Oral Answers to Questions

Maria Caulfield Excerpts

Tuesday 24th January 2023 Commons Chamber

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

22. What recent steps he has taken to implement the women’s health strategy for England.

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

Last summer we published the first Government-led women’s health strategy for England, which sets out our 10-year ambition to boost the health and wellbeing of women and girls and to improve how the health and care system listens to them. I am pleased that we have set out the first eight priorities for the first year of the women’s health strategy, and that we are already delivering on many of them.

[Ellie Reeves]

After 13 years of Conservative Government, more than half of maternity units now consistently fail to meet safety standards. Almost 40,000 women now wait over a year for gynaecological treatment, up from just 15 women 10 years ago. Women in the poorest areas are dying earlier than the average female in almost every comparable country. At every stage of a woman’s life, her health is being compromised. When will these failures be reversed, and when will we see real investment in the NHS workforce and in women’s health?

[Maria Caulfield]

I am sorry that the hon. Lady does not welcome our announcement of this country’s first women’s health strategy, which is putting women as a priority at the heart of the health service.

We have eight priorities for this year. We are rolling out women’s health hubs around the country as a one-stop shop to make healthcare more accessible to women. We are improving women’s health provision by setting out a women’s health area, with reliable information, on the NHS website. We are working with the Department for Work and Pensions to support women’s health in the workplace. We are recognising pregnancy loss by developing the first ever pregnancy loss certificate for babies who are born and lost before 24 weeks. We are improving and standardising access to in vitro fertilisation for same-sex couples around the country. And we are launching the first ever hormone replacement therapy prepayment certificate in April. That is some of the work we are doing, and I am disappointed the hon. Lady does not recognise that effort.

[Alex Davies-Jones]

A stated intention of the women’s health strategy is to explore mechanisms to publish national data on the provision and availability of IVF, on which there has since been no Government progress. This issue affects families and would-be parents across the country. We know all too well that a postcode lottery exists, and it is just not good enough. Will the Minister support my private Member’s Bill to address this issue, which is due to have its Second Reading on 24 March?

[Maria Caulfield]

I pay tribute to the hon. Lady for the work she is doing in this space. I was in the Chamber when she presented her Bill last week and I can reassure her that, as part of the work we are doing with integrated care boards, we are collating and publishing data on the commissioning of fertility services, so that women in each part of the country can not only see what services are available to them, but compare what is being offered locally. That is happening in England; I cannot comment about what is being done in Wales. Let me also say that the Human Fertilisation and Embryology Authority is publishing data about add-ons, which I know is a particular interest of hers. We want to make sure that that information is available on the NHS, so that women can make an informed decision.

[Chloe Smith (Norwich North) (Con)]

I welcome that update, and the tone and, as always, the calm confidence with which the Minister provides it. Does she agree with me and with the Chancellor that the NHS has to help people back into work?

[Maria Caulfield]

I thank my right hon. Friend for her kind words. I absolutely agree on that, which is why helping women back into work and dealing with their health issues in the workplace is one of the first eight priorities of the women’s health strategy. We are working with colleagues in the Department for Work and Pensions on that. Last night, I had a roundtable with tech and STEM— science, technology, engineering and maths—employers, and they were desperate to keep their women in the workforce and to recruit more. Whether we are talking about young women who need support as they go through endometriosis or IVF treatment, or older women who are dealing with the menopause, we are absolutely committed to supporting women’s health needs in the workplace.

[Mr Philip Hollobone (Kettering) (Con)]

I welcome the recent announcement of enhanced breast cancer facilities at Kettering General Hospital. Is that not just the sort of extra investment we need to improve the delivery of women’s health services?

[Maria Caulfield]

I thank my hon. Friend, who has always been campaigning for better health services in Kettering. Let me reiterate what he has just said: that announcement followed the announcement last week of £10 million for NHS breast screening services, to provide 29 new mobile units and static breast care units across England.

[Mr Speaker]

I call the shadow Minister.

[Feryal Clark (Enfield North) (Lab)]

The women’s health strategy was an opportunity to fundamentally change the inequalities women face. Women were promised a clinical women’s health lead in the NHS, yet a former Health Minister, the hon. Member for Sleaford and North Hykeham (Dr Johnson), admitted that there has not even been a discussion about establishing the role. Women in east Kent were promised change after the damning review of local maternity services, yet the Care Quality Commission is now threatening the trust there with enforcement action. Time after time, women’s voices are at best being ignored and at worst being silenced. So I ask the Minister: when will this Government stop letting women down with empty promises? Is the women’s health strategy worth the paper it was written on?

[Maria Caulfield]

Perhaps the shadow Minister will reflect on her comments when she receives the “Dear colleague” letter later today outlining the eight priorities areas for our first year of the strategy, with work such as the prepayment certificate for hormone replace treatment being done already; it is launching in April and saving women hundreds of pounds on the cost of HRT. May I say that I am gobsmacked by the Labour party’s position on this? Not only does it struggle most days to define what a woman actually is—for reference, it is a female adult human—but it cannot stand up for women either. There was no greater example of that than what we saw in this Chamber last week, when Labour Members were heckling the hon. Member for Canterbury (Rosie Duffield) and intimidating my hon. Friend the Member for Penistone and Stocksbridge (Miriam Cates). Come back to us when the Labour party is reflecting on the behaviour of its own MPs before dictating to us.

[Mr Speaker]

Let me just remind people: these are questions to the Government.

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[Alex Cunningham (Stockton North) (Lab)]

13. What assessment he has made of the implications for his policies of the number of excess deaths in 2022.

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

Excess deaths data are published on the gov.uk website, which was most recently updated on 12 January. They show that causes of death from conditions such as ischemic heart disease contributed to excess deaths in England in the past year.

[Debbie Abrahams]

The UK’s all-cause mortality for working-age people was 8.3% above the average for the previous five years and the fifth highest in Europe. On top of that, excess deaths are disproportionately experienced by the most deprived and by people of African, Caribbean and Asian descent. Given that these figures are driven by structural inequalities, and that those inequalities are getting worse—the richest 1% have bagged nearly twice as much wealth as the remaining 99% in the past two years—does the Minister think that it is appropriate to recommend that people pay for their GPs?

[Maria Caulfield]

The Government are not recommending that people pay for their GPs. In fact, we are investing more in primary care than ever before, unlike the shadow Secretary of State who wants to dismantle the GP system and privatise the healthcare system as well. I think the hon. Lady needs to have a conversation with those on her own Front Bench. Not only did the shadow Secretary of State insult primary care teams for running up their vaccination programme, calling it “money for old rope”, but we are the ones who are investing in primary care services and making them more accessible to people.

[Alex Cunningham]

According to Cancer Research and Action on Smoking and Health, smoking costs the NHS in Stockton £9 million a year and social care £5 million a year, and it costs some £47 million in lost productivity, unemployment and premature deaths. Assuming that one day soon we will get the Government to back a control plan, will Ministers ensure that it includes the desperately needed funding for local smoking cessation services?

[Maria Caulfield]

Local decisions on public health are taken by local commissioning groups and local authorities, and it is for each local area to decide how it spends the money on public health.

[Esther McVey (Tatton) (Con)]

The chief medical officer recently warned that non-covid excess deaths are being driven in part by patients not getting statins or blood pressure medicines during the pandemic. However, when looking at the data on statins on OpenPrescribing.net, which is based on monthly NHS prescribing, there appears not to be a drop, so where is the evidence? If there is none, what is causing these excess deaths? Will the Minister commit to an urgent and thorough investigation on the matter?

[Maria Caulfield]

We are seeing an increase in excess deaths in this country, but we are also seeing that in Wales, in Scotland, in Northern Ireland and across Europe. There is a range of factors. As we saw, there was an increase in December in the number of people being admitted with flu, covid and other healthcare conditions. That was seen not just in this country, but across Europe.

[Andrew Bridgen (North West Leicestershire) (Ind)]

The Office for National Statistics has not issued mortality data by vaccination status since 31 May last year. Will the Minister confirm that her Department has collected that data for the rest of 2022 and inform the House when it will be published?

[Maria Caulfield]

I am happy to write to the hon. Gentleman with that information. However, I must be clear that we planned for an increase in admissions this winter. That is why we got on and delivered on our plans for 7,000 extra beds, and why we brought forward our flu and covid vaccination programme and lowered the age of eligibility. There are a number of factors, and they are the same factors that have driven excess deaths across the United Kingdom and across Europe.

[Mr Speaker]

I call the shadow Minister.

[Andrew Gwynne (Denton and Reddish) (Lab)]

There were 50,000 more deaths than we would otherwise have expected in 2022. Excluding the pandemic, that is the worst figure since 1951. The Health Secretary—part man, part ostrich—says he does not accept those figures, but as many as 500 people are dying every week waiting for essential care, and we are still getting the same old Tory denial and buck-passing. In her answer, will the Minister finally take some responsibility, accept the ONS excess deaths figure, and recognise the damage that she and her Government are doing to our NHS?

[Maria Caulfield]

I prefer to deal with facts rather than—[Interruption.] The BMJ has ranked the UK mid-table in Europe for mortality figures, which makes it comparable with Italy. In fact, Germany has higher excess deaths, at 15.6%, as do Finland, at 20.5%, and Poland, at 13.3%. However, if the hon. Gentleman wants to hear about what is happening in Labour-run Wales, the statistics available on the gov.wales website show that Wales, in December, had the highest number of red calls ever and that only 39.5% received a response within eight minutes—the lowest figure on record. Those are clinical reasons for excess deaths, not political ones. Perhaps the hon. Gentleman needs to recognise that fact.

[Alison Thewliss (Glasgow Central) (SNP)]

9. What recent assessment he has made of the potential impact of the UK’s departure from the EU on recruitment in the health and social care sector.

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[Kim Johnson (Liverpool, Riverside) (Lab)]

T5. According to a recent Care Quality Commission report, black people experiencing mental health crisis are 11 times more likely to be sectioned and to receive restrictive and violent community treatment orders. How will the Minister tackle these inequalities and implement the recommendations in the report?

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

I thank the hon. Lady for her question. She is right that black and ethnic minority groups are more likely to be detained under the Mental Health Act 1983. We are planning to reform the Mental Health Act. There has been pre-legislative scrutiny, and I hope that when we reform that Act there will be an improvement in those figures.

[Kelly Tolhurst (Rochester and Strood) (Con)]

The Kent and Medway integrated care board reported that we had an increase of over 230,000 in the number of GP appointments offered to patients between September 2020 and September 2022. However, Medway has some of the lowest numbers of GPs per head in the country, and demand has increased. What support is the Department giving to the ICB to further increase access to GP appointments in Medway?

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[Matt Western (Warwick and Leamington) (Lab)]

T7. Last week, the Government decided to mothball the covid-19 testing facility in Leamington, which will leave up to 670 people without a job. The lab reputedly cost more than £1 billion—perhaps the Minister could confirm—and when the investment was made, I was promised that it would be used for other purposes, such as pathological testing and other diagnostics. Why is that not happening?

[Maria Caulfield]

As the hon. Gentleman knows—we discussed the issue over the telephone last week—the decision was taken to wind down the Rosalind Franklin Laboratory because the number of PCR tests has reduced significantly and NHS laboratories can take that capacity. There is a residual service and additional use of the laboratory is being considered.

[Martin Vickers (Cleethorpes) (Con)]

I recently met a dentist in my constituency whose practice group operates over 19 sites where the rate for units of dental activity ranges from £25 to £36. He is convinced that there needs to be a uniform UDA rate to attract NHS dentists to areas such as Cleethorpes. Can the Minister consider that?

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[Dr Rupa Huq (Ealing Central and Acton) (Ind)]

T9. In the light of the Government’s welcome announcement of the Strathdee rapid review of in-patient mental health services, can we revisit West London NHS Trust’s decision to make the covid closure of the Wolsey wing permanent, which leaves Ealing, the third biggest borough in London, with no acute mental health beds for under-65s?

[Maria Caulfield]

Local healthcare decisions are made by local commissioning groups, but I am happy to raise that on behalf of the hon. Lady. We are putting an additional £2.3 billion a year into expanding and transforming mental health services in the community and patient services.

[James Morris (Halesowen and Rowley Regis) (Con)]

Although I welcome the new investment in emergency mental health services that was announced this week, does the Secretary of State agree that we must not lose sight of the fact that we need a long-term plan for the transformation of mental health services so that we achieve parity of esteem between mental and physical health in the NHS?

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[Charlotte Nichols (Warrington North) (Lab)]

The most recent figures published by the UK Health Security Agency show that, last year, the rate of syphilis cases reached its highest since 1991 and the total number of cases hit its highest since 1948. That shocking increase in syphilis transmission is just one reason why we need the Government to set out their vision for sexual and reproductive health in their long-overdue sexual and reproductive health action plan. Can I therefore ask the Minister to set out when the plan will be published and what she is doing to stop the spread of syphilis?

