. That is not good enough, and we are aiming to tackle it.

[Abena Oppong-Asare]

What conversations has the Minister been having to make sure that ICBs are currently being updated to be as robust as possible?

[Maria Caulfield]

I will go through that. One of the first things we have done is to be transparent about what is being offered. We have asked every ICB—the whole 42—to detail their provision. We are now publishing that on gov.uk, so if ivf.gov.uk is entered, the table will come up. That illustrates the number of cycles offered by every ICB, the age provision, the previous children rule and what funding is offered for cryo-preservation. That is not just to say, “This is what’s on offer” so that women and couples can see what is available in their area; it is also the start of the process of holding ICBs’ feet to the fire—and for local MPs to be able to say, “Look, they’re offering free cycles in Sussex; why are we not offering that in our local area?”

[Abena Oppong-Asare]

The Minister may be about to get to this point, so I apologise if I have intervened too quickly. In terms of transparency, it is great that the Minister is publishing the data, but what are the Government doing to make sure that more work is being done by ICBs to provide a better—or adequate—service, given that publishing data does not require them to take any action?

[Maria Caulfield]

As the hon. Lady will know, it was only last year that we published the women’s health strategy. IVF was front and centre of that—the first year priority. Getting that information is the first step, and then we are able to look at the ICBs that are not offering the required level of service, have those conversations about why and have a step change to improve the offer. That is just one tool in our box to fulfil our ambition to end the postcode lottery for fertility treatment across England.

Colleagues have also raised the issue of lack of information about IVF, both for the public and healthcare professionals. We are working closely with NHS England to update the NHS website to make IVF more prominent, and also with the royal colleges to improve the awareness of IVF across healthcare professions. One area we are dealing with is that of add-ons, which the hon. Member for Pontypridd (Alex Davies-Jones) and my hon. Friend the Member for Cities of London and Westminster (Nickie Aiken) addressed. As part of our discussions with the HFEA, it now has the add-on rating system, so that people can see what percentage difference an add-on would make and make an informed choice about whether they want to do that as part of their IVF treatment.

I have also just received the HFEA’s report about modernising the legislation, with particular regard to its regulatory powers. That will cover the provision of add-ons, and I hope to be able to respond to the report as quickly as possible. We are making really big changes to some of the issues that have been holding back IVF for a long time. I know that for many people this is not quick enough, but I reassure hon. Members that progress is being made.

For female same-sex couples and same-sex couples across the board, I know that this is a really important matter. I took the position that it was unacceptable for female same-sex couples to shoulder an additional financial burden to access NHS-funded fertility treatment. On the transparency toolkit now on the gov.uk website, we can easily see which parts of the country are asking for six cycles of self-funded insemination, for instance. In Cambridgeshire and Peterborough it is 12 cycles, in Bristol and north Somerset it is 10. As the hon. Member for Erith and Thamesmead (Abena Oppong-Asare) said, that is exactly the information we need so that we can tackle the issue head-on and directly with the ICBs. Indeed, one of our key commitments in the women’s health strategy was to remove this injustice once and for all. We were hoping to do that completely in the first year; it will in fact take us a little longer, but it will not take us 10 years.

[Hannah Bardell]

It is certainly comforting to hear that, but I urge the Minister to supercharge that work, so that female same-sex couples and, indeed, the trans community can make sure they can access that. Will the Minister say something about surrogacy, because I know that across the UK—though, again, we have somewhat better standards and access in Scotland—there are still major challenges, legal and otherwise, for male same-sex couples accessing surrogacy?

[Maria Caulfield]

The Law Commission has recently produced a report on changes to surrogacy, which we are in the process of responding to. It will address some of the issues raised today. The Government’s position is to abolish the requirement for female same-sex couples to undergo six cycles of self-funded treatment before they can access NHS-funded treatment. We have been clear that the NHS-funded pathway should now offer six cycles of artificial insemination followed by IVF to female same-sex couples, giving everyone access to NHS-funded fertility services. Some ICBs are doing that already, but others have delayed implementation, and that is what we want to focus on now. We are clear that that needs to be urgently addressed, because same-sex couples’ expectations have rightly been raised and the service has not met them swiftly enough. I take that on board from the debate today and reassure colleagues that that is a priority.

To accelerate action, NHS England is developing advice to assist ICBs. I hope they will be able to share that soon. I will share that with the House as soon as it is available. When it is published, we expect ICBs to update their local policies. There should be no further delay and no waiting for NICE guidelines when they are published next year. ICBs must urgently address all local inequalities in access to fertility treatment. There is a reason that IVF was made a priority in the women’s health strategy and a reason it was a priority in the first year.

