New Covid Variants: Government Preparedness

Maria Caulfield Excerpts

Wednesday 28th June 2023 Commons Chamber

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

I thank the hon. Member for Kirkcaldy and Cowdenbeath (Neale Hanvey) for securing this debate and raising this important issue. It is correct that the Government are held to account on future pandemic preparedness and lessons learned from covid.

I remind the hon. Gentleman that pandemic preparedness is a devolved matter and Scotland, like all parts of the United Kingdom, faced huge pressures. I understand that the former Scottish Health Minister has been giving evidence today and has also pointed that out, saying that

“Scotland, like other countries throughout the world, was dealing with a virus which was unknown and new.”

She also said she did not believe that

“there is a plan that would have been possible that would have been able, in and of itself, to cope with covid-19.”

That sets out how all four nations of the United Kingdom were learning about covid. With hindsight, it is very easy to look back and make recommendations, and we must learn from those. I look with interest to the results of the covid inquiry to make sure that we are as prepared as possible for any future pandemics, whether of covid or any other disease.

For most people, covid-19 is now a much less serious risk than it was three years ago, and that is in no small part because of the UK’s world-leading vaccination programme. We were the first country in the world to administer an approved vaccine and the first European nation to protect half our population with at least one dose. That success continues, with vaccines and boosters still on offer to eligible groups, and we take recommendations on when to roll out booster programmes and who to vaccinate from the Joint Committee on Vaccination and Immunisation.

Antivirals provide a further layer of protection for those who are immunocompromised, enabling us to effectively treat eligible people with covid-19. All those successes have come to protect us against the virus and allowed us to live with covid-19 and regain many of the freedoms that we lost during the pandemic.

We have scaled back our covid-19 response because of that reduced risk, but that does not mean that the response is not there. It is scaled back, but it is ready to be stepped up should we need it, focusing on testing, diagnosing, treating and protecting those at greater risk of severe illness. We are keeping vigilant at all times. I work closely with the UK Health Security Agency, which is the organisation that leads on pandemic preparedness. We take its advice extremely seriously.

--- Later in debate ---

Motion made, and Question proposed, That this House do now adjourn.—(Fay Jones.)

[Maria Caulfield]

We know that the virus has the potential to evolve with new covid-19 variants that may evade immunity and the vaccinations that we have in place. We also know that we could face new pathogens with pandemic potential, so we remain vigilant at all times not just in the United Kingdom but with our global partners.

It is imperative that we retain the ability to detect and identify any new covid-19 variants as well as wider threats. The House will be aware that the community infection survey ended in March. It was commissioned by UKHSA as part of a suite of covid-19 surveillance programmes and delivered by the Office for National Statistics. The survey was world-leading, playing a critical role in enabling decision making during the pandemic. However, it is right to ensure that that surveillance programme remains proportionate, cost-effective and commensurate with how we monitor a range of other infectious diseases that pose a similar risk to public health. That is why we have scaled it back, but again, should we need to, we can step it up.

That does not mean that we are not taking any action going forward. We are maintaining surveillance for covid-19 and respiratory pathogens through a number of programmes. Those programmes will enable the evaluation and effectiveness of vaccination against a range of clinical outcomes, informing vaccine deployment and appropriate disease management. Our surveillance programmes are underpinned by the continuation of genomic sequencing to determine and assess variant severity and vaccine effectiveness.

A range of vaccines are still available, which clearly we monitor on an ongoing basis. mRNA vaccines are one part of our toolkit, but others are still available. That is why continued surveillance is important, but it is proportionate that it has been reduced since the peak of the pandemic. UKHSA continues to sequence covid samples each week, so should a variant of concern emerge, we would identify it relatively quickly. It publishes the results of that sequencing and surveillance in the national influenza and covid surveillance report.

Obviously, covid-19 is a global risk, so as well as looking at what is happening in the UK, we continue to support international surveillance, and we work closely in partnership with other organisations and international partners to monitor covid-19 globally. The Government continue to fund new variant assessment platforms, increasing the capacity to provide genomic sequencing in nine countries and establishing the International Pathogen Surveillance Network. That will enable us to be alive to the risks of covid-19 elsewhere in the world. I am sure that hon. Members will recognise the importance of that work and agree that it is vital to continue it to understand and respond to dangerous new variants should they emerge.

If a variant of concern with potential immune evasion is detected, the Government have proportionate contingency response capabilities in place, a range of which are set out. Those capabilities will support an initial response to any new and dangerous variant of concern. The Department for Health and Social Care and UKHSA continue to work together to ensure that appropriate commercial mechanisms are in place to support a longer response to covid-19, whether through testing or vaccination.

I do not agree with the hon. Gentleman that vaccination is the only tool in our armoury. Our surveillance is our key weapon in identifying a new variant of concern. We still have testing capability should we need it, and of course, our vaccination programmes are nimble and can respond to any new variant should it emerge.

[Neale Hanvey]

The Minister is giving an interesting response to the question about surveillance. What is the surveillance mechanism exactly? Can she take us through how the virus is being monitored in the wild? What practical steps are being taken? Is waste water being assessed? How is it being identified? What border controls are expected if there is a novel threat somewhere else in the world? How are we managing our borders and ensuring that the 1.5 million passengers in the air at any one time do not immediately bring a new threat right to our door?

[Maria Caulfield]

There are several ways, and I did try to set some of them out. As I said, UKHSA tests samples from covid-positive patients around the country every week and does genomic sequencing to identify new variants or variants of concern.

We are not currently doing international border checks, but we are working with international partners, so should a new variant emerge in another country, we can step up that capability. We introduced border controls on new arrivals a couple of months ago due to the risk of a new variant from China, but that was stepped down because testing showed that there was no risk to the general population. Waste water testing is also still available should it be required, so there is a range of testing capabilities to identify variants of concern and respond quite quickly.

Moving on to vaccines, we are developing mRNA capability, but not just in covid-19 vaccinations. That is one way of delivering covid vaccinations, but that capability is also being used for respiratory illnesses and cancer vaccination trials. There is the potential for that technology to be used in a range of vaccines, not just for covid-19. A range of different vaccines are available, and should a variant of concern or change of variant emerge, we will take advice from the JCVI as to which vaccine is best to use and which group of the population is best to vaccinate. That is an ongoing piece of work.

On some of the hon. Gentleman’s other points, the covid inquiry is obviously ongoing. As the Minister responsible for pandemic preparedness, I am keen to learn the lessons about testing capability, PPE, and vulnerable groups that may need greater protection in future pandemics. But we also need to be live to the fact that a pathogen could emerge that is completely different from covid, flu, or avian flu, which we are also monitoring actively. We need to be nimble in our response to any future pandemic. My concern is that we may just look at covid as the only future threat, but that is absolutely not our policy; we are looking at a wide range of threats, both in the UK and abroad.

[Sir Christopher Chope]

The Minister referred to mRNA technology. Are the Government absolutely convinced that the technology is safe and effective? Are they in danger of putting all their eggs into that particular basket?

[Maria Caulfield]

We are certainly not putting all our eggs in the mRNA basket for covid, or for any other use of mRNA technology. Such vaccines must still pass the MHRA assessment in order to be licensed for use. As mRNA technology develops for other clinical conditions, whether cancer or respiratory illnesses, those vaccines will also have to be awarded a licence by the MHRA. It is not the case that mRNA vaccines are given carte blanche because they have been used in covid; they will have to pass the necessary research hurdles to gain licences for future use. We are certainly not just relying on mRNA for covid—although it has been effective and the technology means that it can react to variants and be altered depending on the variant. We are using other vaccines for covid, and working with other partners. I reassure my hon. Friend on that.