[Maria Caulfield]

Can I just reassure the hon. Lady that we take sexual health services very seriously? Local authorities in England have received more than £3 billion from Government to support those services. We have produced a number of plans to improve sexual and reproductive health, from the HIV action plan in 2021 to the women’s health strategy, which focuses on sexual health as well.

[Maggie Throup (Erewash) (Con)]

The all-party group for diagnostics will hold its inaugural meeting on 8 February, and plans to conduct a short inquiry with the aim of providing a blueprint for how community diagnostic centres should operate in the longer term. As part of the inquiry, will my right hon. Friend commit to meeting members of the group to discuss what more the Government can do to maximise the role of diagnostics in addressing the pressures on the NHS?

Oral Answers to Questions

Maria Caulfield Excerpts

Tuesday 6th December 2022 Commons Chamber

[Stephanie Peacock (Barnsley East) (Lab)]

3. What recent steps his Department has taken to reduce waiting times for neurological diagnosis and treatment.

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

Reducing waiting times for diagnostics and treatment is a priority for this Government. The delivery plan for tackling the elective backlog sets out steps to recover and transform out-patient services across all specialisms, including neurology.

[Stephanie Peacock]

In March 2021, my constituent suffered a severe head injury. By the time they have their first neurology appointment in January 2023, they will have waited nearly two years for treatment. In the meantime, they have been unable to work, been rejected for disability benefits and are in severe pain. Does the Minister accept that this wait is unacceptable, and will she outline what support the Department is making available for those who are suffering while they wait for vital appointments?

[Maria Caulfield]

I thank the hon. Lady. I know she raised her constituent’s case in a Westminster Hall debate on 22 November and my understanding is that they now have an appointment for January, but there is absolutely a backlog from covid patients. We know that. That is why we are putting in over £8 billion in the next three years to deal with that backlog. That is in addition to the £2 billion we have already provided through the elective recovery fund. We have already virtually eliminated the two-year wait and we are now on track, by April, to eliminate waits of 18 months or more.

[Andrew Lewer (Northampton South) (Con)]

4. What steps his Department is taking to increase the size of the social care workforce.

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[Jim Shannon (Strangford) (DUP)]

5. When his Department will publish the 10-year cancer plan.

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

Earlier this year, we held a successful call for evidence on a new cancer plan, which received 5,000 responses. We are now considering those responses and how we can best support the diagnosis and treatment of cancer patients. I will be in a position to update the House shortly.

[Jim Shannon]

I thank the Minister for her response, but it has been five months since July, when the 10-year cancer plan was due to be published, and 10 months since February, when the war on cancer was announced. While the Government have delayed, cancer patients have faced unacceptable waiting times for diagnosis and treatment. Performance over the past five months has been the worst on record against the target of a 62-day wait between the GP referral for suspected cancer and the first treatment. I ask the Minister respectfully: does she agree that we in this House and the people of this country now need a long-term, ambitious plan to reduce waits and ensure that cancer patients in this country have the best outcomes possible? Will she set out a timeline—not just say “shortly”—for delivering such a plan?

[Maria Caulfield]

As the hon. Gentleman knows, I cannot comment on what is happening in Northern Ireland, because health is a devolved matter. I can only update him on what is happening in England. We are not waiting for a cancer plan to start on the backlogs: that is why this Government are investing £8 billion over three years to clear the elective backlog. We are seeing record numbers of patients. Cancer treatments continued throughout the pandemic, but we are seeing a higher number coming through than usual. Despite the increase of more than 129% in patients getting urgent GP referrals since September 2019, 91% of patients in England are receiving their treatment within 31 days of the decision to treat, compared with just 87% of patients in Northern Ireland in June. We are very committed to reducing cancer waiting times. I suggest that the hon. Gentleman may wish to speak to the Minister in Northern Ireland as well.

[Maggie Throup (Erewash) (Con)]

Diagnostic activity, whether in vivo or in vitro, forms part of more than 85% of clinical pathways. Will my hon. Friend confirm that it will receive due recognition in the 10-year cancer strategy?

[Maria Caulfield]

May I thank my hon. Friend for all her hard work during her time as a Health Minister? We are going through the responses to the call for evidence right now; as I have indicated, we will update the House shortly. I will very much take her points on board.

[Dame Meg Hillier (Hackney South and Shoreditch) (Lab/Co-op)]

My constituent Jesse, who is 24, was diagnosed with grade 4 glioblastoma multiforme, a type of brain cancer. It has been devastating to her. She has had a very difficult year of treatment; crucially, after her initial round of treatment, there were delays in accessing a scan because of the backlogs in the NHS. There is a real need for a proper cancer care plan to make sure that she gets her scans as regularly as necessary. Other patients need them as well, but her scan was two months later than it should have been under the standard of care, leaving her in absolute terror that her cancer would come back. The fear is almost as bad as the disease itself. What plans does the Minister have to make sure that the 10-year cancer plan really gets to grips to the backlog, which is devastating people’s lives?

[Maria Caulfield]

I am sorry to hear about the experience of the hon. Lady’s constituent. I am sure that she will welcome the 91 community diagnostic centres that have already been set up to provide a range of tests, including CTs, ultrasounds and MRIs. We are expecting to deliver up to 160 community diagnostic centres in total, with the capacity for up to 9 million more scans per year when they are fully operational. That will not just deal with the backlog, but future-proof our diagnostic services.

[Dame Caroline Dinenage (Gosport) (Con)]

The Minister will know that cancer is the biggest cause of death in children under 14. There are countless instances of failure and missed opportunity in how we detect it, how we treat it and how we care for children with cancer. I am grateful to her for meeting my constituent Charlotte Fairall earlier this year, who tragically lost her daughter Sophie. Does the Minister agree that we need a childhood cancer mission embedded in the heart of any cancer strategy if we are serious about saving other families from that tragedy?

[Maria Caulfield]

I thank my hon. Friend for all her hard work in this space and for leading our debate on childhood cancer outcomes in this Chamber. I was delighted to meet her constituent Charlotte, who is campaigning so hard on the issue. I promised her that we would look at a child cancer mission; we will update the House on our progress shortly.

[Ruth Cadbury (Brentford and Isleworth) (Lab)]

6. What progress his Department has made on its commitment to recruit 6,000 additional GPs by 2024.

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[Clive Efford (Eltham) (Lab)]

T5. Parents are becoming increasingly worried about the current prevalence of strep A. It is a time of year when parents are going to have children with high temperatures and sore throats, so concern is likely to be very high. There are also concerns about the availability of antibiotics. Does the Secretary of State believe that this is a moment where the Government need to make a statement and show clear leadership to calm people down and reassure them about the situation?

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

We held a cross-party briefing last night on strep A. We want to reassure parents, and if their children have symptoms and they are concerned, please seek help. GPs are ready and A&E departments are ready, and we have directors of public health proactively going into schools where there are cases. There is no shortage of antibiotics—we want to reassure people on that—and we are keeping an eye on that on a daily basis.

[Antony Higginbotham (Burnley) (Con)]

The East Lancashire community diagnosis centre already includes Burnley hospital, and as part of that we are opening two new endoscopy rooms in the spring. Residents, the trust and I know that the local hospital can do even more to reduce the covid backlog with the right Government investment. Will the Minister agree to meet me to discuss phase 9 of the hospital’s development, which would bring a brand-new radiology suite?

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[Sajid Javid (Bromsgrove) (Con)]

We are seeing a sad increase in suicide rates across the country. In 2012, the then Government published a 10-year cross-Government suicide prevention plan. Earlier this year, the Government under the leadership of my right hon. Friend the Member for Uxbridge and South Ruislip (Boris Johnson) committed to a new 10-year plan that would be published before the start of 2023. There is no sign of that cross-Government 10-year suicide prevention plan, but maybe I am wrong, and perhaps the Government are about to publish it, because I know that so much of the work has already been done. May I ask my right hon. Friend the Secretary of State to show that he takes suicide prevention seriously and publish this plan as soon as possible?

[Maria Caulfield]

I thank my right hon. Friend and pay tribute to him for all his work in this area; he has driven this agenda forward. I want to reassure him that we are looking at that. He will understand that we have had some changes in recent weeks, but I assure him that tackling the issue of suicide is a high priority, and we will make an announcement shortly.

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[Gavin Robinson (Belfast East) (DUP)]

This morning, we tragically learned that a five-year-old girl who was a P2 pupil at Black Mountain Primary School died yesterday in Belfast with strep A. I am grateful to the Minister for the answer she gave to the hon. Member for Eltham (Clive Efford) on strep A and her encouraging commitment that antibiotics including penicillin are available, but can she ensure that our public health agencies across this United Kingdom co-operate with one another and that if additional resource is required, it will be made available?

[Maria Caulfield]

I am very sorry to hear about that tragic case in Northern Ireland. We want to reassure people that, while there is a slightly higher number of cases than usual for this time of year, the UK Health Security Agency is on top of this and is not concerned that there is a wider outbreak than would be expected. We want to encourage parents who are concerned that their children are not responding to get help as soon as possible. Antibiotics are available, and local directors of public health should be co-ordinating local activity, but if there are any concerns, Members should come and see me.

[Anna Firth (Southend West) (Con)]

On Saturday, I visited Chalkwell Grange, a brilliant new care home in picturesque Leigh-on-Sea which is struggling to recruit due to the guidance that all care workers should wear face masks. Will the Secretary of State give care homes the best Christmas present ever and change the word “should” to “can” or “may”, to put them in charge of their own infection control?

[Daisy Cooper (St Albans) (LD)]

My constituent is a victim of sexual misconduct by a medical professional, but they cannot challenge that professional’s fitness to practice because of the five-year rule. The General Medical Council wants that rule to be scrapped and the Government consulted on whether to get rid of it more than a year ago. Can the Minister say whether it is the Government’s intention to scrap it? Will she meet me to discuss how important it is that the GMC can explore whether a potentially dangerous medical professional who is still practising may be unfit to do so?

[Maria Caulfield]

I thank the hon. Lady for her campaigning on this serious issue. I am happy to meet her and I suggest that we also meet the patient safety commissioner, Henrietta Hughes, to discuss it further.

Oral Answers to Questions

Maria Caulfield Excerpts

Tuesday 1st November 2022 Commons Chamber

[Andrew Jones (Harrogate and Knaresborough) (Con)]

3. What steps he is taking to support people with mental health conditions.

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

The NHS long-term plan commits to investing at least an additional £2.3 billion a year by the next financial year to expand and transform mental health services in England. That will be supported by an additional 27,000 mental health professionals in the workforce to deliver that transformation.

[Andrew Jones]

I thank my hon. Friend for that answer. I recently met the child and adolescent mental health services team in Harrogate, and they confirmed that there are long waiting lists for attention deficit hyperactivity disorder and autism diagnosis. Will the Minister consider the criteria to help those who need the service most to get the support they need?

[Maria Caulfield]

I thank my hon. Friend, who raises a good point. He does a huge amount of campaigning in Harrogate and Knaresborough on this issue. We recognise there can be long waits for diagnosis both for ADHD and autism, and that is why we refreshed our national autism strategy last year, backed by more than £74 million to help to reduce diagnosis waiting times. NHS England is now setting out the process of how children, young people and adults might receive a diagnostic assessment much more quickly.

[Emma Hardy (Kingston upon Hull West and Hessle) (Lab)]

Delayed discharge from mental health beds is preventing people from getting the treatment that they need. In fact, in Humber NHS trust 42% of learning disability beds are taken by people with delayed discharge, 5.5% of secure beds have patients in waiting for adult social care, as do 70% of adult mental health beds, 22% of CAMHS beds and 27% of community beds. To deal with the problem in mental health, we need to deal with the problem of lack of adult social care placements. When will the Government be able to fix that?

[Maria Caulfield]

The Government actually started working on the plans around delayed discharges this summer, because of course they affect mental health services. They also affect a range of acute beds. With the winter coming, we know that there will be additional pressure on those beds, and that is why we are working with local government social care services and integrated care boards which have responsibility for that in their local areas.

[Dr Rosena Allin-Khan (Tooting) (Lab)]

In the last four weeks, there have been three investigations on abuse in in-patient mental health settings. The Government should be on top of the situation, not relying on undercover reports from Sky, The Independent, or “Panorama” that show patients languishing in seclusion, excessive use of restraints, bullying and dehumanisation, and falsification of medical records. Patients and their families rightly expect to be safe. Tory chaos has meant that the Government have not engaged with abuse allegations. For weeks there has been no functioning mental health Minister. Will the Minister conduct a rapid review of mental health services, respond to our concerns about in-patient services and apologise to patients and their families now?

[Maria Caulfield]

Of course we apologise for the cases that we have seen; anyone who watched some of those programmes will have seen the distressing and unacceptable care. I am the Minister with responsibility not just for mental health but for patient safety, so I will be looking at the cases in “Panorama” and other programmes, and at cases across the board, because I want to ensure that in-patient mental health services are as safe as possible. We know that these are some of the most vulnerable patients who often cannot speak out when there are problems. We are looking at the staffing, training and reporting mechanisms. On the case that was highlighted in “Panorama”, the Government are working closely with NHS England, the Care Quality Commission and the individual trusts.