Our health service pioneered the use of IVF in the 1970s. It is a great British invention that should be available to every couple who want to start a family, because the Government back women and families and the accessibility of IVF to those who need it. I look forward to the hon. Member for Jarrow continuing to hold my feet to the fire until we have delivered the change—deliver it we must.

Worker Protection (Amendment of Equality Act 2010) Bill

Maria Caulfield Excerpts

Consideration of Lords amendments
Friday 20th October 2023 Commons Chamber

[Justin Madders]

Yes, that is absolutely right. The Equality Act is framed in such a way that it protects everyone from harassment on the basis of their sex. I think that we now have a Bill that, after the amendments, to our regret will not protect workers from third-party harassment. The duty to take all reasonable steps has now been reduced or watered down to taking reasonable steps. We are disappointed that the Bill returns in a form that looks very different from what was originally passed by this House. It seems that the original good intentions of the Bill have—to use the terms of the hon. Member for Devizes—been “gutted”, and I am sorry to say that seems to have been with the support of the Government. Let us not forget that, when the Bill passed through the Commons originally, it did have support from the Government and it also had cross-party support, which is a rarity these days. Therefore, it is extremely disappointing that the democratically elected House seems to have given in to the unelected Lords, seemingly with the endorsement of the Government.

I have to say that the Government’s decision to support the Lords amendments that have taken the guts out of the Bill is frustrating, given that the Bill was enacting pledges that the Government had made.

[The Minister for Women (Maria Caulfield)]

Does the hon. Gentleman not recognise that this is the Bill of the hon. Member for Bath (Wera Hobhouse) and it is up to her to decide which amendments she does or does not accept? The Government have fully supported the hon. Lady. This is not a Government decision; it is part of the parliamentary process.

[Justin Madders]

I thank the Minister for her comments. The Government have a majority, so if they wanted to keep the Bill in its original form they could have ensured that it passed. Let me quote what she said at Committee stage. She said that

“the Government committed to a package of new measures aimed at reducing incidences of workplace harassment. That includes the two legislative measures being brought forward in the Bill: explicit protections for employees from workplace harassment by third parties, such as customers and clients; and a duty on employers to take all reasonable steps to prevent their employees from experiencing sexual harassment.”––[Official Report, Worker Protection (Amendment of Equality Act 2010) Public Bill Committee, 23 November 2022; c. 10.]

--- Later in debate ---

[Justin Madders]

No, that is not what I want, which is why I have said that we will not oppose the amendment, but we are still entitled to express our disappointment about the capitulation. The Equality and Human Rights Commission’s 2018 report found

“a quarter of those reporting harassment saying the perpetrators were third parties”

and that third-party sexual harassment was dealt with poorly and considered

“a ‘normal’ part of the job”

by some employers. I do not think that is a situation that we should defend. Let us be clear: we would not have objected to the Bill if that had been in place—we certainly would have supported it—but we will support it as it stands because, as the hon. Member for Bath said, it is an important step in the right direction, albeit a much smaller step than originally intended.

The question remains: what is the Government’s plan to deal with third-party harassment? If they will not bring forward a legislative solution, what do they intend to do? If there were a repeat of the scenes at the Presidents Club tomorrow, what would be the consequences for the perpetrators? We need answers to those questions.

Despite the removal of the word “all” from the Bill, the duty to prevent sexual harassment is, as the hon. Member for Bath said, a new duty that represents a positive step forward. Establishing that preventive duty will shift the emphasis away from a reliance on individuals reporting harassment to employers and will encourage employers to take preventive steps. We are optimistic—we can be—and hope that the Bill will drive structural change by fundamentally shifting the responsibility from the individual to the institution, but what that will mean in reality and how much capacity the EHRC will have to investigate complaints remains to be seen. Its responsibility to create a statutory code of practice should mean that the focus will be more on working with employers. Does the Minister have any information on when she expects that statutory code of practice to be published, should the Bill be passed, and will it draw mainly from the non-statutory code of practice that has already been produced?

We believe that everyone should be able to go to work safe from sexual harassment, knowing that their employer has taken steps to create a safe working environment. That is why a Labour Government would go much further than the House has today.