I am very happy to continue updating Members on the progress that we are making and any future booster vaccination programmes for covid-19 that will be running, and to update the House on the work of UKHSA regarding monitoring, surveillance, and future testing capabilities.

[Neale Hanvey]

I thank the Minister for being a good sport and allowing me to intervene again. I did make a couple of requests in my contribution: I asked for some written feedback from the Minister, and whether she would be able to find time in her diary for a meeting to discuss some of the finer points. I would be very grateful if she would agree to that.

[Maria Caulfield]

I am very happy to meet up with the hon. Gentleman, and also to write to him regarding the specific points on which he asked for clarification. It is important that we give the public confidence that our vaccine portfolio is very diverse, guarding against both current variants and future variants. The contracts that we have in place with vaccine developers are flexible, so should the need arise, we have the ability to stand up vaccinations in a speedy manner. I am happy to write to the hon. Gentleman and to meet with him, because in order to bust some of those myths that he has pointed out exist, it is important that we are open and transparent about the arrangements that are in place, the risks that we face, and the tools that we have in our arsenal to fight any future pandemic.

With that, Madam Deputy Speaker, I will draw my remarks to a close.

Question put and agreed to.

Learning Disability and Autism

Maria Caulfield Excerpts

Tuesday 27th June 2023 Written Statements

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

Today I am delighted to announce the launch of the consultation on the draft Oliver McGowan code of practice (the code) on statutory learning disability and autism training. The launch of this consultation represents a significant moment in the journey towards improved care and treatment of people with a learning disability and autistic people. I welcome anyone with an interest to complete the consultation and share their views on the draft code. An easy read version of the draft code and consultation will be made available as soon as they are ready.

The purpose of the code is to ensure that service providers registered with the Care Quality Commission (CQC) have the necessary guidance to meet the new legal requirement introduced in the Health and Care Act 2022. The effect of the new requirement is that, from 1 July 2022, CQC-registered providers are required to ensure their staff receive training on learning disability and autism, appropriate to their role. To aid those who need to comply with the new training requirement the Secretary of State is obliged by the 2022 Act to issue a code of practice setting out what we consider is required in order for them to comply. Therefore, this draft code sets out the standards this training must meet to comply with the legislation and guidance on what I believe providers need to do to meet those standards.

As set out in the draft code, the Oliver McGowan Mandatory Training on Learning Disability and Autism is the Government’s preferred and recommended package to support CQC-registered providers to meet the new requirement introduced by the Health and Care Act 2022. The training is named after Oliver McGowan, a young autistic teenager with a mild learning disability, who sadly died after having a severe reaction to medication given to him against his and his family’s strong wishes. Oliver’s parents, Paula and Tom McGowan, have campaigned for better training for health and care staff to improve understanding of the needs of people with a learning disability or autistic people. The training was trialled in England during 2021 with over 8,000 people and is helping to ensure that staff are equipped with the right skills to care for people with a learning disability and autistic people.

In my role as Under-Secretary of State at the Department of Health and Social Care, I have heard experiences of the poor care and treatment received by people with a learning disability and autistic people, which has highlighted the importance of introducing this legal requirement and the development and publication of the code.

I look forward to receiving responses to this consultation to help us to develop a code that supports health and care staff to provide high-quality care for people with a learning disability and autistic people which complies with the legislative requirements. Too often people with a learning disability and autistic people experience poorer health outcomes and higher mortality than the general population. We are confident that these disparities can be reduced when health and care staff are equipped with the right skills and knowledge. The draft code therefore represents a crucial step in the right direction.

[HCWS885]

Legislative Definition of Sex

Maria Caulfield Excerpts

Monday 12th June 2023 Westminster Hall

[The Minister for Women (Maria Caulfield)]

It is a pleasure to serve under your chairmanship, Sir George.

I am especially grateful to the hon. Member for Gower (Tonia Antoniazzi) for introducing this debate in such a sensitive way, and I am also grateful to all right hon. and hon. Members for their contributions. I feel that we should be able to debate these issues openly and honestly, without being labelled or attacked for having particular opinions or views, and that we should be able to disagree respectfully. I also feel that on all sides of the debate, despite the reservations of some, we have been able to do that this afternoon in a civilised way and I pay tribute to everyone involved.

[Peter Gibson]

Members will have noticed that my hon. Friend the Member for Bridgend (Dr Wallis) has not returned to the Chamber. As he is this House’s only openly trans Member, I think it is really important that we send a message to him that this important debate is not about him and that it should be conducted with love, respect and care for every single person who is in the trans community, whether they be in this House, in the Public Gallery or watching from outside.

[Maria Caulfield]

I thank my hon. Friend for making that point. I spoke to my hon. Friend the Member for Bridgend (Dr Wallis) before this debate, because he had some genuine concerns that he wanted to raise, and I am very happy to follow up after the debate to make sure that we can talk through any concerns that he did not get a chance to raise.

The Equality Act 2010 is at the heart of today’s debate. As with any other piece of legislation, over time we need to reflect on its effectiveness and purpose. It is only right—indeed, it is our duty as parliamentarians—to ensure that we constantly review legislation, to keep assessing whether the statute book is still able to provide a framework that is relevant and responsive to the issues that we face today. Put bluntly, our law has to be functional and able to take into account everyday experiences and respond to modern challenges. Failing to guarantee that would be to do a disservice to our constituents and those who rely on the law to carry out their functions and safeguard their basic rights. With legislation, it is important to note that work on the ground and in practice means recognising that there are instances where protections interact with—and are at times in tension with—the rights of others, giving rise to discussion and debate about how to ensure that the rights of all involved are best protected.

Currently, references to sex in the Equality Act relate to a person being either a man or a woman. A woman is defined as

“a female of any age”,

and a man is defined as

“a male of any age”.

Reference to sex has generally been considered under the Equality Act to refer to whether a person is a man or woman in law, rather than to their biological sex or sex at birth.

[Joanna Cherry]

Can I just be very clear that those of us who support the first petition are not seeking to define sex in law for the first time? Sex has long been recognised in the common law. I refer to the Minister to the House of Lords definition in Bellinger v. Bellinger. I am sure that the Minister will agree that we are not seeking to define it for the first time. Everyone knows what a man is and what a woman is.

[Maria Caulfield]

Absolutely. For most people, their sex in law is the same as their biological sex. It is different where a transgender person has legally changed their sex to their acquired gender on their birth certificate by obtaining a gender recognition certificate. If “sex” meant someone’s sex in law, references to a woman in the Equality Act would include a trans woman with a gender recognition certificate but not a trans woman without a gender recognition certificate. That said, the Equality Act protection applies on the basis of perceived characteristic as well as actual characteristics, so a trans woman who passes as a woman can claim protection from discrimination on that basis. The debate today is about whether that basis of sex, based on law rather than on biology, needs changing to ensure that the rights of biological women are also protected. That is the crux of the matter that we have been debating today.

It is in that spirit that the Minister for Women and Equalities, my right hon. Friend the Member for Saffron Walden (Kemi Badenoch), sought advice from the EHRC as the independent equality regulator for Great Britain. When seeking that advice, she set out that she is concerned that the Equality Act may not be sufficiently clear in the balance that it strikes between the interests of people with different protected characteristics. It is everyone’s best interests that we establish whether the law in its existing format is sufficiently clear, because not doing so, as we have heard today, could have very practical consequences. The continued debate on this matter inevitably creates additional considerations for organisations and service providers to navigate, potentially preventing them from carrying out their functions or indeed from complying with the responsibility for equality.