[Gill Furniss (Sheffield, Brightside and Hillsborough) (Lab)]

4. What steps he is taking to improve diagnosis for people with endometriosis.

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

Gynaecological conditions, including endometriosis, are a priority in the women’s health strategy, which we published in the summer. We are committed to improving care for women with endometriosis and are particularly looking at the patient experience and journey from first seeing their GP through to diagnosis.

[Gill Furniss]

Last week, the all-party parliamentary group on endometriosis heard from many different women about their shocking experiences of getting diagnosed and treated. Despite the very good women’s health strategy, they are not seeing that on the frontline. Long waiting times, poor care and disbelief from medical professionals are all still too prevalent for women with endometriosis. Commitments in the women’s health strategy are long overdue and women are not fully feeling those benefits. When can we expect to see real progress to back that up and end this national scandal once and for all?

[Maria Caulfield]

I thank the hon. Lady for her question. The Government introduced the first women’s health strategy to make issues such as endometriosis a high priority. Of course it will take time—we published the strategy only in the summer—but work is happening already. The women’s health ambassador is working to better inform young women about the signs and symptoms of endometriosis, so that they cannot be fobbed off with advice such as, “This is just a normal period.” Better and mandatory training for healthcare professionals in women’s health is being introduced and we are working with the royal colleges to streamline the referral process.

[Dr Luke Evans (Bosworth) (Con)]

Early diagnosis in endometriosis and many other conditions is important, so I welcome the news that a community diagnostic centre was approved in Hinckley last week. That will bring MRI, ultrasound and CT scans to the heart of my community, but we are looking for more. For the likes of endometriosis, people sometimes need to have a day case procedure. Will the Minister meet me to discuss having a day case unit in Hinckley? A bid is going through that I am keen to see ensured, so that we can get the diagnosis of things such as endometriosis in the heart of my community.

[Maria Caulfield]

My hon. Friend campaigned hard for the CDC in Hinckley and I am glad that he has been successful. Community diagnostic centres will provide a range of tests to speed up the diagnosis process. I am happy to meet him, because they are just the start of a huge opportunity, particularly for conditions such as endometriosis, to get diagnoses as soon as possible.

[Drew Hendry (Inverness, Nairn, Badenoch and Strathspey) (SNP)]

5. What recent assessment he has made of the potential long-term effects of cold weather over the winter on the health of (a) children and (b) pensioners.

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[Paul Blomfield (Sheffield Central) (Lab)]

22. What estimate he has made of the average waiting time for mental health treatment.

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

Waiting time targets for adult talking therapies were exceeded in 2021-22, with 91.1% accessing those services within six weeks and 98.6% within 18 weeks.

[Mary Glindon]

Young people in the north-east potentially have to wait up to three years for mental health treatment. Local Metro Radio launched Charley’s campaign to get young people more timely health support. The campaign is in memory of 12-year-old Charley Patterson, who took her own life waiting for treatment. Labour has a fully costed plan to guarantee mental health treatment within a month of referral for patients who need it. Will the Minister commit to adopting that target now?

[Maria Caulfield]

I thank the hon. Lady for her campaign on this issue. I am very sorry to hear of the tragic case of Charley Patterson. We recognise that, particularly with the pandemic, there has been a significant rise in mental health conditions for young people and children. We are expanding services so that an additional 345,000 children and young people can access NHS mental health support, and we are providing more support in colleges too. I am very happy to meet the hon. Lady to discuss her campaign further.

[Paul Blomfield]

When I recently visited Sheffield College, students told me about the difficulty they face in accessing mental health services, and it is the same every time I visit a school to talk to students about the priorities for this place and for the Government. According to Mind, one in six young people have a mental health problem. We know that referrals for children and adolescents hit record numbers this summer. Early intervention is crucial but is simply not available. Young people are waiting months and months for their first appointment with child and adolescent mental health services after referral. There is a deepening crisis and, frankly, what the Minister just described will not address it, so what more will she do to ensure proper funding of mental health services for young people?

[Maria Caulfield]

I have highlighted that there are additional pressures—more children and young people are coming forward with mental health conditions—but I assure the hon. Gentleman that we are putting early intervention directly into schools. Mental health support teams now cover 26% of pupils, with the aim of going up to 35% of pupils by April, and we intend to increase that further. So we are getting in as early as possible. Over 420,000 children and young people were treated through NHS-commissioned services in the last financial year. There is more to be done, but we have made a good start.

[James Morris (Halesowen and Rowley Regis) (Con)]

There is a real danger that prioritisation of mental health services is not what it was a few years ago. Does the Minister agree that we need to take urgent action on workforce development and other measures to increase capacity for mental health services, so we do not let down the hundreds of thousands of young people who are on the waiting lists? We need to take action now.

[Maria Caulfield]

I agree and we are taking action now. Our aim is to expand the mental health workforce by an additional 27,000 healthcare professionals by 2023-24. We have already seen an increase—almost 6,900 more full-time equivalent staff. The workforce are the key to that, which is why are investing in them so heavily.

[Sir Gary Streeter (South West Devon) (Con)]

Waiting times to access mental health specialists in my area are unacceptably high, and I am constantly told there is simply an inability to recruit mental health specialists. I know the Minister works very hard on this subject and she just mentioned what we are doing over the next couple of years. What practical steps can the Government take to ensure that, this year, 2022, there are more mental health specialists available to serve my constituents in Plymouth and south-west Devon?

[Maria Caulfield]

My hon. Friend makes a good point. We have introduced standards to measure waiting times because the situation is very diverse across the country. NHS England is consulting on introducing five new standards so we can keep track of where the gaps are. Patients can also refer themselves to talking and psychological therapies: over 1 million people have self-referred through the NHS website without having to go and see their GP, so they can get direct access and support when they need it.

[Mark Fletcher (Bolsover) (Con)]

7. What steps his Department has taken to help improve local dental provision.

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[Carolyn Harris (Swansea East) (Lab)]

10. When he plans to respond to the all-party parliamentary group on menopause’s report on the impact of menopause.

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

I am very grateful to the hon. Lady for all her work on issues around the menopause and to all those on the all-party group on menopause for their work. I have read her report and the 13 recommendations. The Government are already working on many of those, from the cost of hormone replacement therapy through to supporting women in the workplace.

[Carolyn Harris]

The lack of information about symptoms is a recognised barrier to diagnosis. As a result, only 14% of the 13 million menopausal women in the UK have a diagnosis and are accessing treatment. More resource, training and awareness are urgently needed. Will the Government listen to the APPG’s recommendations and commit to a menopause-specific health check for all women?

[Maria Caulfield]

The hon. Lady is right about the lack of awareness. Awareness is increasing through her campaign and the campaigns of many others. That is why we are seeing a significant rise in the number of women being prescribed HRT, but there is more work to be done. I am looking through the 13 recommendations from her report, and I am very happy, when we meet regularly, to discuss that further.

--- Later in debate ---

[Jonathan Gullis (Stoke-on-Trent North) (Con)]

Forty per cent. of GP appointments are now related to mental health. That is why James Starkie and I launched the cross-party “No Time to Wait” campaign, which had the support of the Prime Minister when he was Chancellor. We have a fully costed plan with the Royal College of Nursing to pilot such a scheme. Is the Secretary of State willing to meet James and me?

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

I thank my hon. Friend for his suggestion. We are committed to boosting the mental health workforce, and I am happy to meet him to discuss his suggestions.

[Hannah Bardell (Livingston) (SNP)]

My constituent Wilma Ord and her daughter Kirsteen are victims of the Primodos hormone pregnancy drug. Will the Minister update me on where the Government are in getting justice and compensation for the affected families? Many people have died. Will she meet me and other families and representatives from the campaign group to get justice for these families? They have waited far too long.

[Maria Caulfield]

As the hon. Lady knows, there is an ongoing legal case about Primodos, but I am very happy to meet her and the campaigners because I am keen to hear their experience. Unfortunately, I cannot comment further while there is an ongoing legal case.

[Sir Robert Neill (Bromley and Chislehurst) (Con)]

I refer to my entry in the Register of Members’ Financial Interests. Last Saturday was World Stroke Day. Will my right hon. Friend the Secretary of State commend the work of the Stroke Association and its “saving brains” campaign? And will he meet members of the all-party parliamentary group on stroke to discuss how we can increase the provision of life-saving thrombectomy services across England and Wales?

--- Later in debate ---

[Peter Gibson (Darlington) (Con)]

Following a recent unannounced inspection by the Care Quality Commission, some services at Tees, Esk and Wear Valleys mental health trust have improved, but the trust’s overall rating remains “requires improvement.” Can my right hon. Friend assure me and my constituents in Darlington that his Department will keep a laser-like focus on the trust and that he will do everything in his power to ensure the trust carries out the improvements that are so desperately needed?

[Maria Caulfield]

I thank my hon. Friend for raising this important issue. I understand he recently wrote to the Secretary of State, and we will respond shortly. NHS England and the North East and North Cumbria integrated care board have commissioned an intensive support team review of the trust, and I will keep him updated. He is right to make sure that we keep this high on the agenda.

[David Linden (Glasgow East) (SNP)]

Children who are born premature or sick are often discharged from neonatal care with energy-intensive equipment, such as oxygen machines, which has an impact in terms of the cost of living crisis. Is the Secretary of State willing to meet Bliss and myself to look at the costs faced by families who come out of neonatal care and how we can support them better?

Unavoidably Small Hospitals

Maria Caulfield Excerpts

Tuesday 6th September 2022 Westminster Hall

[The Minister for Health (Maria Caulfield)]

It is a pleasure to serve under your chairmanship, Mr Hollobone. I thank my hon. Friend the Member for Isle of Wight (Bob Seely) for securing this really important debate. Small hospitals are often the Cinderella service of the NHS, and their value is not always recognised. We have heard cross-party support from Scotland and Northern Ireland, and if Welsh Members had been present I am sure that they too would have recognised the challenges that unavoidably small hospitals face.

I reassure colleagues that the ministerial team recognises the worth of small hospitals. As my hon. Friend the Member for St Ives (Derek Thomas) said, it is not just about the value they bring to their local communities, but the pressure they take off the wider health service in their regions, which we have seen particularly clearly in recent months and years. When we had covid hot and cold sites in the NHS, smaller hospitals were able to work and function and take some of the pressure off larger hospitals that had large outbreaks of covid. While I acknowledge that small hospitals are more expensive to run, their added value cannot be underestimated. My constituency does not have a hospital, so my constituents have to travel. We do, however, have the Lewes Victoria Hospital—it is a small community hospital, not an unavoidably small hospital—and my constituents really value its work. If they did not have it, they would have to go to the big hospitals in Brighton, Eastbourne or even Hastings, so I am on the same page as many of the Members here.

My hon. Friend the Member for Thirsk and Malton (Kevin Hollinrake) and my right hon. Friend the Member for Richmond (Yorks) (Rishi Sunak) touched on this. When trusts run a portfolio of hospitals, it is often tempting for them to move services to a much more cost-efficient, bigger site, but what then tends to happen is that, once the consultant-led maternity service goes, it becomes difficult for the anaesthetists to keep up their skills, and all of a sudden the hospitals become unsustainable. That is a risk. As my right hon. Friend highlighted, and as I saw when I visited the constituency of my hon. Friend the Member for North Devon (Selaine Saxby), there has been a resurgence in interest in small hospitals and their values. We are putting in surgical hubs and investment because we recognise that they can do specialist work, sometimes more easily than big trusts that have the pressures of big A&E departments, trauma centres and wards that are struggling with capacity.

Smaller hospitals can deliver in different ways, but there are no doubts that they face unique challenges. My hon. Friend the Member for Isle of Wight touched on the significant issue of funding. I will come back to that, but I will first touch on some of the other issues they face. On the Isle of Wight, for example, having a smaller hospital can sometimes produce better quality of care for patients. The ambulance handover delays on the Isle of Wight are minimal. The average handover for emergency conveyancing is less than 15 minutes, and their record on 60-minute breaches is often better than that of some of the larger centres.

The quality of care can also be a significant factor, but that also takes intervention and support. It is not just about the funding and the staffing, which we have also touched on, but the system itself. The recovery support programme that has evolved from the special measures programme is working with small hospitals to provide a systems-focused approach to support them and address some of those challenges. As my hon. Friend the Member for Isle of Wight has said, the hospital there went into special measures in 2017 and it is now rated as good. That resulted from a lot of support from the national systems, but also from the hard work of local clinicians and managers. It is a testament to their hard work.

Retaining workforce is difficult. We know that GPs, dentists and nurses are more likely to stay where they trained. That is difficult for smaller hospitals, because traditionally they do not have their own training programmes. People train in large teaching hospitals and often stay there and develop their practice further.