[Maria Caulfield]

I congratulate the hon. Member for Bath (Wera Hobhouse) on progressing this Bill, which tackles the important issue of sexual harassment in the workplace. I thank her for the pragmatism she has shown to ensure that the Bill can progress with agreement from across the House. It is slightly disappointing to see the shadow Minister, the hon. Member for Ellesmere Port and Neston (Justin Madders), take such a partisan approach, because the Bill has had cross-party support throughout all its stages.

It is often very difficult for private Members’ Bills to pass through this place, but the Government have fully supported the Bill, because it is such an important issue to tackle. We have especially made time for an additional sitting Friday, to ensure that the Bill passes. We remain committed to tackling sexual harassment in the workplace by introducing the employer duty, to strengthen protections in the Equality Act 2010.

While I note the concerns from my hon. Friends the Members for Southend West (Anna Firth) and for Devizes (Danny Kruger), I am very pleased that consensus has been reached here and in the other place, and I hope Members will agree that this important Bill should now be on the statute book. I would like to particularly thank my hon. Friend the Member for Devizes, who has some genuine concerns about the Bill that he has expressed today and at previous stages.

This is a difficult subject. While there may be differences in views and opinions, I am really pleased that the hon. Member for Bath has been able to progress the Bill through both Houses, because we need to make our workplaces better and safer. That is particularly true for women. We have heard recently about some of the experiences of female surgeons in the healthcare system. With my other hat on as a Health Minister, I am particularly pleased that this legislation will hopefully prevent some of those experiences in future.

I turn to the Lords amendments. Lords amendment 1 leaves out clause 1, to remove the proposed liability of employers for third-party harassment in the workplace. I am glad to hear that the amendment to remove this third-party harassment liability eases concerns that it could have had a chilling effect on free speech in the workplace. I am pleased that that has been addressed. There are some—I know the hon. Member for Bath is one of them—who are disappointed that the amendment has removed the third-party harassment liability, for very valid reasons, but this is about getting a compromise, so that we get the majority of the measures in the Bill through this place.

The Government believe it is important that workers are protected against this form of harassment, and good employers are already taking steps to ensure that their employees are protected from harassment by third parties, regardless of the legal position. However, to progress the Bill, we have had to be pragmatic, acknowledge the complexities at play and find a suitable balance. While we want to strengthen protections, we also do not wish to infringe on individuals’ rights to freedom of speech. Everyone has the right to their views and to debate them just as we are doing today, respecting others’ views in the process. The aim of the Bill is to tackle workplace harassment and not limit people’s freedoms. It is important to remember that, despite the removal of the third-party harassment provision, the Bill will still introduce a new duty on employers to take reasonable steps to prevent sexual harassment.

The Government’s priority is to ensure that the legislation works effectively. We have consistently consulted with a wide range of stakeholders and have listened to all their views. As my hon. Friend the Member for Southend West has consulted with her chamber of commerce, the Government have done so more widely. When concerns regarding the potential chilling effect on free speech were first raised as the Bill progressed through the Commons, the Government took on board those issues. It was feared that employers may take unreasonable or drastic measures to avoid liability for harassment of their staff, particularly by third parties, to the extent that they would feel obliged to shut down conversations in the workplace. While employers will be expected to take action against workplace harassment, we recognise that those actions should fall short of prohibiting conversations. Free speech is crucial to our way of life, and it is important that we found a way forward.

With over 40 amendments tabled to the Bill in the other place following its Second Reading on 24 March, even after the Government tabled their amendment, it was clear that there remained concerns that the Bill would still have a chilling effect on free speech. The Government took those amendments very seriously, as they were fatal to the Bill. In our engagement with stakeholders and peers, we heard the strong concern, particularly about the third-party harassment issues, so we were eager to find a balance and a way forward for the Bill to reach the statute book with cross-party support. Therefore, the Government have been pragmatic and alive to the issues raised, and consensus was reached with peers by removing all but two of their amendments. The shadow Minister, the hon. Member for Ellesmere Port and Neston, did not comment on the other amendments—over 38 of them—that we managed to get removed.

Covid-19 Vaccine Damage Payments Bill

Maria Caulfield Excerpts

2nd reading
Friday 20th October 2023 Commons Chamber

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

I congratulate my hon. Friend the Member for Christchurch (Sir Christopher Chope) on securing the Second Reading of this Bill. This is an important issue, and I thank him for the tone in which he has conducted the debate and for his sentiments at the start, when he said that this is not about being anti-vaccination. As my right hon. Friend the Member for Tatton (Esther McVey) indicated, vaccination is a crucial part of our armour in dealing with disease across the world. The Bill is specifically about the covid vaccination and I advocate, as did the shadow Minister, that after clean water, vaccinations are the most effective public health intervention in the world in terms of saving lives and promoting good health.