The Prime Minister has also publicly given his views on this issue. In April he said:

“We should always have compassion and understanding…for those who are thinking about…their gender. But when comes to these issues of protecting women's rights, women's spaces, I think the issue of biological sex is fundamentally important when we think about those questions”.

That is why, when it comes to women’s health, sports or spaces, we need to make sure that we are protecting those rights.

[Jess Phillips]

It is interesting to hear the words from the very top of Government. I wonder if the Minister will be joining us in the Lobbies during the Victims and Prisoners Bill to ensure that specialist women’s services are defined in law and are protected in commissioning at a local level, where currently they are being let go.

[Maria Caulfield]

I know that the hon. Lady campaigns passionately on those issues from her experience of working in the sector. As a Government, we have done a huge amount for women in the space of domestic violence and abuse.

The Equality and Human Rights Commission has published its considered response to my right hon. Friend the Member for Saffron Walden, stating that on balance it believes that redefining sex in the Equality Act to mean biological sex would

“create rationalisations, simplifications, clarity and/or reduction in risk for maternity services, providers and users of other services, gay and lesbian associations, sports organisers and employers. It therefore merits further consideration.”

It has, as the shadow Minister, the hon. Member for Oxford East (Anneliese Dodds) said, said that it could cause some ambiguity as well. That is why it is important that we consider, both in policy terms and in legal terms, the potential implications of this change before we take any further decisions.

The Government have taken that advice and are considering the next steps at the moment.

[Stephen Doughty]

I wonder if the Minister has had a chance to consider the interim advice given by the United Nations independent expert on sexual orientation and gender identity, who has been very critical of suggestions of opening up the Equality Act and reviewing these positions, seeing them as taking rights away from people who should be protected and are protected at present.

[Maria Caulfield]

As we have heard, there are many views on this issue. That is why it is important that we take the time to properly consider the policy around it and take in the legal considerations, too. There are clearly cases where people are struggling to make practical decisions on a day-by-day basis with the Act as it stands. However, we do not want to create additional unforeseen problems by changing or clarifying the Equality Act.

[Joanna Cherry]

The Minister is being very generous with interventions. Is she aware that the United Nations special rapporteur on sexual orientation and gender identity does not speak for all people who have same-sex orientation? He certainly does not speak for me. Is she equally aware that the United Nations special rapporteur on violence against women and girls, Reem Alsalem, takes the opposite view and is very much focused on the protection of women?

[Maria Caulfield]

The hon. and learned Lady highlights the diversity of views in this space. That is why it is so important to take proper consideration and time before deciding our next steps. I know that Members will be eager to hear updates and reassurances, as well as the timeline for our next steps. However, the issues under discussion today are complex, and we need to proceed carefully and respectfully. As we have heard, a wide number of people will be affected by any change. I hope that Members will agree that it is only right and proper that we take timely consideration of the advice that we have been given before coming to any conclusions.

I will touch on some of the issues that were raised in the debate, particularly around single-sex spaces. I would like to reassure Members that the Government are committed to maintaining the safeguards that allow organisations to provide single-sex services. We recognise that being able to operate spaces reserved for women and girls is an important principle, and—to answer the question from the hon. Member for Oxford East—should be maintained.

As many here will already know, under the Equality Act, providers are already able to restrict the use of spaces on the basis of sex and/or gender reassignment where justified. The Act provides protection against discrimination, harassment and victimisation across a number of grounds, including sex. We are committed to upholding Britain’s long-standing record of protecting the rights of individuals against unlawful discrimination.

The EHRC has published guidance on the existing legislation, which provides much-needed clarity to those offering single-sex spaces. It does not change the legal position or the law. As that guidance makes clear, it is currently entirely acceptable for providers of single-sex services to take account of the biological sex of their service users. Where it is a proportionate means of achieving a legitimate aim, the Equality Act is also clear that service providers can exclude, modify or limit access for transgender people even when they have a gender recognition certificate.

When women are asked, privacy and dignity are high on the list of reasons they give for wanting such spaces. That is because they will be in a state of undress or in very vulnerable situations. Those spaces are also frequently relied upon during some of the most harrowing and distressing times that women and girls can experience. Their ability to feel safe and secure should always be of paramount importance, and we understand that creating environments where they are protected from further trauma is a crucial part of enabling them to heal.

My hon. Friend the Member for Bridgend is not now in the Chamber, but I hope he will not mind me saying that single-sex spaces are one of his concerns. We heard a bit about it in today’s debate. We have to be careful when making the assumption that one of the reasons that women want single-sex spaces is because they feel that trans people are of a predatory nature. That is not the case. The vast majority of women just want to be with other women. We need to be mindful of our language and tone, so that the trans community do not feel that they are being given labels or are being targeted in an inappropriate way. My hon. Friend made that point to me ahead of the debate.

The EHRC’s guidance is helpful for those wishing to navigate such scenarios with the care and delicacy needed. I encourage all Members to review it, and if there are queries from constituents, or organisations within constituencies, to refer people to the guidance, because it is helpful in practical terms.

There were a number of Members who touched on the issue of gender recognition and the long waiting list that many people face when going through the process of changing their legal sex. There are processes in place with the right checks and balances to allow those who wish to legally change their gender to do so. We have taken action to simplify the process following the consultation on the Gender Recognition Act. We have modernised the way that individuals can apply for a gender recognition certificate by moving the process online and making it cost significantly less.

In addition, we are opening up more gender identity services for adults. A new pilot gender clinic was opened in Chelsea and Westminster in 2021. We have since established four new community-based clinics in Greater Manchester, Cheshire, Merseyside, London and the east of England, with a fifth opening in Sussex later this year. All those clinics offer a range of clinical interventions that are offered by conventional gender clinics. We are trying to make the process as easy and supportive as possibly by tackling some of the practical barriers that those in the trans community face when they want to transition in a clinical way.

I thank Members again for their contributions. There are strong feelings on all sides, as shown by the numbers of people who signed both petitions, and by the Members of Parliament who fairly represented both sides of the argument today. The Government recognise the importance of biological sex, and we have taken it seriously enough to ask for advice from the Equality and Human Rights Commission. We will come back to this place once we have considered in detail the policy and the legal implications of changing or updating the Equality Act. I thank everyone for taking part in the debate, contributing to the discussion and affording the issue the respect it warrants.

Draft Medical Devices (Amendment) (Great Britain) Regulations 2023

Maria Caulfield Excerpts

Monday 22nd May 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 Medical Devices (Amendment) (Great Britain) Regulations 2023.

It is a pleasure to serve under your chairmanship, Mr Stringer. Medical devices are currently regulated by the Medicines and Healthcare products Regulatory Agency in the United Kingdom, which helps to ensure that they are safe and perform as intended. The past few years have been a time of great change for medical devices. The covid pandemic saw huge advances in life sciences and diagnostic tests, and the UK’s decision to leave the EU has presented a great opportunity to strengthen our regulatory regime. We in this country are lucky to have a dynamic and pioneering medtech sector, and the MHRA is a renowned regulator with an established track record of innovation-friendly regulation.

The main objective of the instrument is to give the medtech sector additional time to transition to our post-EU exit regime for medical devices. To achieve that, it extends the time during which manufacturers and importers can place CE-marked medical devices on the GB market.

Since January 2021, to place medical devices on the GB market, manufacturers have had the choice of either following the UK route to market introduced after the UK’s exit from the EU and marking their devices with a new UKCA mark, or following EU legislation and affixing a CE mark. Without this statutory instrument, that flexibility would cease on 30 June 2023, and manufacturers would only be able to follow the UKCA route. That would impact an estimated 11,000 businesses that have registered devices with CE marking and not UKCA marking. To be clear, this instrument has no impact on medical devices already on the market with a UKCA mark.