Health Education England is working on changing the traditional nature of training. Blended learning programmes use a combination of technology, online learning and the apprenticeship model to make it easier for small hospitals to train their own staff of nurses, healthcare workers and doctors. There is also the apprenticeship model, with apprenticeships now available in a number of healthcare organisations. Existing staff can take apprenticeship routes, stay in their workplaces and not have to travel long distances to universities miles away. That is important, whether it is for the registered nurse degree apprenticeship, healthcare assistant practitioners or the new medical doctor degree apprenticeship. That will make it easier for smaller hospitals to train and develop their own workforce and, crucially, to upskill the existing workforce. Traditionally, if someone wanted to take on an advanced nurse practitioner role or was an anaesthetist wanting more training, they would often have to leave their small hospital and go to a bigger teaching hospital to take such courses. The blended learning programme will make recruitment and retention easier for smaller hospitals, and will be a lot more rewarding for staff.

My hon. Friend the Member for Isle of Wight talked of funding. I am the first to acknowledge that smaller, more rural and coastal hospitals have greater expenses because they cannot get the scale of efficiency of a larger teaching hospital. A lot of work is going in to supporting the funding mechanism. NHS England is responsible for allocating funding. It goes down to the new integrated care boards, which were established in July. Funding allocations for this financial year were published earlier this year. If my hon. Friend cannot find that information, I am happy to provide him with the figures and the algorithm used to achieve them. The formula seeks to acknowledge geographic and demographic distribution, which can vary, as a number of hon. Members have said. Some areas can have an older population, and it is important that the funding formula reflects that. The discussion is between NHS England and the integrated care boards. There has been a change in the formula to take account of the higher costs of providing emergency services in particular in sparsely populated areas, with an adjustment for costs that are unavoidable due to the small nature of the hospital.

If my hon. Friend and other hon. Members feel that the changes to that formula and the relationship between NHS England and the local integrated care boards are not delivering some of the funding measures we had hoped for, I am happy to discuss that further and to sit down with colleagues so that they are clear about the funding formula and allocation. It should not require trawling through pages of documents to find that out. I am happy to help my hon. Friends with that, because it is important to recognise.

I want to touch on urgent and emergency care. It is important for emergency care to be available locally, but that can be a challenge for unavoidably small hospitals, because they see a much smaller number of trauma cases or cardiac arrests. Highly skilled staff, such as anaesthetists, with the support of their royal colleges, need a number of such cases to keep their skills in place, and we need to support them.

I want to reassure colleagues that we are committed to keeping smaller hospitals. The investment in the Friarage surgical hub is a case in point. We have also recently seen investment in North Devon. I also hear the call for the 40 hospitals programme. We are committed to that, and it is important that staff have that reassurance and patience, because it is about not just the services that are technically on a site, but the quality of care. As smaller hospitals often know their patients well, they get a quality of care that they sometimes do not get in larger hospitals with hundreds of patients coming through a department.

[Kevin Hollinrake]

One of the Minister’s predecessors wrote to me on 28 October 2019 and said that a new community services formula was being used for hospitals such as Scarborough Hospital in my constituency, and others that have been mentioned. Will the Minister write to tell us exactly what impact that has had on funding since 2019 so that we can understand what extra resources have been made available?

[Maria Caulfield]

I am happy to write to all colleagues on that. It is important to understand the difference that that formula will make and to assess whether it is working in practice, and Members of Parliament will be able to pick up quickly on whether it is making a difference locally. I also encourage colleagues to meet their integrated care boards—if they have not already done so—which will have a relationship with NHS England and will supply the information on the demographics and geographical variations that make the formula work. The integrated care boards came into force in July, and now is a good opportunity to have those conversations so that ICBs are clear that Members of Parliament and their local communities value smaller hospitals and that that must be considered when decisions on funding and services are made.

We have had a good debate. I want to reassure colleagues that small hospitals are a vital part of the NHS family: they take pressure off some of the larger services and provide good quality service for local residents, who really value them.

[Jim Shannon]

I thank the Minister for her answers. The hon. Member for Caithness, Sutherland and Easter Ross (Jamie Stone) and I both asked questions about health being devolved in Northern Ireland and in Scotland, and we are keen to ensure that some of the thoughts and ideas from the debate are shared with the devolved Administrations. Can the Minister confirm that that will happen?

[Maria Caulfield]

Absolutely. We need a collaborative approach because we all face the same challenges, whether in Scotland, Wales, Northern Ireland or England. I have been in contact with Minister Swann over recent months, and I am happy to work with him and the other devolved Administrations on these matters, because we all have a shared interest in ensuring that small hospitals are successful.

I can reassure colleagues that we want to support our smaller hospitals in future so that they are able to do more for their local communities.

Oral Answers to Questions

Maria Caulfield Excerpts

Tuesday 19th July 2022 Commons Chamber

[Robbie Moore (Keighley) (Con)]

2. What steps his Department is taking to help the NHS achieve net zero.

[The Minister of State, Department for Health and Social Care (Maria Caulfield)]

We are committed to supporting the NHS to achieve net zero by 2040 for direct emissions, with the Government already investing £280 million through the public sector decarbonisation scheme to support that ambition.

[Robbie Moore]

The NHS plays a key role in our national attempts to achieve net zero. I was therefore delighted to see the Airedale NHS Foundation Trust submit its plans for a new Airedale Hospital in my constituency. Those plans of course deal with the severe structural risk associated with aerated concrete, but they are also designed to create Europe’s first ever carbon neutral hospital. Does my hon. Friend agree that these are extremely exciting plans and that they are another reason why we should try to achieve a new Airedale Hospital in my constituency?

[Maria Caulfield]

I thank my hon. Friend, who campaigns hard on this issue for Airedale Hospital. I absolutely understand the urgency around aerated concrete given the effect it is having, and of course I agree that the NHS has a vital role in supporting net zero. He will understand that I cannot commit to any one application. We are reviewing all applications and we aim to make a final decision later this year.

[Jim Shannon (Strangford) (DUP)]

Can the Minister assure me, and the House, that the money used for the purpose of achieving a net zero NHS will have no impact on, for instance, those who are on waiting lists for cataract operations, who cannot even see the environment because they have been waiting for their operations for so many years? Net zero is very important, but what is more important is getting those operations done.

[Maria Caulfield]

I think we can do both. We have already reduced emissions in the NHS by 30%, and there are a number of ways in which we can reduce them further, from changes in procurement—the NHS will no longer purchase from suppliers that are not aligned with net zero ambitions—to the delivery of estate change.

[Alison Thewliss (Glasgow Central) (SNP)]

3. If his Department will take steps to fully implement the international code of marketing of breastmilk substitutes.

--- Later in debate ---

[Matt Western (Warwick and Leamington) (Lab)]

7. What recent estimate he has made of the average waiting time for emergency care.

[The Minister of State, Department for Health and Social Care (Maria Caulfield)]

NHS Digital publishes information on average waiting times, and the data for May shows that the median average total time spent in A&E for all patients was three hours and six minutes.

[Matt Western]

Across the west midlands, 38 people died waiting for ambulances between March and May 2022. In the same period in 2021, two people died; before 2019, in the corresponding period, there were no deaths. A week ago Sunday, 80 people were waiting in accident and emergency in my constituency. What are the causes of these problems?

[Maria Caulfield]

The west midlands is more affected than many regions of the ambulance service. There are a number of causes, the first of which is that we are living with covid, which has not disappeared. If we look at the in-patient rates, we see that they have increased significantly; last month, they were 17.9 per 100,000 and they are now up to 24.4 per 100,000 in the west midlands, which is experiencing significantly higher rates than other parts of the country. [Interruption.] If the shadow Secretary of State wants to hear this, I can tell him that we also have a significant number of staff sicknesses from covid; this time last year, it was about 4% of staff but when I spoke to some trusts this weekend I heard that it was up to 6%. That has a knock-on effect on acute and emergency services and ambulance services being able to respond.

[Mark Logan (Bolton North East) (Con)]

Derek Taylor came to my surgery as his late wife Lynda had tragically passed away in Moses Gate country park while they were out walking together. The ambulance was unable to access the park due to barriers impeding entry, and he will never know whether Lynda’s life could have been saved. What steps can the Minister take to ensure that all public parks are accessible to ambulances in cases of emergency?

[Maria Caulfield]

I am very sad to hear of the experience of my hon. Friend’s constituent and he is right to say that emergency services need to be able to access public areas. I am happy to talk to him about that afterwards to see what more can be done.

[Ruth Cadbury (Brentford and Isleworth) (Lab)]

“24 hours in A&E” was a reality TV programme but now it appears to be the reality for far too many people. The zero tolerance standards on 12-hour A&E waits and 30-minute ambulance handover delays are being systematically and seriously breached. So when do the Government plan to achieve those standards, which were set and delivered by the Labour Government?

[Maria Caulfield]

Let me place on record my thanks to all the ambulance staff up and down the country who have gone above and beyond in the past 24 to 48 hours to be able to respond to extreme pressures that are only really seen in winter times. Let me give a scale of the pressures they are under. Compared with the situation in May last year, there have been over 100,000 more calls to the ambulance service, and there were 2.1 million attendances at A&E departments in June, which is 3.6% higher than the figure for June 2019. So they are under incredible pressure, and I pay tribute to all of them doing their best.

[Mr Richard Holden (North West Durham) (Con)]

One issue affecting waiting times in many acute hospitals is the fact that so many people could be in community hospitals instead. In my constituency, I have a bid in to replace Shotley Bridge Community Hospital, doubling the capacity to 16 beds from the current eight. However, this is not under way just yet, as a few more hoops need to be jumped through. Will the Minister or Secretary of State come on a visit with me to North West Durham to see what more we can do to speed through the replacement hospital for Shotley Bridge as quickly as possible, to help ease some of the issues in our acute hospitals?

[Maria Caulfield]

My hon. Friend is right; the delayed discharges and being able to free up those beds has a knock-on effect on A&E, which in turn has a knock-on effect on ambulances being able to unload. We have the £2 billion better care fund, which is supposed to be addressing just that, to help integrated care boards deliver and help patients get out of hospital. I have a meeting with all the integrated care boards tomorrow, so his is a timely question, but I am happy to meet him as well.

[Mr Speaker]

I call the shadow Minister, Dr Rosena Allin-Khan.

[Dr Rosena Allin-Khan (Tooting) (Lab)]

Thank you, Mr Speaker. A&E waiting times are through the roof, and we have people waiting without a bed—not even a trolley. This is removing the dignity that every patient deserves, but, sadly, it is not a one-off; this is commonplace up and down the country. It is not the Health Secretary who is on the receiving end of it, but staff, who are running from patient to patient trying to ease pain, diagnose illness and save lives—most importantly, it is of course the most vulnerable themselves. When the Minister hears reports such as this, does she not feel ashamed of the decisions her Government have made over the past 12 years?

[Maria Caulfield]

I say gently to the hon. Lady, who does amazing work on the frontline in A&E, that I have worked in A&E under the last Labour Government—I am showing my age now—and there were trolley waits and ambulance queues then as well, just as there are in Wales, where Labour is running the NHS, and in Scotland and in Northern Ireland. This is unprecedented pressure, because we are trying to live with covid and deal with a backlog of procedures and rising cases. The shadow Secretary of State was not here yesterday, so he may have missed some of the support that we are putting in. We are putting £150 million of extra funding into the ambulance service, £50 million into 111 to increase capacity, and £30 million into an auxiliary ambulance service to increase support. We are supporting the service, but we must recognise that it is facing unprecedented pressures.

[Dr Allin-Khan]

With respect, I will take no lectures from the Minister about working in A&E under a Labour Government and a Conservative Government. I have worked in the NHS under a Labour Government, when NHS waiting times hit record lows, and I have worked under a Tory Government, when NHS waiting lists hit record highs.

The Minister can use the pandemic, the heatwave, or even winter as justification. I have seen that emergencies do increase demand for services, but there is no excuse for not hitting the four-hour A&E waiting target for seven years. There is no defence for stroke and heart-attack victims waiting almost an hour for an ambulance. Undoubtedly, lives will be lost that could have been saved. Will the Minister apologise for those failings?

[Maria Caulfield]

The hon. Lady says there is no excuse for missing those waiting times, but perhaps she can explain why the Labour Government in Wales are also missing those times.

[Nicola Richards (West Bromwich East) (Con)]

8. What steps he is taking to improve cancer outcomes.

--- Later in debate ---

[Colleen Fletcher (Coventry North East) (Lab)]

10. What steps his Department is taking to support innovation in the treatment and care of NHS patients.

[The Minister of State, Department for Health and Social Care (Maria Caulfield)]

The NHS has made significant progress in recent years in embracing innovations, from the NHS app where patients can now access their medical records, to the expansion of electronic patient records making it easier for healthcare professionals to share information for better, safer care for patients.

[Colleen Fletcher]

I recently visited Coventry and Warwickshire Partnership NHS Trust’s wound healing service and saw the ground-breaking work being undertaken there, which is changing the lives of people who were thought to be living with unhealable wounds. By adopting innovative methods of healing, the service has not only healed the unhealable, giving patients back the quality of life they deserve, but reduced the average cost of healing at the trust. Will the Minister look at how this approach could be adopted more broadly to improve patient care, save money, and reduce on-costs incurred through unhealed wounds?