The flu vaccination, which is being rolled out as we speak, will enable many people to be healthy over this winter and avoid hospital admission. The HPV vaccination for preventing cervical cancer, which is rolled out to young girls and boys in our schools, has the potential to eradicate cervical cancer in future, and we must remember that vaccination has a powerful role to play in the health of our nation. Globally, we have one of the best immunisation programmes around the world, and it is important to pay tribute to all those staff who take part in vaccinations programmes and make them such a success.

Let me turn to the covid vaccination. The UK was at the forefront of tackling covid-19 through the vaccination programme, and it was the first healthcare system in the world to deliver the covid vaccination outside clinical trials. We should be proud of that. As the shadow Minister said, it was one reason why we were one of the first countries to lift restrictions, because of our success in covid vaccination. On the point made by my hon. Friend the Member for Shipley (Philip Davies), I am happy to go on record and say that although covid vaccines have saved tens of thousands of lives, unfortunately there have been extremely rare circumstance where individuals have, very sadly, experienced harm and difficult circumstances, following a covid vaccination. Thankfully, such cases remain rare, but that does not reduce the impact on those individuals who experienced that and their families. I am sure the whole House will join me in expressing concern for those individuals who suffered such harm, and their families.

Vaccination remains the best way for individuals to protect themselves and others from the impact of covid-19. We have done the right thing by encouraging people to have the vaccine, to protect both themselves and other more vulnerable members of society.

[Philip Davies]

I am grateful for what the Minister has said, but I think that the people who, as she acknowledges, have suffered harm and damage from the vaccine—they were coerced into taking it in one form or another—would probably prefer more than just sympathy and concern from people in the House. What they really want is proper compensation. Will she therefore take on board what my hon. Friend the Member for Christchurch (Sir Christopher Chope) said and ensure that people are adequately and properly compensated for the damage done to them? Will she at the very least ensure that the maximum amount that can be paid out rises in line with inflation?

[Maria Caulfield]

I will come to those points shortly. All medicines have risks and side effects—even simple paracetamol, which is taken safely by the vast majority of people, can have serious side effects for some—and it is no different for the covid vaccine. That is true of all vaccinations, and that is why we set up the scheme specifically for vaccinations in the first place.

The Government cannot support the Bill’s proposals to make provision about financial assistance specifically for those who have had a covid vaccination. The scheme as a whole is to support anyone who has had side effects to a certain level of impairment from any vaccination, and it would be wrong to single out covid-19 for a separate scheme. The Government already provide long-standing mechanisms to offer financial assistance to individuals suffering disablement following vaccination in the form of the VDPS.

Just to clarify, the VDPS is not a compensation scheme. It was established in 1979 to provide a one-off tax-free payment to individuals who had been found on the balance of probability to have been harmed by a vaccine listed in the Vaccine Damage Payments Act 1979. In December 2020, covid-19 was added to the scheme to ensure that those who had severe disability found to be linked to the covid-19 vaccine would receive support through this tried and tested system.

The Government’s current focus is on scaling up the scheme’s operation by the NHS Business Services Authority, which took over its running in November 2021 from the Department for Work and Pensions, because we felt it was better placed to access patient notes and to improve timeliness. We have seen a significant improvement in trying to process claims, which I will come to.

The Bill also asks the Government to report on the merits of a no-fault compensation scheme for covid-19 vaccine damage. Establishing a dedicated stand-alone scheme would risk favouring those who, in extremely rare circumstances, have sadly experienced harm following a covid-19 vaccine above those harmed by other vaccines, which, again, does happen in rare circumstances. That would create inequality between vaccines, which could be damaging to other vaccination programmes.

Another element of the Bill is to question whether there should be an upper limit on the financial assistance available. It is important to reiterate that the VDPS offers a one-off lump sum payment. It is not intended to cover lifetime costs for those impacted. The amount has been revised periodically by statutory sums orders. The initial payment when the scheme was set up in 1978 was £10,000. It has been reviewed several times, with the current amount set at £120,000 as of July 2007. The award should be considered in addition to the Government’s support package for those with a disability or long-term health condition, which includes statutory sick pay, universal credit, employment and support allowance, attendance allowance and personal independence payments.

[Philip Davies]

The Minister says that the figure has been reviewed periodically and that we are now at £120,000. She just said that it was last reviewed in 2007, which was 16.5 years ago. Does she not think it is time for another periodic review?