The MHRA is working to implement an extensive reform to future regime medical devices, and the intention is that that core aspect will be applied from July 2025. Therefore, this SI will give the industry flexibility to continue to use CE or UKCA markings on medical devices until that date. This instrument will not only help to minimise any loss of medical devices from the market, but will ensure that patients can continue to access safe, high-quality medical devices and to smooth the transition to future regulatory requirements until 2025.

I will summarise some of the key changes. First, the instrument provides that medical devices compliant with the medical devices directive or active implantable medical devices directive with a valid declaration and CE marking can be placed on the GB market up until the expiry of the device certificate or 30 June 2028, whichever is sooner. Secondly, in vitro diagnostic medical devices compliant with the EU IVD directive can be placed on the GB market up until the sooner of the expiry of the device certificate or 30 June 2030.

Thirdly, medical devices, including custom-made devices, compliant with the EU medical devices regulation and IVDs compliant with the EU IVD regulation can be placed on the GB market up until 30 June 2030. That is in keeping with the Government’s response to the consultation on the future regulation of medical devices in the United Kingdom, which took place from September to November 2021.

By supporting these regulations, we can help to ensure that patients and the wider public benefit from continued access to quality, safe medical devices, that the UK therefore remains an attractive market for manufacturers of medical devices, and that the wider medtech industry has adequate time to prepare for transition to the future regulatory framework for medical devices planned for 2025. I commend the regulations to the Committee.

--- Later in debate ---

[Maria Caulfield]

I will do my best to respond to the points made by hon. Members. The hon. Member for Bristol South asked a number of questions. She is right: there is a long list of devices, which fall into various classes of device that the MHRA regulates, and there are different rules for the different types of devices. The MHRA has taken a wide-ranging approach in consulting with the industry and the medtech sector. The consultation that was developed between September and November 2021 is still being looked through. That is why we have this SI: because the MHRA has taken on board some of the concerns and suggestions of the industry.

The final regulations will be operational from 2025. We have set that date so that we have a lead-in period, and then a transition time up to 2030. The MHRA regularly engages with trade associations, for the very reasons that the hon. Lady set out. The recent consultation received more than 900 responses. The explanatory memorandum includes a contact at the MHRA; any industry people listening who have concerns or suggestions and did not manage to take part in the consultation can still make contact with the MHRA, which will be able to give guidance and support on the plans. When we are further down the road to 2025, the MHRA will issue guidance to the industry as well.

Further regulations will be introduced later this year in relation to the long-term changes, and we will keep Members updated on that. This is a big change and the MHRA is doing a significant amount of work in this space. It is taking steps to ensure that, in implementing the further changes to medical devices regulations, it has the capacity and capability to continue to perform, as it always has, to the highest level, putting patient safety first but supporting the industry as well.

The hon. Lady talked about future realignment. As part of our wider work to reform medical devices regulation and take advantage of Brexit opportunities, we will make provision for alternative routes for medical devices to reach the GB market. That will involve possible recognition of devices with approval from other trusted regulators. We will keep Members updated on that as we work towards it.

[Emma Hardy]

I am concerned about the point about other trusted regulators. Different countries have completely different rules for medical devices. I will not mention vaginal mesh again, but the rules in the USA are quite different from those across the European Union. The community would be incredibly concerned if we were to accept other countries’ criteria for what is considered safe or not. I hope that the Minister will explain that we will have a stricter and more thorough system for regulating what goes inside our bodies.

[Maria Caulfield]

I take the hon. Lady’s point, and that is exactly the point that I wanted to make: we want to have the safest regulations possible. However, that does not close the door to recognising the work of other regulators. As I say, we will keep Members fully informed of those decisions as we go forward.

I know that this is slightly out of scope, Mr Stringer, but on the use of mesh, that was done while we had the existing EU regulations for CE-marked devices. There is now the possibility to track devices—they have barcodes on them—such as breast implants or replacement hips, and we have certainly accepted almost all the recommendations of the Cumberlege review, which looked specifically at mesh. I do not wish to test the Chair’s patience by going outside the scope of the draft SI, but that is why it is important that when we set the new UK mark, we learn lessons from the past. The CE mark has served us well, but there were instances of safety being compromised.

[Emma Hardy]

I thank the Minister for giving way again, and I thank you, Mr Stringer, for your generosity. Will the Minister indulge me by commenting quickly on the yellow card system and on how people can report more effectively?

--- Later in debate ---

[Maria Caulfield]

Absolutely, Mr Stringer. I am happy to follow up on the yellow card outside the Committee, because it is outside the scope of the regulations.

The aim of the draft regulations, as we move away from the CE mark to the UK mark, is to give businesses time to transition to the new regulatory regime, which we are planning to introduce in 2025, with some transitional arrangements after that date. The MHRA is working hard with industry and is in regular contract with trade associations. We want to make the transition as smooth as possible, and the draft SI will allow the sector leeway so that we can introduce the changes at pace.

Question put and agreed to.

Abuse and Sexual Assaults in the NHS: Investigations

Maria Caulfield Excerpts

Tuesday 16th May 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, Dr Huq, and I thank the hon. Member for St Albans (Daisy Cooper) for securing this important debate. First and foremost, I want to express my utmost respect for the bravery and resilience shown by all those individuals, whether patients, staff or visitors, who come forward to report sexual safety concerns in the NHS. None of those incidents is acceptable, and I reassure hon. Members that we are taking this matter extremely seriously. We have been doing significant work in this space for a while, and sexual abuse is one of the key priorities in the women’s health strategy published last year. We believe sexual abuse and violence is a health issue.

The Secretary of State and I held a meeting a few weeks ago with health leaders from across the NHS to discuss how sexual misconduct, harassment and abuse in the NHS are being dealt with. We discussed the actions that the Government are taking in collaboration with the NHS to combat the problem. We expect every NHS trust to take action to ensure the safety of patients, staff and visitors on its premises.

I will come back to the data in more detail, but we know that victims and perpetrators can span a mix of patients, staff and visitors, and that the highest number of cases occur in mental health settings. We take that very seriously indeed. A rapid review is happening at the moment. It is looking at in-patient mental health settings and, specifically, sexual abuse and the data around it. We will respond to the review shortly.

Tackling sexual violence and abuse, and ensuring that all patients and staff who experience sexual violence and abuse are supported, are top priorities for NHS England. Domestic abuse and sexual violence are more likely to be disclosed to a healthcare professional than to any other professional, and often, some data that records sexual violence is not always about sexual violence that happens within the trust, but if a report is made to a healthcare professional—by a fellow member of staff, a visitor or a patient—it is reported through NHS data systems. That is not to say that abuse does not happen within the setting itself, but it does explain why the figures are sometimes significantly higher—healthcare professionals have a duty to report any complaints they receive.

Sexual safety covers a range of inappropriate sexual behaviours with different legal and operational definitions, including language of a sexualised nature, sexual harassment, sexual assault and rape, but every one of those is unacceptable.

The hon. Member asked what we are doing. We are taking action. We expect local NHS employers to be proactive in fully supporting staff and patients, and ensuring that their concerns are listened to and acted on. We encourage anyone who has been a victim to come forward and report that, in the knowledge that the report will be taken seriously. Every organisation within NHS England systems, whether community trusts, hospital trusts or any other setting, has robust systems in place not just for reporting allegations and concerns, but for following them up. All reports must be recorded, investigated and dealt with by NHS providers. That includes, where necessary, taking action against the perpetrator, but also involving the police.