[Maria Caulfield]

I thank the hon. Lady, because it is the first I have heard of that and it sounds very exciting. I know how difficult it is with chronic wound management to get wounds to heal. Often these are patients with multiple co-morbidities such as diabetes that make the wounds very difficult to treat. I am keen to visit her constituency and her trust to learn more about it.

[Rushanara Ali (Bethnal Green and Bow) (Lab)]

11. What steps he is taking to help reduce waiting lists for people transferring to a care setting.

--- Later in debate ---

[Alan Brown (Kilmarnock and Loudoun) (SNP)]

22. If he will make an estimate with Cabinet colleagues of the amount of unusable PPE procured by Government since the outbreak of covid-19.

[The Minister of State, Department for Health and Social Care (Maria Caulfield)]

Around 3% of PPE that the Department purchased was unusable. We are working to dispose of this unusable stock in the most environmentally friendly way.

[Kirsten Oswald]

I am grateful for that response. From the onset of the covid-19 pandemic, the Scottish Government have worked with the NHS and Scottish suppliers, as well as on a four-nation basis, to ensure that Scotland has adequate stocks of PPE. In Scotland, 88% of PPE is produced locally, and the overall cost of pandemic procurement was a third less than for the UK. The Scottish Government have committed to retaining powerful safeguards on the use of public money in healthcare through strong procurement rules. Will the UK Government follow suit and replicate this ethical model?

[Maria Caulfield]

I am very interested to hear from the hon. Lady, because according to The Herald on Sunday recently, half a billion pounds-worth of procurement in Scotland during the pandemic did not go through the usual scrutiny process. I would be very interested to hear her update on that.

[Alan Brown]

The Public Accounts Committee found that there is £4 billion-worth of unusable, substandard PPE in storage, which is due to be incinerated, which is hardly environmentally friendly. While cronies and donors were fast-tracked, this substandard PPE put frontline workers’ lives at risk by preventing them from accessing the right equipment. How much of that £4 billion will be recovered, and what other actions are being pursued against these so-called suppliers?

[Maria Caulfield]

To put this in context, I make no apologies for all the efforts that were made to secure PPE for frontline staff. We delivered more than 21.5 billion items of PPE to keep frontline staff safe during a time when we had a dangerous virus that no one knew anything about, we had no vaccine and there was a global push on the market resources. Those products that we procured that did not meet the standards for health and social care were used in other avenues. For example, we donated masks to transport operators and to schools, so that we could reopen the economy and to help them to keep safe.

[Mr Speaker]

I call SNP spokesperson, Martyn Day.

[Martyn Day (Linlithgow and East Falkirk) (SNP)]

While the Tories flogged off PPE contracts to party donors and friends of Ministers through their unlawful VIP PPE lane, the Scottish Government’s processes ensured value for money, as we have heard; their PPE costs were less than a third of the UK Government’s. Will the UK Government follow Scotland’s example in future, and refuse to engage in cronyism and corruption?

[Maria Caulfield]

I outlined in my answer to the hon. Member for East Renfrewshire (Kirsten Oswald) that around half a billion-worth of pounds of procurement in Scotland did not go through the usual channels. All offers that were identified, regardless of route, underwent rigorous financial, commercial, legal and policy assessment, led by officials, and the final decision on whether to enter a contract sat with the appropriate accounting officer at the Department.

[Ian Byrne (Liverpool, West Derby) (Lab)]

T1. If he will make a statement on his departmental responsibilities.

--- Later in debate ---

[Cherilyn Mackrory (Truro and Falmouth) (Con)]

Last week, I chaired a joint meeting of the all-party parliamentary groups on maternity and on baby loss, where we heard from bereaved parents, maternity staff, and the fabulous and dedicated Donna Ockenden. Given that the women’s health strategy is about to be published, can the Minister or the Secretary of State reassure everybody in the sector that it will address maternity safety and the maternity staff numbers we so badly need?

[The Minister of State, Department for Health and Social Care (Maria Caulfield)]

I thank my hon. Friend for all her hard work campaigning on pregnancy and baby loss. We will publish the women’s health strategy shortly. Baby loss featured heavily in the call for evidence, and we committed to provide more than £200 million of funding to improve maternity staffing after the Ockenden review.

NHS PPE Supply Chains: Forced Labour

Maria Caulfield Excerpts

Thursday 14th July 2022 Westminster Hall

[The Minister of State, Department for Health and Social Care (Maria Caulfield)]

It is a pleasure to serve under your chairmanship, Ms Rees.

I start by congratulating the hon. Member for Strangford (Jim Shannon) on securing this debate and on all his hard work, alongside Members such as my hon. Friend the Member for Congleton (Fiona Bruce), on this significant issue. It is important to debate the supply chain for NHS PPE, to learn lessons from the past and to ensure that robust systems are in place for the future. I reassure him, and all hon. Members, that this matter is a priority for the Department and we continue to take steps to ensure that there are robust systems to safeguard against the coming into the system of supplies that may be linked to slavery or forced labour. I am pleased that this issue was debated during the passage of the Health and Care Act 2022, and further legislation will be introduced to address it.

However, I must put it on the record that our priority during the pandemic, as Members will understand, was to protect our frontline staff. This was a global crisis, in which we were competing against many countries to secure PPE for our frontline workers. Nevertheless, we had and still have a responsibility to those across the PPE supply chain to make sure that when PPE is procured, it is done responsibly and does not put people in any part of that chain at risk. It is absolutely important that we do that both globally and domestically, because although the hon. Member for Strangford rightly mentioned the Uyghurs in China, we have heard only too well this week from Mo Farah that slave labour and slavery exist in this country as well.

I take the point that the hon. Member for Coatbridge, Chryston and Bellshill (Steven Bonnar) raised about his concerns about the Government’s approach, but I will gently say that the Herald on Sunday stated that during the pandemic, half a billion pounds-worth of procurement in Scotland did not go through the usual scrutiny process, either—and that was just one report. That reflects the fact that all countries during the pandemic had to make tough decisions to get supplies through, safeguard frontline services and ensure that those pieces of equipment were in place. Where lessons need to be learned, we absolutely will do so. Since the pandemic, almost 40 billion items of PPE have been ordered and almost 20 billion were distributed by March 2022. We are still distributing over 600 million items a month. That shows the scale of the amount of PPE that we have had to distribute. Hon. Members will be aware that covid rates are still high at the moment, so PPE is still very much needed by our frontline staff.

Global chains were used to procure many supplies, whether aprons, gloves or masks, but where possible we have tried to escalate domestic supply, because while it is not 100% failsafe against slavery, it is more likely that there are robust systems in place. To effectively distribute the supply across health and social care settings, we have built a distribution network from scratch and adopted a sophisticated sales and operations planning system to regulate supply and distribution. We have a clear understanding of where the stock has come from and the processes in place to ensure that slavery or forced labour was not used in any part of that chain. Part of the network is using technology to track and trace where that supply comes from, and if there are queries or concerns in the future, we are able to look back and see where those supplies came from. Since April 2020, over 6.9 billion PPE items have been ordered through that e-portal system.

As we move to living with covid, the decision has been made to step down some of the Department’s work on the PPE programme, and we are handing that over to the NHS supply chain more generally. Safeguards in the Act ensure that some of that work will continue to happen. Modern slavery encompasses the offences of slavery, servitude, forced and compulsory labour and human trafficking. The NHS has a significant role to play in combating modern slavery, including by taking steps to ensure that the NHS supply chains and business activities are free from labour abuses. The Government rely on their suppliers for the delivery of many important public services, and we expect high standards of business ethics from our suppliers—and their agents. They will be routinely checked for that.

The Department follows a procurement approach, as set out in the UK Government modern slavery statement, that includes a zero-tolerance approach to modern slavery and a commitment to ensure that respect for human rights is built into all our contracts, self-assessments, audits, training and capacity building. I reassure the hon. Member for Strangford that if there is a complaint or a suggestion of any supply being involved in slavery or forced labour, we can lock down that stock until an investigation is concluded. We can then unlock it if no evidence is found, but we can stop some of those contracts if there is evidence of forced labour. We look at what happens in other countries—he touched on the US—and if other countries are finding evidence of slave labour used in any part of the supply chain, investigations will start on UK stock as well.

[Jim Shannon]

I thank the Minister for her positive response. Clearly, the United States has taken a line of legislative action. Has the Minister had a chance to discuss or get ideas from what the States are doing and what drove them to do that? I posed that question and both hon. Members who spoke asked the same question. If they can do it in the States, we can do it here.

[Maria Caulfield]

Absolutely. We have secondary legislation coming forward that will enact what was agreed in the Health and Care Act 2022, which will look at some of this issue. The Procurement Bill is also passing through the House of Lords and will come to our Chamber. It will look at procurement more generally, not just NHS procurement. If he and other hon. Members with a keen interest in the subject, such as my hon. Friend the Member for Congleton, have specific questions on NHS procurement, I am happy for them to write to me and we shall see whether we can look at them as part of scrutiny of the Bill as it progresses. He is right that we want to ensure that we are learning lessons and sharing best practice across the board. I cannot speak for other Departments, but we are keen to get that right for the NHS where possible.

We are taking steps to achieve greater supply chain visibility, particularly where risks are highest, with the recognition that workers in the lower tiers of supply chains are often the most vulnerable. In line with that, we ensure that all contracts placed by the Department adhere to standard terms and conditions that include clauses requiring good industry practice to ensure that there is no slavery or human trafficking in supply chains.

Suppliers appointed to NHS supply chain frameworks must also comply with those standards or they can be removed from consideration for future opportunities. All the suppliers of PPE frameworks let in conjunction with the Department were registered and required to complete a modern slavery assessment and a labour standards assessment. Our purchase process includes safeguards to strengthen due diligence and to terminate a contract should there be substantiated allegations against a provider.

We are not content to rest on the status quo, which is why the Health and Care Act contained a regulation-making power that will come into force, designed to eradicate the use in the NHS of goods or services tainted by slavery or human trafficking. The regulations will set out the steps that the NHS should be taking to assess the level of risk associated with individual suppliers and the basis on which it should exclude them from a tendering process. Those regulations will help to ensure that the NHS, the biggest public procurer in the country, is not buying or using any goods or services produced by or involving any kind of slave labour. It represents a significant step forward in our mission to crack down on the evils of modern slavery wherever they are found. We are grateful to the work of modern slavery campaigners, who hailed the regulations as

“the most significant development in supply chain regulation since the Modern Slavery Act 2015”.

Alongside those regulations, the Health and Care Act also requires the Secretary of State to carry out a review into the risk of slavery and human trafficking taking place in NHS supply chains and to lay before Parliament a report on its outcomes. That review will focus on NHS supply chain activity, as well as supporting the NHS to identify and mitigate risks with a view to resolving issues. The review and the regulations will send a clear signal to suppliers that the NHS will not tolerate human rights abuses in its supply chain; they will create significant incentives for suppliers to review their practices; and they will block, if necessary, any suppliers that are found to be using human trafficking or slave labour.

I was moved to hear the cases of the Uyghurs that the hon. Member for Strangford raised. He is right that that goes far beyond the NHS, which is why the Procurement Bill, currently passing through the other place, is an important piece of legislation. I am sure that he and other hon. Members, such as my hon. Friends the Members for Wealden (Ms Ghani) and for Congleton, and my right hon. Friend the Member for Chingford and Woodford Green (Sir Iain Duncan Smith), who are assiduous campaigners on the issue, will take a keen interest in that.

I conclude by thanking all hon. Members for their contributions. Modern day slavery is a deplorable practice that causes irreversible harm to those affected. We all have a responsibility to call it out. As a Department, we take it extremely seriously. I hope that, by sharing what is happening, I have given hon. Members confidence that we will do all we can to root it out and take out of our supply chains any affected pieces of equipment.

[Catherine West]

The Minister is being generous; I recognise that she is speaking from a health perspective. Will she undertake to write to hon. Members present about the Government’s progress on cross-departmental best practice sharing from her Department?

[Maria Caulfield]

I am very happy to do that. While I have been able to highlight what the NHS is doing, some good cross-departmental work is also being done on procurement and on identifying where slavery is happening both globally and domestically. I highlighted the evidence from Mo Farah this week. We must not take it for granted that slavery is not happening in this country. I am happy to write to the shadow Minister and those who have taken part in the debate to highlight the work that is happening across the Government. It has to be a cross-Government initiative to make sure that we are all working together to root this out. Much remains to be done to ensure that we deliver the message that modern day slavery is completely unacceptable. I look forward to working with MPs across the House to make sure that we all do our bit.

[Christina Rees (in the Chair)]

Jim Shannon, would you like a couple of minutes to wind up?

Ambulance Services and National Heatwave Emergency

Maria Caulfield Excerpts

Wednesday 13th July 2022 Commons Chamber

[Wes Streeting (Ilford North) (Lab)]

(Urgent Question): To ask the new Secretary of State for Health and Social Care if he will make a statement on ambulance services and the declaration of a national heatwave emergency.