[Maria Caulfield]

My hon. Friend makes a point. A review of the limit is not just down to the Department of Health and Social Care. I went to a meeting of the all-party parliamentary group chaired by my hon. Friend the Member for Christchurch, where that question was asked. Of course, we will look into that, but I cannot give a commitment at the Dispatch Box today. We will keep it under review as part of ongoing business and cross-Government discussions.

Finally, I turn our opposition to adjusting the criteria for disability. I recognise that some hon. Members who have spoken would prefer the level of disability for the scheme to be assessed on a sliding scale. However, assessing it on that basis would run counter to the intention behind it, namely to provide a one-off lump-sum payment.

The current scheme eligibility of 60% disablement is in line with the definition of severe disablement set out by the Department for Work and Pensions in “Industrial Injuries Disability Benefit”, which is a widely accepted test of disability and puts it in line with many other assessments across the board. Very few claims are rejected for not reaching the 60% disability threshold, and in the event that an application is turned down on that basis, there is also the option for claimants to appeal against the decision and provide additional evidence. We will continue to review the latest data on covid-19 to ensure that when decisions are reviewed, the reviewed decisions are based on up-to-date evidence. When I spoke to the APPG, concern was expressed about the time taken to appeal against decisions. I have given a commitment that if an appellant has been waiting for a significant time, I shall be happy to follow it up if the APPG contacts me about any individual case.

The Bill asks for an adjustment of the provisions on awarding payments to include all cases in which there is no other reasonable cause for death or disablement. Such an amendment to the scheme would not be beneficial at this time, because the payments are awarded on the basis of causation on the balance of probabilities. As the criterion for the scheme is already established and is being applied by medical assessors to conclude the remaining covid-related claims, any such amendment would risk further delaying outcomes for all claimants, including those most in need.

A number of questions have been asked this morning, and I have tried to answer as many as possible. My right hon. Friend the Member for Tatton (Esther McVey) asked about the MHRA. I hope I can reassure her by saying that following the Julia Cumberlege report “First Do No Harm”, there have been significant changes at the MHRA. I am pleased that it reviewed the AstraZeneca vaccine and made two changes based on evidence, but I can give reassurances about other medicines as well. The MHRA has had a significant influence on the recent statutory instrument concerning the use of sodium valproate, which is used mainly for epilepsy but can cause harm during pregnancy. There have been a number of such pregnancies. The MHRA met campaign groups such as In-FACT—the Independent Fetal Anticonvulsant Trust—and as a result of its influence, the SI provides that sodium valproate can be dispensed only in the manufacturer’s original packaging, so that women are aware of the risks. That is an example of the way in which the MHRA is changing. As Dr June Raine said, it is not just a regulator now; it is part and parcel of the patient safety framework around medicines. I hope that that provides some reassurance.

[Esther McVey]

Is my hon. Friend as concerned as I am that the head of the MHRA has said that the covid pandemic catalysed the transformation of that regulator from watchdog—which it should be—to enabler? It has shifted its purpose significantly.

[Maria Caulfield]

I cannot speak for Dr June Raine, but I can say that I take “enabler” to mean “enabler of patient safety”. The fact that, in a number of cases, the MHRA has stepped in means that it is advocating for patient safety and is not simply a body that processes applications for clinical trials or runs a yellow card system. It is willing to meet a range of groups, and indeed I suggested that the APPG invite it to one of its meetings.

Let me briefly touch on the issue of claims. As I said earlier, we have moved the scheme from the DWP to NHSBSA. The point of that was to speed up the claims, because the limiting factor in terms of turnaround time is obtaining clinical notes, and NHSBSA is much more able to gain access to them than the DWP. We have introduced the subject access request so that there is just one consent form to get notes from a variety of sources, from primary care through to secondary care.

To update Members on the latest figures, as of 6 October, 7,574 covid claims have been made to the vaccine damage payment scheme. Of those, 3,593 have been processed, with 149 having received a payment. On average, it is taking six months to investigate and process claims. Some will be outside that because of difficulties getting their clinical records, but the average is six months.

[Sir Christopher Chope]

Is my hon. Friend looking forward to the Government giving evidence to module 4 of the UK covid-19 inquiry? In particular, is she pleased that the inquiry will be looking into whether the VDPS is fit for purpose?