While local leaders of NHS organisations have a statutory duty to look after their staff and patients, we are taking action in this space nationally. NHS England has expanded the remit and scale of the domestic abuse and sexual violence programme to co-ordinate work on sexual safety in healthcare settings, and it has recently appointed the first national clinical director, Dr Peter Aitken, to make our NHS safer, with a focus on areas such as data collection and reporting, prevention, and early intervention and support for those who have experienced sexual violence and abuse within the NHS.

Data is important, and data on sexual safety is being recorded. We can see that through the national reporting and learning system, which takes all the data from local datasets. Where local risk management systems from trusts around England are reporting in, that is fed through to the national reporting and learning system, so that we have oversight of the scale and types of problems that are being seen.

Building on commitments in the women’s health strategy, NHS England is collecting more consistent and granular information on patients who experience sexual violence and domestic abuse. The domestic abuse and sexual violence programme is consolidating NHS England’s data improvement actions into a single cross-cutting project. Data is important so that we know the type of incidents that are happening, where they are occurring and in which settings. It means we can quickly pick up any single perpetrator who may be acting in one or multiple trusts and can ensure safeguards are put in place as quickly as possible.

Data collection is not the only tool we have; this is also about reporting. The data is only as good as the information that is reported, and that is why we are encouraging people to come forward if they have been a victim or if they have witnessed an incident about which they have concerns. Unless we know about it happening, the action that can be taken to prevent incidents happening again is limited.

The hon. Member spoke about professional regulators. If staff, patients or visitors go to a trust and either feel that the complaint was not taken seriously or that action has not been forthcoming, there are also professional regulators. She talked about the GMC and I will come to the five-year issue in a moment. Professional regulators take action and have complaint systems in place that allow anyone to report a concern. We also have freedom to speak up guardians, particularly for staff. They can whistleblow if there are concerns about the culture or behaviour in a particular setting, so that staff can feed in concerns without having to go to their line manager or a member of their team. That will be treated confidentially.

We are committed to making it easier for patients to report historical concerns and are looking at modernising the GMC’s five-year rule. There was a consultation recently on regulating healthcare professionals. The Government responded to that in February and said they would take that forward, so there are plans to modernise the GMC’s five-year rule on complaints. I will happily update the hon. Member on timelines after the debate. The patient safety commissioner, who looks after patient safety across the board, is in post, and I am happy to discuss with her how we can co-ordinate responses from trusts and regulators so that they are joined up and so patients and staff feel their responses are not being passed from one organisation to another.

However, better data collection and good reporting is not enough on its own. We have to take action to stop sexual safety incidents happening in the first place. That is why NHS England has committed to a number of preventive actions, including creating a gold standard for policies, support and training relating to staff who experience sexual violence. That is being rolled out across ICBs, trusts and royal colleges, because it is important to create a culture where people feel safe to come forward and where, if their complaints are not taken seriously, they have someone else to go to who will listen to them and their complaints will be responded to.

In particular, in mental health settings, the NHS patient safety strategy is running a mental health safety improvement programme specifically focused on sexual safety. It is important to ensure that safeguards are in place to protect vulnerable patients who may not be able to say no but do not have the capacity to consent.

Where sexual incidents do occur in the NHS, the right support must be available. NHS England has commissioned 48 sexual assault referral centres across England, which are open 24/7. They provide medical, practical and emotional support to victims, whether their sexual assaults occurred outside the NHS, but they are reporting it to NHS practitioners, or the incidents occurred within the setting.

We have rightly focused on patients, but I want to make the point that the data shows that staff are the most common victims of sexual assault, so work is being done to support staff and to make their workplaces safer. We have a high number of patient-on-patient incidents, too, so it is not always staff-on-patient incidents. We absolutely need to take robust action against any staff who assault or commit sexual violence or abuse on any patient, but we also need to ensure that patient-on-patient abuse is identified as quickly as possible, that safeguards are in place and that our staff are protected from violence from patients or visitors.

In the short period of time that I have had, it has been difficult to go through all the initiatives we are putting in place to adequately and accurately record the scale of the problems. We want people to come forward and we want numbers to be recorded. We need to ensure that the reporting processes are in place and that action is taken at a national level, by each individual trust and by the healthcare regulators. Delivering on this agenda is a top priority and I cannot overstate my personal commitment to progress in this space. Again, I recognise the bravery of every patient and staff member who has witnessed or been the victim of sexual abuse. I am happy to keep Members updated on the progress we are making in this space over the coming weeks and months.

Question put and agreed to.

Statutory Medical Examiner System

Maria Caulfield Excerpts

Thursday 27th April 2023 Written Statements

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

I wish to inform the House of the Government’s plan for introducing a statutory medical examiner system from April 2024. Medical examiners are senior medical doctors who provide independent scrutiny of the causes of non-coronial deaths. In scrutinising deaths, they:

seek to confirm the proposed cause of death by the medical doctor and the overall accuracy of the medical certificate of cause of death;

discuss the proposed cause of death with bereaved people and establish if they have questions or any concerns relating to the death;

support appropriate referrals to senior coroners; and

identify cases for further review under local mortality arrangements and contribute to other clinical governance processes.

The changes will put all of the medical examiner system’s obligations, duties and responsibilities on to a statutory footing and ensure they are recognised by law. For example, it will be a legal requirement that medical examiners scrutinise all non-coronial deaths. This will help to deter criminal activity and poor practice, increase transparency and offer the bereaved an opportunity to raise concerns.

In preparation for this, the relevant provisions of the Coroners and Justice Act 2009 and the Health and Care Act 2022 will be commenced by autumn 2023. We will also publish draft regulations by autumn 2023, and will lay the regulations when parliamentary time allows.

The introduction of medical examiners is part of a broader death certification, registration and coronial process. We are working closely across Government to ensure that from both a legislative and operational perspective we are supporting the professions involved so that they are prepared for the full introduction of the statutory system from April 2024.

[HCWS750]

Mental Health Support: Wirral

Maria Caulfield Excerpts

Monday 24th April 2023 Commons Chamber

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

I congratulate the hon. Member for Wirral South (Alison McGovern) on securing this important debate. I am always pleased to have the opportunity to talk about the progress that we are making with mental health services, not only locally but throughout England.

Mental health affects us all, and for those of us who experience poor mental health, its impacts can be detrimental to the ability to live well, thrive and achieve personal goals. That is why improving mental health outcomes, particularly for those who experience worse outcomes than the general population, is a top priority for me and, in particular, for the Government. As the hon. Lady said, mental health still has some way to go before it is put on a par with physical health in terms of expectations, help, support and treatment, but we are making progress, in the Wirral and across the country.

The NHS long-term plan commits an additional £2.3 billion a year to the expansion and transformation of mental health services in England by 2024, which means that that 2 million more people will be able to receive NHS-funded mental health support than were able to receive it in 2018-19. For instance, we will have invested nearly £1 billion every year in community mental health care for adults with severe mental illnesses by the end of the current financial year, which will give 370,000 adults with such illnesses—including older adults—more choice and control over their care and support.

Let us not be under any illusion. We have seen a tsunami of referrals as older adults, children and young people have sought help and asked to be referred. In a way we have been successful in breaking some of the taboos and stereotypes related to mental health, which means that people are willing to come forward and ask for help, but our challenge now is to ensure that the services are able to meet that growing demand.