[The Minister of State, Department for Health and Social Care (Maria Caulfield)]

Our ambulance service performs heroics every single day, and I put on the record my thanks to every single one of its staff for their dedication and hard work. We have a duty to support this vital service and give it the resources it needs.

The latest figures from the NHS in England show that ambulance service response time performance has improved month on month, and that ambulance hours lost are also improving month on month. However, we fully acknowledge the rising pressures facing the service, and there are three significant factors influencing the situation. First, bed occupancy is currently around 93%, which we would normally see during winter. Secondly, there are high rates of hospital covid admissions—whether “with covid” or “because of covid”—and that puts pressure on A&Es’ ability to admit patients. Thirdly, void beds are running at roughly 1,200, partly due to a 16% increase in the length of stays. Delayed discharges are another significant influence, but they remain flat. We also have record numbers of calls to the ambulance service—100,000 more compared with May last year. There is therefore significant pressure on the system.

We also have to be mindful of the weather in the coming days. We do have a heatwave plan for England, which was published earlier this year—I am sure the hon. Gentleman has read it—and we also have the hot weather plans that NHS trusts have put in place. In addition, we are providing sector-specific guidance setting out the best way to protect people who may be at risk. We are also supporting the service more widely to make sure it has the resilience it needs. We have allocated £150 million of extra funding for the ambulance service this year, and we are boosting the workforce too. The number of national 999 call handlers had risen to nearly 2,300 at the start of June, which is a considerable increase on the previous September, and we are on track to train 3,000 paramedic graduates a year nationally every year until 2024. On top of this, we have invested £50 million in NHS 111 to help give extra capacity to the service.

I will be meeting all 11 ambulance trusts over the coming days to make sure that they have the capacity and the resilience they need not just to deal with the pressures now, including with the warm weather, but to prepare for the forthcoming winter pressures that we know are inevitable. This is an important issue that I take extremely seriously, and I will keep the House updated as the situation develops.

[Wes Streeting]

Thank you, Mr Speaker, for granting this urgent question, but what a disgrace that the Secretary of State is not here. Our NHS is going through the biggest crisis in its history, every ambulance service is on the highest level of alert, patients are forced to wait hours in pain and discomfort, and he is yet to say a word about any of it. The Home Secretary was not at the Home Affairs Committee this morning, and the Health and Social Care Secretary is not here this afternoon. This is not even a Government in office, let alone in power.

One person who is still in office, however, is the Minister. Her boss resigned saying he could not put loyalty above integrity any longer. Well, the Minister obviously made a different choice. Can she say whether any further meetings of Cobra are scheduled beyond the meeting held on Monday? As we saw during the pandemic, public health emergencies require clear communication from Government. Can she tell the House what the consequences of a national heatwave emergency would be for schools, public transport services and other public services, and what guidance will be provided to the general public? What assessment has she made of the suitability of care homes to protect residents from the extreme heat, and what contingencies are in place should further measures be necessary?

Every ambulance service is now on the highest level of alert, so what is the Secretary of State doing about it? The Minister talks about targeted help for ambulance services—she is going to be hitting the phones this week; presumably the Secretary of State is too busy—but, as I think she acknowledged, this is a crisis across the health service. Last month, a crew in the west midlands waited 26 hours outside A&E because clinical staff were not available to hand over to. What are the Government doing to provide additional support to A&Es during this heatwave? These pressures are not new. Average waiting times for stroke and heart attack victims are one hour. Patients in the north-east were told to phone a friend or call a cab rather than rely on emergency services. Is it not the case that, although extreme weather is of course putting further pressure on our emergency services, it is 12 years of Conservative underfunding that has left them unable to cope?

In conclusion, if people such as the Home Secretary and the Health Secretary cannot be bothered to turn up to do their jobs and are not interested in the business of running this country because they are too busy making endorsements for fantasy candidates with far-fetched promises, perhaps it is time they step aside so that Labour can give Britain the fresh start it needs.

[Maria Caulfield]

Can I say how disappointed I am at the shadow Secretary of State’s response? If he is not happy that a female Minister with over 20 years’ experience in the NHS is able to answer a question on NHS waiting times, I find that very disappointing.

As I said in the debate a few weeks ago, I do not want to bring politics into health because I think it is too important, but if the shadow Secretary of State wants to play politics, I will give him politics. If we look at Wales, where Labour runs the NHS service, we see that the ambulance service and A&E departments are facing exactly the same pressures. Only 51% of red calls in Wales are being seen in eight minutes; the target is 65%. If he looks at the call time for strokes, he will see that only 17% of those people are being seen in time. Those numbers are falling month on month, whereas in England our responses are improving month on month. On the four-hour wait in A&E in Wales, 34.9% of people have been seen within four hours.

[Wes Streeting]

indicated dissent.

[Maria Caulfield]

The hon. Gentleman shakes his head, but he stood at the Dispatch Box just now and said that Labour would do better. It is not doing better in Labour-run Wales; it actually has either similar response times or worse response times.

I have set out a plan. It is clear that the hon. Gentleman has not read the heatwave plan for England, which was published earlier this year, because he would have the answers there. We are making sure that all NHS trusts are prepared. I am happy to work with each and every Member across this House to make sure that the ambulance service, our A&Es and hospital trusts have the support that they need, but if all he wants to do is play politics, I think that is extremely sad.

[Mark Pritchard (The Wrekin) (Con)]

Would the Minister like to put on record her thanks to all the hard-working ambulance crews of the West Midlands Ambulance Service, particularly those working throughout the county of Shropshire? Does she agree with me that this is not just about ambulances, but about local authorities—in my case, Shropshire Council and the borough of Telford and Wrekin—working alongside acute trusts such as the Shrewsbury and Telford Hospital NHS Trust? A collective effort is required, not a single effort by a single ambulance service.

[Maria Caulfield]

I thank my right hon. Friend, who is absolutely right, because a number of factors are influencing the wait times at A&E. While delayed discharges are not increasing, there are still a significant number of them, which means that the NHS and local authorities have to be working together. That is why we have created the integrated care boards, which Opposition Members voted against, to better co-ordinate care between health and social care so that we can have better systems in place to discharge patients sooner. As I have said, we have 1,200 void beds, which is either due to infection control measures because of covid rates increasing or because patients cannot be discharged. I will be meeting every single ICB in the coming days, because as part of our winter preparation, we need to improve co-ordination in those areas.

[Daisy Cooper (St Albans) (LD)]

Last October, I revealed through a parliamentary written question that every ambulance service in England was at the highest alert level. We are now nine months on, and we are in that situation again. We are facing warnings of extreme weather this weekend. The Government need to reinstate the funding for discharge packages into social care homes. We need primary care to be used to stabilise people in communities, and we must be using first responders from the fire service. Will the Minister agree to convene an urgent meeting of Cobra today to protect patients and paramedics, who are really operating at the brink?

[Maria Caulfield]

I say to the hon. Lady that we have put additional investment this year—over £150 million of extra funding—into ambulance services to help them meet demand, because they do have significant demand. The rates we are seeing at this time of year are the sorts of rates we would normally see in winter, and we are doing exactly as we would then. We have our heatwave plan, which was published earlier this year, and we are confident that we are working with all NHS trusts, and all the ambulance trusts too, to make sure they have the support they need. Can I gently say to her that this is not just about funding? This is about bringing care together to ensure that hospital beds are freed up so that when ambulances arrive at A&E they can unload their patients. As I said to the shadow Secretary of State—I am not sure if he is going to take me up on this—I am happy to work with every single Member across this House to make sure that we support our emergency services.

[Scott Benton (Blackpool South) (Con)]

I welcome the reassurance the Minister has provided regarding capacity and resilience planning over the coming weeks. A&E services at Blackpool Victoria Hospital have been under significant pressure of late, and the planned £15 million Government-funded improvements to increase capacity there frankly cannot come soon enough. Will the Minister meet me to discuss the progress of these plans to ensure that patients can see the benefits as soon as possible?

[Maria Caulfield]

I thank my hon. Friend, who has been campaigning vigorously for better healthcare provision in his local area. I am very happy to meet him to discuss those plans, and I recognise that there is an urgency about that. I can reassure him that six areas of the country account for about a third of the handover delays, and we are specifically focusing our efforts on them. This is about relieving the pressures in the system, whether through more capacity at A&E so that patients can be seen more quickly once they arrive by ambulance, or support for the ambulance service itself. I am very happy to meet him to discuss the problems in his local area.

[Grahame Morris (Easington) (Lab)]

Despite the promises and assurances that the Minister set out in the heatwave plan and in her response, I am very disappointed that previous promises made in the House by the Minister, that she would speak with North East Ambulance Service whistleblower Paul Calvert, my constituent, have not been honoured. If Ministers will not engage with those who identify ongoing problems and learn lessons to fix our failing ambulance service, how can we expect the ambulance service to respond to an acute crisis such as the current heatwave?

[Maria Caulfield]

The North East Ambulance Service is one of three areas of concern in terms of performance. I reassure the hon. Member that I have met the families, and offered other families a meeting, to discuss the matter. In relation to his constituent, there is a tribunal ongoing. It is difficult for me to meet him while that is ongoing. Once that is over, however, I would be happy to meet his constituent to discuss the issues that he raised as a whistleblower.

[Theresa Villiers (Chipping Barnet) (Con)]

The Minister will be aware that the chances of recovery for those who suffer a stroke are greatly improved if they get specialist care within the first half hour, 45 minutes or so. So will she do everything she can to address administrative blockages and other delays, to ensure that people get the chance of life-saving treatment at the earliest possible stage?

--- Later in debate ---

[Maria Caulfield]

Yes, and I thank my right hon. Friend for raising that point. Different response times are required, depending on the reason for the call. Strokes would be a C2 emergency, for which the target is 18 minutes. The latest figures we have are from May, when we were performing better than in April. The figures are not where we want them to be, but we are seeing month-on-month improvements. For C1 and C2 cases, which need urgent treatment as soon as possible, particularly for strokes, every minute counts and we want to see further improvements in those times.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

The Manchester Evening News is reporting that the North West Ambulance Service has raised its operational pressure level to “critical incident” level, which indicates a potential for failures as ambulance services try to cope with extreme pressure. A&E departments at the Royal Bolton and Stepping Hill Hospitals have admitted that they are extremely busy, with long queues of ambulances at some times. The Minister did not even mention social care in her response, which we know is so broken that it adds to delays and discharges. Twelve years of Conservative mismanagement and neglect have left those services, on which my constituents rely, so vulnerable. What does the Minister have to say to the patients suffering as a result?

[Maria Caulfield]

I am sorry that the hon. Lady did not hear my response. I specifically mentioned social care as well as the integrated care boards that we have set up to bring health and social care together—I think Labour Members voted against that. As I said, one factor affecting ambulance delays is the bed occupancy issue. Part of that—not all of it—is about delayed discharges and lengths of stay are 16% higher. We have a plan for fixing social care and it is unfortunate that Labour Members voted against it.

[Alex Chalk (Cheltenham) (Con)]

Cheltenham General Hospital’s A&E was saved from a trust plan to close it, thanks to the fantastic support of more than 20,000 of my constituents. Does my hon. Friend agree that, in addressing the enormous challenge of the demands we face, capacity is important as well as flow through the system? In the light of that demand, the decision of the trust, and indeed the Government, to keep Cheltenham’s A&E open has been vindicated.

[Maria Caulfield]

I am pleased that my hon. and learned Friend is already seeing the benefits of the A&E in Cheltenham staying open. He is very modest—I am sure he played a significant part in ensuring that it stayed open. This is absolutely about capacity and there is no magic bullet that will make the pressures on the ambulance and emergency services any easier. This is multi-faceted and capacity at A&E is crucial. I am meeting the ambulance trusts to find out where good practice is making a difference, so we can help to share that across the country.

[Taiwo Owatemi (Coventry North West) (Lab)]

In June, a 59-year-old man collapsed in the west midlands, going into cardiac arrest. Neighbours called an ambulance, but it took 90 minutes for one to arrive—six times longer than it should have taken. Sadly, the man soon passed away. We see this time and again across my region, where ambulance waiting times are among the worst in the country. When will the Government provide the much needed extra support to stop horrific incidents such as that reoccurring?

[Maria Caulfield]

I am sorry to hear about the sad death of the hon. Member’s constituent. Her region is one of the six areas that have the worst handover times and at which we are targeting support. I would be happy to meet her and update her on the specific support that we are offering her region.

[Barry Gardiner (Brent North) (Lab)]

When discussing ambulance response and waiting times, the Minister kept using the phrase “month-on-month” improvements. Can she specify which months? She will know that it depends on which month you choose as your baseline—if it was the worst month in recorded history, it is not difficult to show month-on-month improvements.

[Maria Caulfield]

When we look at our figures, of course we look month on month, but we also compare them with previous years. As I said in my opening remarks, we are seeing an increase in calls—over 100,000 more compared with May 2019. The hon. Member shakes his head, but those are the facts. We are comparing month on month, and comparing with previous years. We are seeing an improvement in response times and in the amount of ambulance hours lost to ambulances queuing at A and E.