[Maria Caulfield]

The Government are always happy to give evidence to the inquiry. My hon. Friend makes a good point. I have had correspondence from constituents and from people around the country asking for the covid inquiry to cover vaccines, too. We have talked today about transparency and about being able to have an open and honest dialogue on vaccines. My right hon. Friend the Member for Tatton is right that to give confidence to vaccine programmes, people need to be able to raise concerns, to raise it when they have had an adverse event and to feel confident that those things will be investigated and not brushed under the carpet.

[Philip Davies]

I felt that the Minister was coming to a close. Before she does, I want to raise the point I made in my speech about the clinical trial involving children and a Bradford patient recruitment centre. I do not expect her to give a definitive answer now, given that I have just raised it, but will she give me a pledge that she will look into this matter, take on board the comments I have made and write back with her thoughts about what is happening with that trial?

[Maria Caulfield]

Absolutely. I will finish my points to my hon. Friend the Member for Christchurch and then come back to my hon. Friend the Member for Shipley. It is for the inquiry to decide what it investigates, but it would be helpful for vaccines to be discussed at the inquiry, so that people can put their concerns forward and so that we have a thorough look at the vaccine programme. That will enable us to learn lessons for the future, should we ever need to roll out a vaccine programme on that scale ever again.

To touch on the point made by my hon. Friend the Member for Shipley, I worked in clinical trials before I came into this place, and there are strict rules about posters advertising clinical trials, particularly for children. I do not know the details of the particular trial he is talking about, but if he has concerns about how it is being recruited to, that is a matter for the MHRA. I suggest that he contacts the MHRA, or I would be happy to discuss it with him after the debate.

[Esther McVey]

That point goes back to what I said about the MHRA moving from watchdog to enabler. I would like the role of that watchdog to be looked at.

[Maria Caulfield]

I hear that loud and clear from my right hon. Friend. I would just say that when advertising and recruiting for a clinical trial, any posters—I have not done this for a couple of years now—would usually have to be submitted to the MHRA for approval, and it is important to know whether that has happened in this case. We can certainly look at that after the debate.

To close, my hon. Friend the Member for Christchurch has made some good, valid points about the safety of vaccines and about encouraging people to come forward. We want people to come forward if they feel they have had side effects from the vaccine. It helps build up the profile and enables better decision-making for the future. He also made points about the vaccine damage payment scheme. We recognised that the process was taking too long, and that is why we moved it from the DWP to the NHS. We recognised that there were multiple requests for access to patient notes, which is why we brought in the subject access request forms. We want to ensure that those who have, on rare occasions, experienced side effects can access the scheme. Unfortunately, we cannot support the Bill at this time, because our focus must remain on improving the operation of the scheme and continuing to process claims as quickly as possible, but I very much welcome the debate today.

[Madam Deputy Speaker (Dame Eleanor Laing)]

With the leave of the House, I call Sir Christopher Chope.

[Sir Christopher Chope]

We have had a preview of the Government’s response to the UK covid-19 inquiry module 4, which will take place next July. All I can say is that I hope the Government improve their performance before then, because I do not think the arguments put forward today will be very well received. Basically, the Government are saying, “It’s all hunky-dory. There have been a few delays, but we are sorting that out. We are not going to change anything, whether in relation to the £120,000 limit, the eligibility criteria, the 60% disablement threshold or all the rest of it. And don’t worry, the vaccine damage payment scheme deals with other vaccines as well.” That was how the Minister started her response. She said there were other claims being made under the vaccine damage payment scheme, but I do not think she has really comprehended—or certainly did not give an indication that she comprehended—the gravity of the difference. She talked about the importance of flu vaccines. There have been, between 1 October 2021 and 1 September 2023, 35 claims under the vaccine damage payment scheme in respect of flu, nine claims in respect of HPV, and 6,809 claims in respect of covid-19. Surely the Minister can see there is a disparity between those figures.

[Maria Caulfield]

I did not address the point my hon. Friend made on that. The difference is that around 93% of the population received at least one dose of the covid-19 vaccine—tens of millions of people. HPV and flu vaccines are targeted at a much smaller group; they are not open to the whole population. That is why, naturally, we will see fewer claims coming forward.

[Sir Christopher Chope]

If that is the explanation, I am sure that also covers the fact that only 15 cases have been referred to the vaccine damage payment scheme in relation to MMR vaccines, compared with 6,809 in relation to covid-19. If the Minister thinks they are all equivalent then so be it, but all I can say is that the evidence suggests otherwise and there are serious questions now about whether the VDPS is fit for purpose. That is why it is great news the inquiry will be looking into that issue.