The hon. Lady mentioned targets as a way of being able to give people an indication of how long they should be waiting. Until fairly recently, mental health did not involve any waiting time standards, but we have introduced targets for children and young people with eating disorders. Let me give an example to illustrate the sheer scale of the current demand. The number of children and young people entering urgent treatment for eating disorders has increased by 11% in the last two years, and in the previous year it increased by 73%. A record number of people now need help, and our challenge is to provide the services that will provide it.

NHS England is currently consulting on the introduction of five new access waiting time standards for mental health services, which we hope will address some of the concerns expressed by the hon. Lady. They include introducing a target for urgent referral to a community-based mental health crisis service that patients across all ages should be seen within 24 hours of referral. For very urgent referrals to a community-based mental health crisis service, a patient should be seen within four hours of referral across all ages. Patients referred from A&E should be seen face to face within one hour by a mental health liaison or equivalent children and young people’s service. Children, young people and their families presenting to community-based mental health services should start to receive care within four weeks. Those are the standards we are trying to introduce, and I will commit to updating the House on the progress we are making, because the standards in the Wirral that the hon. Lady has talked about in her speech are the standards that we would like to see across the country.

[Alison McGovern]

All those targets are about emergencies, which is important, but I hope that the Government will also be looking at targets for non-urgent care, because that is the way we prevent people from getting to the urgent bit in the first place.

--- Later in debate ---

[Maria Caulfield]

I absolutely agree and I will come on to talk about some of the work we are doing in that space in a moment.

We know that the number of children and young people experiencing mental health problems is rising, and that many of them risk continuing to experience mental health problems throughout their life as a result. This has been exacerbated by the pandemic, which is why there is a further £79 million to address the impact of covid on children’s and young people’s mental health. That has allowed around 22,500 more children and young people to access community health services in order to support them as early as possible.

One of the most exciting things we are doing relates to getting in at an earlier stage, as the hon. Lady has just suggested, and talking about mental health rather than just talking about mental illness. This involves our programme of mental health support teams that have been rolled out in schools and colleges. As of spring last year, there were 287 mental health support teams in place in around 4,700 schools and colleges across the country. The type of support they are able to provide to the young people and the teachers in those schools means that children who need help through early intervention can be signposted to it and that those with more complex needs can get into the system a lot quicker.

Our challenge now is to roll that out across all schools, and we are hoping to be able to do that as quickly as possible. In the hon. Lady’s patch, there are 25 mental health support teams in place or planned in the area covering Cheshire and Merseyside, four of which are in the Wirral. I am hoping that she will start to see them being rolled out and that she will feel they make a difference. Mental health support teams now cover 26% of pupils a year earlier than originally planned, but we fully recognise that that is still a long way off 100%.

We know that there is more to do in terms of capital investment in mental health services so that local communities can have the infrastructure to see people earlier, rather than waiting until they are in crisis and need to be seen in A&E or in-patient facilities. That is why recently we provided £150 million of capital investment to be rolled over in the next two years via NHS England. From that fund, £408,000 is being invested in improvements in NHS 111 and crisis line infrastructure at the Cheshire and Wirral Partnership NHS Foundation Trust, to try to start that process of getting early intervention to people as quickly as possible.

The hon. Lady has pointed out that waiting times for some mental health services are longer than we would like, and I am happy to put my hands up and admit that that is the case. I can assure her that both locally and nationally we are doing all we can to ensure that people are getting the support they need as quickly as possible. Her local foundation trust has implemented a series of measures to help reduce those waiting times, and the number of young people waiting for appointments has been reduced by 68% since March last year. Her trust has also recruited 13.4 whole-time equivalent roles and made provision for additional sessions of consultant psychiatry. Again, there is lots more to do, but we are starting to make inroads into some of those long waits.

I have already pointed out that NHS England is consulting on five new waiting time standards, and I will update the House as soon I have the information on when they are likely to be rolled out in practice. It is also important to note that many patients with mental health needs also suffer poorer physical health outcomes, which is why we announced in January that mental health will be part of the major conditions strategy so that we deal with both issues for people who are struggling with mental illness.

It is important that we talk about the local issues in Cheshire, Merseyside and the Wirral, and the hon. Lady’s local integrated care board is currently undertaking a transformation programme within its mental health services. I understand from NHS England that local services in the Wirral are establishing a community model of mental health as part of their long-term plan ambition, with the aim of removing the gap between primary and secondary mental health services.

We want people to be seen much earlier when they go into crisis. Nationally, we are already seeing fewer people turning up to A&E because crisis teams are able to see them in the community much quicker and much earlier, with better outcomes for managing their symptoms. Talking Together Wirral has achieved the national target of 50% recovering through talking services since January 2023, and the Every Mind Matters website enables people to self-refer to talking therapies. We are doing quite well in getting first appointments, but our challenge is where people need further sessions, which is often where the long waits occur. I reassure the hon. Lady that we want to make it as easy as possible for people to self-refer into the system and, locally, the Wirral is starting to recover the waiting times for such services, but of course I am happy to work with her to see what more can be done.

The hon. Lady mentioned the fantastic, proactive work of her local health system. Cafe Create is a pilot programme launched in April 2022 as a joint commissioning venture between health services and Wirral Borough Council, and it provides an informal place for young people at risk of mental health crisis to drop in and access support from professionals and peers, counselling and drug and alcohol support. We want to support more programmes like that.

The myHappymind programme is rolling out in the Wirral, reaching 22 primary schools by the end of last year. Plans, including a business case, are now in place to bring the programme to every primary school in the Wirral by 2024, and I am happy to work with the hon. Lady on that because it is important to establish in every school that mental health is on a par with physical health. We teach young people and children about the importance of a good diet and exercise, and it is equally important to teach them about what mental wellbeing looks like and when to reach out for help.

There is a lot of work to do, and I do not dismiss in any way the hon. Lady’s point about the significant number of people who want help and the sometimes long waits to access services, but we are making progress on trying to deal with the large number of cases coming forward and on supporting local communities such as the Wirral to roll out services.

I hope I have been able to reassure the hon. Lady of our commitment to improving mental health services, to introducing some of the standards she mentioned—I take her point that it needs to be about more than just urgent care standards—and to supporting local communities to address crises in the community rather than waiting for a person to need admission, sectioning or in-patient care. I hope we will be able to demonstrate the progress we have made.

Let me touch on one final point about staff. We have an ambition to recruit 27,000 more mental health workers and we are on track to meet that. That covers a wide range of mental health practitioners, from mental health nurses to psychiatrists, counsellors and psychologists. They are working in a wide range of roles, and I wish to reassure the hon. Lady that we are on track to meet that target. It is the key to providing these extra services; without the staff, we will not be able to provide the services we need. I hope I will be able to update the House fairly soon on further work we are doing, not only on recruitment, but on the retention of our fantastic staff, who do a really hard job. When we hear news about the health service being under pressure, we often hear about accident and emergency, intensive care units and hospital beds, but mental health workers do some of the hardest jobs in health and social care, and I pay tribute to them

I hope that I have reassured the hon. Lady that we are working hard. I absolutely identify with the points she has made and look forward to working with her to improve mental health services in the Wirral.

Question put and agreed to.

In-patient Abuse: Autistic People and People with Learning Disabilities

Maria Caulfield Excerpts

Tuesday 18th April 2023 Commons Chamber

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

I thank the hon. Member for Worsley and Eccles South (Barbara Keeley) for securing an Adjournment debate on this really important issue. I hope she will see from my response that we are by no means complacent about it. It is appalling to see reports of the care and treatment that some autistic people have experienced, and we absolutely take them very seriously.