[Chi Onwurah (Newcastle upon Tyne Central) (Lab)]

Of the 22,000 people who visited Newcastle’s Royal Victoria Infirmary A&E in May, 13%—more than 3,000 people—faced a wait of more than four hours. In the last month, people were facing waits of seven hours, and constituents with rapid heart fluctuations were told that they faced a wait of 11 hours for an ambulance and that they needed to get a cab. Is not it negligent of the hon. Lady’s Government to leave our NHS unable to protect my constituents, particularly facing a heatwave, and what is she going to do to ensure that they have the resources necessary?

[Maria Caulfield]

As I explained in answer to the shadow Secretary of State, these are problems facing all devolved nations. I highlighted the four-hour waits in Wales, but in Scotland there are similar pressures—in Ayrshire there is a three-hour wait. These problems are not specific to any one Government. I have set out what we are doing to help all ambulance trusts and regions of the country. We have put in funding to support the ambulance service and to support NHS 111 to try to take some pressure off the ambulance service. We are looking at the novel approaches that in some parts of the country are working well—whether that is having GPs in A&E to try to take pressure off people who are waiting a long time, or having paramedics in GP surgeries. Whatever works we will look at, to help to take pressure off the system.

[Tony Lloyd (Rochdale) (Lab)]

Rochdale is especially vulnerable because its A&E was closed many years ago. It means people are dependent on an ambulance service that is not in crisis because of the heatwave; it has been in crisis for some considerable time. We do not need blandishments. Why does it take a crisis for the Minister to come before the House to explain what has not yet happened?

--- Later in debate ---

[Maria Caulfield]

We are not waiting for a crisis. I have set out the funding that we have put in place this year—£150 million extra funding for the ambulance service—and highlighted how we are boosting the workforce. In case the hon. Gentleman did not hear my opening remarks, there were nearly 2,300 more 999 call handlers at the start of June, and we have invested £50 million in NHS 111 capacity, to help us reduce demand. We have been doing this. There will be pressures on the ambulance service and our emergency services at times. We saw that with covid and the heatwave this week will put pressure on the NHS. There will also be pressures in winter. Opposition Members may think there is some magical way to avoid pressures, but there is not. We need to provide resources and capacity to ensure that the service can meet that demand.

[Hilary Benn (Leeds Central) (Lab)]

Further to the question about strokes, as we know, every minute counts. The Minister just told the House that in not every case is the ambulance response meeting the 18-minute time that she said is the target. Given that, what advice would she give to members of the public who think that a loved one has had a stroke? Should they ring 999 and hope that the ambulance will turn up within the 18 minutes? If not, should they put the person in a car or taxi and take them to A&E? When they arrive at A&E and say, “I think my loved one has had a stroke”, what confidence might they have that they will be seen quickly, given that time is of the essence?

[Maria Caulfield]

As someone who has suffered a stroke myself, I am very aware of the urgency of seeing stroke patients on time. I am not going to give clinical advice at the Dispatch Box. It is important that, if a person suspects a stroke is occurring, they dial 999 immediately. The ambulance callers will normally stay on the line with that person, advise them on what to do, depending on their symptoms, and get an ambulance to them as quickly as possible. Once they arrive in hospital, if a stroke is suspected, they will be seen immediately—we are not seeing reports of stroke patients being delayed once they are in hospital. It is crucial that those patients are seen urgently, and the advice is to dial 999 and clinical advice will be given to them over the phone.

[Steve McCabe (Birmingham, Selly Oak) (Lab)]

The West Midlands Ambulance Service says that it has been at resource escalation action plan 4—the highest level of alert—for several months now, which is almost unprecedented. Has the new Secretary of State spoken to the chief ambulance officer for the west midlands yet about that terrible situation?

[Maria Caulfield]

The hon. Gentleman is absolutely right: ambulance trusts are under record pressures, the sorts of pressures that we would normally expect in winter. We are seeing them in the summer months, which is usually their down time, a fact that is extremely concerning for the months ahead as we head into winter.

As I said, I will meet all 11 ambulance trusts over the coming days. In the first few days of his appointment, the Secretary of State has already been out with ambulance crews to hear from them directly about the pressures they are facing. I hope the hon. Gentleman is reassured that we are both taking the issue extremely seriously.

[Margaret Greenwood (Wirral West) (Lab)]

This is a situation that my constituents are desperately worried about. We know that ambulance waiting times were not being met before the pandemic, so this problem has a long background to it, as the Minister knows. We also know that there has been a crisis in A&E waiting times, and in my own hospital of Arrowe Park—a hospital in my constituency—in May this year, almost half of patients had to wait more than four hours.

Given that this problem has been a long time in the making, that the Government have known about it, and that one senior leader in the north of the country who does not want to be named has described the situation as “dire” for staff and patients, can the Minister tell us what the Government are going to do as a matter of urgency to sort it? My constituents are desperately worried about this issue. I have constituents who have lost people because of—well, we cannot say “because of”, but in circumstances that have involved very long ambulance waits, so this issue could not be more important to them. I would like an answer about what the Government are going to do urgently.

[Maria Caulfield]

There are two aspects to that question. In terms of urgency, we have procured a contract with a total value of £30 million for an auxiliary ambulance service, which will provide national surge capacity if needed to support the ambulance response during periods of increased pressure. That capacity is there, should we need it.

The hon. Lady also talked about long-term plans. We have been investing in the ambulance service since 2010. I talked about the extra paramedics: we are training 3,000 graduates every year to 2024 in order to increase our capacity. We have also made significant investments in the workforce, with an almost 40% increase since February 2010, so we are improving. Sometimes, those changes take time to come through, but we are investing in the workforce, providing more funding and training more paramedics, and we also have an auxiliary ambulance service procured should we need it.

[Naz Shah (Bradford West) (Lab)]

“24 Hours in A&E” used to be a reality TV programme; now, it is Government policy. Can the Minister tell me why this Government have presided over a watering down of standards that will see the zero tolerance for 12-hour waits in A&E and the 30-minute standard for ambulance handover delays scrapped?

[Maria Caulfield]

The reason I am standing at this Dispatch Box is my experience of working as a nurse in A&E under the last Labour Government. I believe it was them who introduced the four-hour target. [Interruption.] Does the hon. Lady want to listen to my response? Those targets looked good on paper, but were very often just driven as tick-box exercises.

I used to look after patients. I remember an elderly gentleman who was waiting for over four hours on a hospital corridor when I was a nurse under the last Labour Government. He was lying there on his trolley, wanting to go to the toilet, and all we could do was wheel a curtain around him on a busy hospital corridor so that he could do so. That was the experience under the last Labour Government, so I will not take any lectures from Opposition Members about performance.

[Matt Rodda (Reading East) (Lab)]

I urge the Minister to consider the position again, and consider declaring an emergency. I especially want to draw her attention to issues in the South Central Ambulance Service area, where there are long-standing, severe pressures, particularly around recruitment and retention of staff—linked to the high cost of living in central and southern England—and areas of very high house prices where NHS staff pay has not kept up with the local labour market. In particular, I draw her attention to the additional enormous pressure of the heatwave in the south of England and London, where temperatures are particularly high. I hope she will look at this issue on a national basis, but also consider the particular problems that exist in our parts of England.

[Maria Caulfield]

I have set out to hon. Members the work we are doing to increase capacity in the ambulance service, including £150 million in funding, training more paramedics, and increasing the workforce by 40%. We published the heatwave plan for England earlier this year—the shadow Secretary of State, the hon. Member for Ilford North (Wes Streeting), was not sure whether he had read it, but I urge all Members to do so. We are watching this issue on a daily basis. It is not just about the heatwave; it is about covid pressures, enabling hospitals to discharge patients, the winter pressures that will come later this year, and making sure we have resilience in the system.

[Mary Kelly Foy (City of Durham) (Lab)]

I have heard from one of my constituents who suffered a stroke and was left to wait for nearly two hours for an ambulance, and is now severely disabled. That issue is being seen repeatedly across the country, so can the Minister tell me what she is doing now, urgently, to make sure that when my constituents in Durham need an ambulance urgently, they get one? The plans she has outlined and the investment she has spoken about are obviously not good enough.

[Maria Caulfield]

We are working urgently on this issue—as, I am sure, are the health services in Wales and Scotland, which are facing the same problems. We are all working hard to address them. As I have said, we have procured a contract with a value of £30 million for an auxiliary ambulance service to increase capacity, should we need it. I will be meeting all ambulance trusts in the coming days to make sure we have the resilience we need, not just to catch up with some of the pressures that existed before covid or to deal with the pressures that those trusts are facing now, but to future-proof them for the coming winter months.

[Matt Western (Warwick and Leamington) (Lab)]

Joyce, a 96-year-old survivor of the Coventry blitz, sadly fell in her care home back in April, and lay in agony screaming for 10 hours. At the time of the 999 call, there were 63 people awaiting ambulances, and on that day, over 1,100 hours were lost due to hospital handover delays. Clearly, a major factor in those delays is the handover capacity in our A&E services and in wards. The Government have had 12 years to sort out the issue of social care, so does the Minister support the calls from various leadership candidates to make tax cuts and remove the national insurance increase that was supposed to support social care?

--- Later in debate ---

[Maria Caulfield]

I am not sure whether that means the hon. Gentleman is now supportive of the social care levy, which is there to pay for improvements to social care. This Government are making those changes and bringing forward the integrated care boards that are bringing health and social care together to deliver on those delayed discharges. I have been very honest: delayed discharges are having an impact on bed capacity and a knock-on effect on our ambulance services. If the hon. Gentleman has changed his mind and now supports the social care levy, I welcome that news.

[Dame Diana Johnson (Kingston upon Hull North) (Lab)]

With the greatest of respect to the Minister, I cannot fathom why the Secretary of State for Health and Social Care is not at the Dispatch Box when we are facing such a perfect storm. Given that the Home Secretary failed to turn up to the Select Committee on Home Affairs this morning, may I ask the Minister whether this is the Government’s new approach: that members of the Cabinet no longer turn up to be accountable and so that scrutiny can happen in this House?

[Maria Caulfield]

I can reassure the right hon. Lady that I am the Minister responsible for ambulances, which is why I am standing here at the Dispatch Box. The Secretary of State has been out on visits this morning, meeting clinical teams; it is important that he hears at first hand from those who are on the frontline. I got into politics to make sure that those of us who work on the frontline—[Interruption.] The right hon. Lady rolls her eyes; maybe she does not have much respect for those of us who worked on the frontline. We are dealing with this situation, and will be supporting the ambulance service over the coming months. The right hon. Lady’s response is extremely disappointing.

[Mr Speaker]

I granted the urgent question because the shadow Secretary of State tabled it and normally we would expect a Secretary of State to come. I recognise that they may be busy in other areas, but it is something we ought to be aware of. More and more, we are seeing fewer Secretaries of State across all Departments, not just this one.

[Helen Morgan (North Shropshire) (LD)]

Last Friday, I passed by Royal Shrewsbury Hospital. It is in a neighbouring constituency, but it serves my constituents. It was not a particularly bad day, but there were eight ambulances with their doors open in the heat, waiting to transfer patients. This is not a new situation and I have repeatedly raised the issue in this place: on my first day in Parliament with the Prime Minister; with the Secretary of State for Health in an Adjournment debate; and in a Westminster Hall debate with the hon. Member for Charnwood (Edward Argar). All those people have now resigned. Shrewsbury and Telford Hospital Trust has declared its fifth critical incident this year. When will the Government end the chaos and infighting, and start taking steps to prevent avoidable deaths in Shropshire and across the country?

[Maria Caulfield]

I can reassure the hon. Lady that the hon. Member for Telford (Lucy Allan) has been working very hard behind the scenes to get more investment into that local hospital. We will be making announcements shortly on future funding for hospital trusts.

[Jim Shannon (Strangford) (DUP)]

The Minister and the Government were able to respond to the covid-19 pandemic and showed that resources could be made available. Can I ask the Minister this question in a positive fashion? Is it possible to use some of the very successful covid-resourced helplines for people to contact to provide short-term advice on heat-related issues, rather than perhaps ringing, as they often do, the GP out of hours? What else can the Minister’s Department do to take pressure off A&E and out-of-hours GP surgeries?

[Maria Caulfield]

The hon. Gentleman makes a very constructive suggestion—one of the first of the afternoon, if I may say so. There were lessons during covid that are being rolled out across emergency services. We are looking at best practice in those parts of the country where response times are better to see if we can share it. I am very keen to look at any option that relieves the pressure. We are investing in 111, which enables people to have alternative ways of getting urgent care directed to them. We are looking at 111 being able to make direct referrals as well, so there are a number of options. I am happy to take suggestions from any hon. Member if they are keen to see those happening in practice.

[Mr Speaker]

You have tempted me and I should not really, but it would be very helpful if you reopened Chorley A&E for 24 hours rather than 12 hours. It would reduce the number of ambulances queueing at Preston and Wigan, and we would have more ambulances on the road.