As the Minister responsible for patient safety, I have made it clear to the House that everyone in an in-patient mental health facility is entitled to high-quality care and treatment and should be safe from harm. These are very vulnerable people who should feel safe and looked after in any in-patient setting: that applies to all patients admitted, but particularly to people with a learning disability and autistic people.

When in-patient care is absolutely necessary, it needs to provide a therapeutic benefit. It should be high quality, it should be close to home, and it should be as unrestrictive and for as short a time as possible—we have been very clear about that. Abuse cannot and will not be tolerated. That is why we are committed to taking steps at a national level to prevent the abuse and poor treatment of people with a learning disability and of autistic people in in-patient settings.

As we announced in January, the Government have commissioned a rapid review, independently chaired by Dr Geraldine Strathdee, of mental health in-patient settings. The review is focusing on how we use data and evidence, on how we respond to complaints, on how we listen to feedback and on how whistleblowers can raise the alert to identify risks to safety in in-patient settings.

I have met many Members across the House with concerns about in-patient care in their constituency. We absolutely take the issue seriously. We want to ensure that the right people get the right information, so patients get the care and support they deserve, and to ensure that if there are concerns, we can identify them as early as possible.

[Barbara Keeley]

There is obviously a considerable amount of detail in both what the Minister is saying and what I covered in my speech. However, the Breightmet Centre in Bolton, where Amy was detained, has been in and out of special measures, and it is inadequate. Amy was sent back to the unit and abused further, although the centre had been declared inadequate across all its settings. I am therefore finding it difficult to align what the Minister is saying with the actual situation. The list of scandals that have emerged since Winterbourne View extends across the country. We keep finding extra hospitals in which people have been abused, including Littlebrook Hospital in Kent. The CQC is taking some action, but these places are still open, they still have patients, and patients are being abused. How does what the Minister is saying line up with the reality out there?

[Maria Caulfield]

As I have said, we instigated a rapid review in January to examine the national picture across England because we wanted to see what was being done in in-patient settings. This will include looking at the data concerning the use of restraints, the safety of patients, how concerns are flagged and how many patients are being treated out of area, because that does increase the risk. However, the review—which will report very soon—does not prevent us from investigating further particular concerns about particular in-patient units, and once it has been published we will come to the House to update Members in response to many of the points that the hon. Lady has raised about specific in-patient settings.

[Barbara Keeley]

As I have said, there has already been a review. NHS England published a report on the 1,770 individual reviews of the care of autistic people and people with learning disabilities, including children, who had been detained. As I also said, that report was commissioned following the tragic deaths at Cawston Park, and revealed that there were high levels of restrictive practice and that 41% of people did not need to be in hospital at all but could not be discharged.

Does the Minister not accept that things are going seriously wrong, and that there is not the necessary provision in the community or the necessary training of staff to work with people? I cited the case of Danielle, and I hope the Minister will look at that case, along with the hon. Member for Maidstone and The Weald (Mrs Grant), because it is an example of someone being moved around for 13 years of her life, from one inappropriate facility to another. We are destroying lives, in many cases young people’s lives, because this often starts with children and teenagers.

[Maria Caulfield]

I will come on to what we are doing to try to keep people out of hospital, and to get others discharged. We fully recognise that there are too many people in in-patient settings at present, but we also want to ensure that when people are in an in-patient setting and need to be there, the service is safe and they do not come to harm.

NHS England has established a three-year quality improvement programme which seeks to tackle the root causes of unsafe, poor-quality inpatient care. We all acknowledge that there has been practice that has caused harm to patients. We want to see the picture across the country, and then look at specific trusts that are not providing the standard of care that patients and their families expect. Baroness Hollins is overseeing independent care and treatment reviews relating to people in long-term segregation, and a senior intervener pilot has been undertaken to help individuals in the most restrictive settings to be moved towards discharge. Work is being done to examine the specific units about which we have concerns.

The CQC, which the hon. Lady mentioned, has a central role in identifying cases of poor in-patient care and taking immediate action when that is necessary. We acknowledge that some settings are not delivering the high quality of care that everyone deserves, and we want to ensure that we are setting standards so that units, integrated care boards and commissioners are aware of the standards that should be expected and can raise concerns when they are not being met.

[Barbara Keeley]

As I said towards the end of my speech, around one in 12 of the 2,000 autistic people and people with learning disabilities being held in these inappropriate units are being held in units rated by the CQC as inadequate. The Breightmet Centre in Bolton, run by ASC Healthcare, has been in and out of special measures and is rated inadequate. Why is the Minister allowing people to be held in those units? She is talking about setting standards, but that is not an adequate standard. Would it not be a good place to start to say that no one with autism or learning disabilities can be held in a unit that is rated inadequate? That is an incredibly low bar.

[Maria Caulfield]

Admissions to services that are rated inadequate are an absolute last resort, and they should be being done with patients and their families being consulted and consenting to being placed in those units. We are minimising the number of new admissions to a unit that has been rated inadequate and we are working with the CQC to see how those units can be better supported to improve the quality of the service they offer.

The hon. Lady touched on funding. We are investing £121 million in this financial year across community support for people with learning abilities and autistic people as part of the NHS long-term plan. We are recruiting 27,000 mental health workers and we are on track to meet that target to increase the support available in the community. It is absolutely the solution to look after people in their communities with the care that they need so that admission to hospital—which, as she points out, is often not just for days or weeks or even months—is the absolute last resort.

The hon. Lady touched on the Building the Right Support action plan. We are drilling down on implementing the actions. We have short-term and long-term actions, and some of the work has had an effect already. At the end of February this year, the number of people with learning disabilities and autistic people in a mental health in-patient setting was 2,045, so we are seeing a reduction. That is a net decrease of 860 people, or 30%, since March 2015. Unlike someone with a physical health need, which can be quite complex in terms of planning their discharge, it is not just a case of finding people homes; they often have to have the right support in those homes. It is not just a case of providing them with support, because they often need complex support. The in-patients who still need to be discharged are the more complex cases, who, as the hon. Lady has pointed out, have often been in hospital for years. Adapting to moving back into the community is not an easy process for them, and that is why it is taking time to get them the packages of care that they need.

[Barbara Keeley]

I just wonder how the Minister can reconcile the figures as if they were increasing when I have told her that we found, through written parliamentary questions trying to get to the financial picture, that the investment in community services actually fell between 2021-22 and 2022-23, from £62 million to £51 million. With rocketing inflation and soaring costs to providers, that funding needs to increase.

I recommend that the Minister consider the issue of dowries, as was suggested in the Health and Social Care Committee’s report on this issue a few years ago. Time and again we find situations where a county council or urban council responsible for social care does not have the funding to provide that support. Millions and millions are being spent. We do not even know how much these placements cost, but some of them are very expensive. I am sure the Minister is aware of how expensive they can be. Decades ago, when we discharged people from long-term psychiatric institutions, a dowry accompanied them. We talked about Danielle’s case. If there were a system of dowries, Kent County Council could have the funding to provide her with housing and support. I have never understood why such a system has not been brought in. We included that in our Select Committee report. Cost-shunting is really a factor here. Local authorities do not have to fund an NHS England place, and that is part of the problem, yet we never get around to tackling that.

[Maria Caulfield]

The hon. Lady is right; a number of organisations are responsible for caring for people in the community, and it is often about pulling those organisations together. That is why we have the integrated care boards, which now have responsibility for looking after people with learning disabilities or autism and helping with their discharge.

[Barbara Keeley]

It is not just about responsibilities; it is also about the budget to go with those responsibilities. If the budgets were transferred from NHS England, which is shelling out millions for these inappropriate units, to the ICBs, I could see it working. It certainly worked all those years ago for discharges into the community. I was a councillor and vice-chair of social services in Trafford, and we might get a dowry of £1 million to settle someone from a long-term psychiatric hospital. That is the sort of funding we need to be thinking about, and it does not happen.

[Maria Caulfield]

A key reason why we sometimes find it hard to discharge someone from an in-patient setting is the housing element. We have capital funding available. I recently met ICB chairs and chief executives to encourage them to ask their local councils—particularly district councils, which do the planning element—to consider the funding that is available. The county councils, the upper-tier authorities, are often responsible for care, so it is about joining up the funding, but we are not building the right type of housing to support people back into the community. The capital funding is there. Sometimes one of the frustrations is making sure that the money flows with the patient so that they are able to get the care they need, but sometimes the money is there and it is about joining up the services to make it happen.

[Barbara Keeley]

Is the Minister saying that there is unspent money that could be used or transferred to local authorities? If so, how much is available? I have asked written questions about this, but it seems to me that the money has tailed off. Whether it is money to help pay for housing or money to pay for workforce improvements, the Government have halved the funding. People need housing and they need support, and those elements have been cut back.

--- Later in debate ---

[Maria Caulfield]

There is capital funding available to build supported housing for people with a learning disability or autism, which is why I recently encouraged a number of ICBs to make bids for funding at a local level.

We have made good progress on reducing the number of people with a learning disability in mental health hospitals. We are not where we want to be. Of course, we want every person who is able to be discharged to be either at home or in the community. I recognise that there is work to be done, but the number of in-patients with a single diagnosis of a learning disability and the number of in-patients with both a learning disability and autism are down from March 2015.

I am very happy to keep the hon. Lady updated on the work we are doing. We will be meeting the Building the Right Support team again very soon for an update on progress, but I recognise her point. The two elements for me are that we need to get more people out of hospital, whether by providing the care and support they need through the 27,000 extra mental health staff and by focusing on building resilience in the community, or, when someone needs to be an in-patient, by making the experience as safe and as therapeutic as possible. I have previously made it clear from the Dispatch Box that we will not accept poor care in in-patient settings. Once the independent rapid review reports back very soon, we will set out the next steps to improve safety in such settings.

[Barbara Keeley]

The Minister has mentioned the Building the Right Support delivery board, and I have said that I see it and the plan as vacuous and unambitious. It has been derided by the organisations in the sector that work with it. There is not a lot of confidence in it. I have also quoted to her something that we found out by asking questions about it: the delivery board, which is meant to be driving cross-departmental Government action on this important area to those 2,000 people and their families, has met for only six hours in the 22 months since it was established. How is that enough? It is not exactly a powerhouse is it, with six hours of meetings in all that time?

[Maria Caulfield]

The work goes on in between the meetings. The meeting reports back to update members of the board on specific areas, but the work is happening on a daily basis to both improve the safety and quality of the care that patients are receiving, and to get patients home where they are able to be discharged. That is our absolute focus. I will be able to update the hon. Lady further once the rapid review is completed very soon, and I absolutely take her points on board.

I do not want anyone to be in an in-patient setting unless they absolutely have to be, and if they are in such a setting they should be receiving good-quality, safe care, so that family members and friends can be reassured that their loved one is being looked after well. No one wants that more than me.

Question put and agreed to.

Covid-19 Vaccine Update

Maria Caulfield Excerpts

Monday 17th April 2023 Written Statements

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

His Majesty’s Government (HMG) are committed to protecting people most vulnerable to covid-19 through vaccination as guided by the independent Joint Committee on Vaccination and Immunisation (JCVI).

On 6 April 2023, HMG accepted advice from the JCVI that clinically vulnerable children in England aged 6 months to 4 years should be offered a covid-19 vaccine. I am informed that all four parts of the UK intend to follow the JCVI’s advice.

Although young children are generally at low risk of developing severe illness from covid-19, infants and young children who have underlying medical conditions are over seven times more likely to be admitted to paediatric intensive care units compared to those without underlying medical conditions.

Over 1 million children aged 6 months to 4 years in the US have received at least one dose of the Pfizer-BioNTech covid-19 vaccine since June 2022. Data from the US showed no new safety concerns and the most common side effects reported were similar to those seen with other vaccines given in this age group, such as irritability or crying, sleepiness, and fever.

The UK’s independent medicines regulator, the Medicines and Healthcare Products Regulatory Agency (MHRA), approved the Pfizer-BioNTech infant vaccine for children aged 6 months to 4 years on 6 December 2022 after assessing the safety, quality, and effectiveness of the vaccine against MHRA’s robust standards.

Following this authorisation, the JCVI advised that children aged 6 months to 4 years who are in a clinical risk group (as defined in the UK Health Security Agency Green Book, which sets out information for public health professionals on immunisation) should be offered the vaccine. The JCVI does not currently advise offering covid-19 vaccination to children aged 6 months to 4 years who are not in a clinical risk group.

The JCVI has advised that eligible children should be offered two doses of the vaccine, with an interval of 8 to 12 weeks between the first and second doses. The NHS in England will begin offering vaccinations to those eligible in England from mid-June.

I am now updating the House on the liabilities HMG have taken on in relation to further vaccine deployment via this statement and accompanying departmental minutes laid in 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.

The extension to this cohort of children aged 6 months to 4 years creates a new contingent liability under the indemnities in the existing vaccine supply agreement between HMG and Pfizer.

Deployment of effective vaccines to eligible groups has been and remains a key part of the Government strategy to manage covid-19. Given the terms on which developers have been willing to supply a covid-19 vaccine, we, along with other nations have taken a broad approach to indemnification proportionate to the situation we are in.

Even though the covid-19 vaccines have been developed at pace, at no point and at no stage of development has safety been bypassed. These vaccines have satisfied, in full, all the necessary requirements for safety, effectiveness, and quality.

We are providing indemnities in the very unexpected event of any adverse reactions that could not have been foreseen through the robust checks and procedures that have been put in place.

I will update the House in a similar manner as and when other covid-19 vaccines or additional doses of vaccines already in use in the UK are deployed.

[HCWS708]

Maternity Investigation: Programme Transition

Maria Caulfield Excerpts

Thursday 30th March 2023 Written Statements

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

This statement updates Members on the transition of the Healthcare Safety Investigation Branch’s (HSIB’s) maternity investigation programmes.

On 26 January 2022, Official Report, 25WS, by way of a written ministerial statement, the Department of Health and Social Care announced that a separate Special Health Authority would be established to continue the independent maternity investigation programme, which is currently overseen by the Healthcare Safety Investigation Branch.

The Department is committed to ensuring the continuation of independent, standardised maternity investigations that provide learning to the system and contribute to the Government’s ambition to halve the 2010 rates of stillbirths, neonatal and maternal deaths and brain injuries in babies occurring during or soon after birth by 2025.

Following careful consideration, the Department has determined that the most appropriate and streamlined mechanism for delivering the valued and independent maternity investigations is for the function to be hosted within the Care Quality Commission. The purposes of the maternity investigation programme remain as set out last January: to provide independent, standardised and family-focused investigations of maternity cases for families: to provide learning to the health system via reports at local, regional and national level; analyse data to identify key trends and provide system wide learning; be a system expert in standards for maternity investigations; and collaborate with system partners to escalate safety concerns.

We will now work with the CQC and the HSIB to complete the transition of the maternity investigation programme to the CQC by October 2023.

As announced in the written ministerial statement of 9 February 2023, Official Report, 40WS, the establishment of the new HSSIB will take place in October 2023, to enable all the necessary work to be completed to ensure a smooth transition of these investigation programmes.

[HCWS698]