NHS Dentistry in England

Maria Caulfield Excerpts

Wednesday 22nd June 2022 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 Stringer. I thank my hon. Friend the Member for St Ives (Derek Thomas) for securing this important debate—even if it is two days in a row that we have highlighted some of these issues. I thank hon. Members on both sides for speaking on the matter.

I am slightly disappointed in the response of the shadow Minister, the hon. Member for Enfield North (Feryal Clark). In yesterday’s debate, it was acknowledged that in all four nations, no matter who is in charge—whether it is the Labour Government in Wales, the SNP in Scotland, or in Northern Ireland, where the Assembly is still being formed after the election—there are exactly the same problems. In my speech yesterday I made reference to the fact that in Labour-run Wales there has been a 71% reduction in dental activity in the last year. The shadow Minister spectacularly failed to answer the intervention from my hon. Friend the Member for Totnes (Anthony Mangnall) on that very point.

It is important to recognise that, yes, there have been problems since before covid, but covid has dramatically impacted—

[Feryal Clark]

Here we go.

[Maria Caulfield]

The hon. Lady says, “Here we go,” but it is important to recognise that for two years there were no routine appointments available due to infection control measures. We are now back up to 95% of activity, but the backlog that existed before is significantly larger than it was.

It is also important to recognise that the nub of the problem around covid has been the dental contract. The shadow Minister may not have heard what I said yesterday, but we have been negotiating a new contract with the BDA; we started those negotiations on 24 March, a final offer went to the BDA on 20 May, and we are awaiting its response. We have been in negotiations; we have not just been waiting for the work to be done. We expect to make an announcement before the summer recess—I said that both at oral questions last week and in the debate yesterday. We will be making an announcement in the coming weeks on those contract reforms.

[Paul Blomfield]

It is helpful that the Minister has given us that information about the offer made to the BDA. Can she confirm that the offer addresses the four points I asked her about on flaws in the contract? I raised those points in the debate yesterday, and they reflect concerns across the House. Is it the sort of fundamental reform of the contract that will stop dentists being driven out of the NHS and into private practice?

--- Later in debate ---

[Maria Caulfield]

I obviously cannot comment while there are live negotiations ongoing, as I am sure the hon. Gentleman will appreciate, but the offer will drive some reforms in respect of the issues raised by a number of colleagues around fair payment for dentists’ level of activity. It will also look at the whole dental team and not just dentists. We have looked into whether we need legislation to be able to upskill dental technicians and dental nurses, for example, and we do not, so we are able to make progress on some of those areas, reward them for the work that they are doing and enable them to take on more work. A number of the issues that the hon. Gentleman raised will be covered by that.

The hon. Member for Enfield North may not know this, but before the latest round of negotiations, there had been a number of pilot studies over the last few years looking at completely reforming the UDA model and moving to a capitation model. Those pilot studies unfortunately did not produce the results we were hoping for. They did not increase access for patients, they did not reduce inequalities and they did not point to a sustainable model, so we did not go forward with that model. That is why we started new negotiations earlier this year on reform.

It is wrong of the shadow Minister to say that nothing has been done over the last 12 years. We had two years of covid where there was no routine dental activity; only urgent appointments were undertaken. Before that, there were three years of pilot studies on the capitation model; those were not successful, which is why we have not driven forward those changes. It is important that when we introduce changes, they address the fundamental issues that have been raised in this afternoon’s debate.

[Paul Blomfield]

Could I press the Minister in particular on the point that I made on financial clawback? It has been made clear to many of us who have talked to dentists that one of the most demotivating factors in the current contract is that while they are not rewarded for additional performance with NHS patients, they face clawback if they underperform, including for reasons that are completely beyond their control. I understand that for the last quarter that is currently being considered, 57% of dentists are going to face financial penalties. Those are the sorts of issues that are tipping them out of NHS dentistry. Will that issue be addressed?

[Maria Caulfield]

We are looking at the issue of clawback. Obviously we are in negotiations, so I cannot say what the final outcome will be. However, on the point that the hon. Gentleman makes about clawback during the last quarter, when the omicron variant was a particularly significant factor, we made clear to commissioners and dentists that if there were issues arising from omicron—patients who could not attend their appointments, or dental teams that were unable to be at work—they would not be subject to clawback. I would be disappointed if dentists who could not undertake their units of dental activity for covid-related reasons were penalised with clawback for that, because we made it very clear that there needed to be a flexible mechanism to mitigate some of those issues. If the hon. Gentleman has examples of that, I would be happy to take them away and ask officials to look into them.

[Peter Aldous]

There is some ambiguity about where the negotiations stand. Can my hon. Friend clarify whether a letter has gone to the BDA to start the negotiation process, or whether there are finalised heads of terms ahead of an announcement on a new contract?

[Maria Caulfield]

The negotiations started back in March and there have been a number of meetings with the BDA. The BDA has been sent final recommendations, but we have not yet heard back, so I encourage the BDA to respond.

I will touch on a number of other issues that have been raised, the first of which is overseas dentists. For obvious reasons, no overseas registration examinations took place during the pandemic, creating a backlog of over 800 overseas dentists waiting to take their exams. Exams restarted earlier this year, and extra sessions are being held to get through that backlog of dentists so that we can get them into the system and working as dentists as quickly as possible.

We have also been working with the General Dental Council, which is the regulator, on recognition of overseas qualifications. The GDC did a consultation on regulation and recognition of overseas dentists, which I think closed on 5 or 6 May. We are waiting to hear the feedback from that consultation, but we are happy to lay regulations in this place—if necessary, we can do so by the end of the year—to give the GDC the power to mutually recognise overseas dentists according to its judgment. It is not for the Government to mutually recognise qualifications; it is for the regulator. However, we are happy to give the GDC the power to do so, and we look forward to its feedback on the consultation it undertook, because our overseas dentists are a rich source of the talent and skill that we need.

When it comes to getting more dentists into certain parts of the country—obviously, one of those areas is the south-west, whether that is Cornwall, Devon or Plymouth —significant work is going on. I met with Health Education England this morning to look at how we can set up centres for dental development. Those centres are different from dental schools, which are often very expensive and take a long time to set up, and, as was said during the debate, there are not always dentists available locally to supervise the training. Centres for dental development can be much more flexible and meet existing local needs while also looking at what needs could develop.

As such, we will be working up a programme, looking at what we can do in those specific parts of the country with the greatest need. In Norfolk, I recently met a group of local MPs and representatives from the local university and the local enterprise partnerships, all of whom are willing to work together to make that happen. I am going to Portsmouth on Monday, to Gosport, to see exactly the same thing—dentists coming together to come up with local solutions that will make a difference.

[Anthony Mangnall]

I am grateful to the Minister for giving way, and I thank her for those words. Far from burying her head in the sand, she is putting her head above the parapet. That is most welcome. As mentioned by my right hon. Friends the Members for Ashford (Damian Green) and for South Holland and The Deepings (Sir John Hayes), there is clearly significant data that highlights the worst affected areas. Given that the data is there, could we expedite that roundtable meeting as quickly as possible?

--- Later in debate ---

[Maria Caulfield]

I am very happy to meet MPs. Once we get through the contract announcements before the end of recess, it has to be a priority to look at how we increase the number of dentists in specific parts of the country, whether in York or in coastal or rural areas. I am very willing to do that. Many parts of the country do have enough dentists, but they do not want to take on NHS work, so we are also going to look at the procurement and commissioning of services. That is where the ICSs will come into their own. At last, local commissioners will be accountable for commissioning dental work. There is no ring-fenced budget for dentistry. We spend about £3 billion a year and the work can be commissioned at a local level. The problem up until now is that no one has taken responsibility for that, so the ICSs will be a key change to make that happen.

[Dr Poulter]

I want to clarify one point. Does my hon. Friend anticipate the new dental contract being a sticking plaster, or does she think that it is here to stay that it will put right these challenges?

There is a real problem with the commissioning of dental services. I am afraid that I do not have faith that ICSs will be a panacea to sort things out, because local CCGs, some of which were not good commissioners of a number of services, have simply been cut and pasted into the same posts on the ICSs. Will my hon. Friend reassure me that she will personally look at the commissioning process and hold those commissioners to account, to ensure that they deliver proper dental services?

[Maria Caulfield]

Absolutely. The whole point of the ICSs is that the commissioning service has not worked up until now. Some commissioners are very good at commissioning dental services, while others do not have anyone with dental experience on their boards and are not so good. ICSs will be accountable, which is the difference from what we have now. I will meet ICSs to ensure that they understand the responsibilities.

[Rachael Maskell]

rose—

[Maria Caulfield]

I will take one last intervention, because I am conscious of the time.

[Rachael Maskell]

I am grateful to the Minister for giving way. When I wrote to her, she kindly replied and said that York could well be one of the areas for a centre of dental development. I would like to know the timescale for such considerations, and what progress has been made since our correspondence.

[Maria Caulfield]

I met Health Education England this morning and we are working through that system. I will be able to update the hon. Lady shortly, because I am keen that we make progress.

A number of Members mentioned prevention. The Health and Care Act 2022 includes provisions relating to fluoridation as standard, and we are working to make progress since it became law recently. We are also working with education colleagues on supervised toothbrushing. As we speak, some of the 75 family hubs that are being set up in the most deprived parts of the country as part of the Start4Life programme are looking at initiatives such as supervised toothbrushing. Where it is not happening at home or where parents need more support, we are ensuring that children are getting that toothbrushing experience.

On the subject of upskilling dental teams, this is about more than just dentists. My hon. Friend the Member for St Ives (Derek Thomas) made the key point that it is about the whole team. At the moment, part of the contract means that only dentists can do certain work. We need to change that. Centres for dental development will be about not just training dentists but upskilling whole teams.

I hope that I have reassured Members from across the House that we are taking this issue extremely seriously. To answer the question put by my hon. Friend the Member for St Ives, the contract changes that we are going to announce will not be the end of it, because there is more reform that we need to do. The Secretary of State is looking at a wider piece of work to provide a long-term, sustainable solution. We are happy to work with the other three nations if they have suggestions and solutions. We are not precious about sharing best practice.

I say to the shadow Minister, the hon. Member for Enfield North, that it would be good if she could come to a dental debate with some suggestions and solutions, rather than constantly criticising. We are determined to solve this issue and I appreciate the urgency that every single one of my colleagues has expressed today.

[Rachael Maskell]

I raised the issue of Ukrainian refugees. The Minister seemed to indicate that she had a response, so could she provide it before she closes?

[Maria Caulfield]

The response is that every overseas dentist, apart from those in the European economic area, currently has to take the overseas registration exam, and that is without exception. That is the work that we are trying to do with the General Dental Council. We are enabling those from Ukraine or Afghanistan, or any refugee from any country, to take part in that process. I am very keen to see mutual recognition with some countries. We are working on that and will enable the legislation to make it happen, but it will be for the regulator to decide; it is not a Government decision.

I hope that I have reassured colleagues that we are on this and appreciate the urgency. I have no doubt that we will return to this Chamber to debate this matter further in the coming weeks and months.

Access to GP Services and NHS Dentistry

Maria Caulfield Excerpts

Tuesday 21st June 2022 Commons Chamber

[Paul Blomfield]

I thank my hon. Friend for that intervention, and she is absolutely right about how that highlights the crisis we are facing in NHS dentistry. That exists right across England, and it was interesting to hear comments from other nations, because significantly less is spent on dentistry in England than in Wales, Scotland or Northern Ireland. The Secretary of State blames everything on the contract, but the cuts to dentistry have been deeper than in the rest of the NHS, with spending a quarter less than it was in 2010, and I am not surprised that he made no mention of that.

Last Wednesday, I met our local dental committee to discuss the problem—dentists who are committed to their profession and to NHS provision, and who want a solution—and following our discussion, they commissioned a survey of waiting lists across the city. Some 37 practices responded, which is about half of the city’s providers, but only one practice could offer a waiting time shorter than a year. For 29% it was up to two years and for 32% more than two years. The most significant number was that 35% of practices were unable to add any patients to their waiting lists.

Across England, the number of dentists providing NHS services fell from 24,700 in 2019-20 to 21,500 now, which is a fall of 15% in just two years—

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

indicated dissent.

[Paul Blomfield]

I see the Minister shaking her head.

However, there is provision for those who can pay. Healthwatch reported last year:

“Whilst some people were asked to wait an unreasonable time of up to three years for an NHS appointment, those able to afford private care could get an appointment within a week.”

That is adding to health inequalities, and it is not because dentists are reluctant to take on NHS patients, but because the system discourages them from doing so. We have patients wanting NHS dentistry and dentists wanting to provide it.

It is true that there are flaws in the 2006 contract. It is based on units of dental activity using figures from the two years prior to its imposition, which are now massively outdated. It contains huge discrepancies in remuneration rates between practices doing the same work. There are penalties through clawback for underperformance for reasons beyond the control of practices, but no reward for overperformance. I see the Minister smirking, but she has been delivering this contract, and the Government have been operating within it for 12 years. There are limits on how much NHS treatment a practice can provide. That is because of quotas and the way that providers are contractually obliged to spread their NHS work. Dentists have a disincentive to take on new patients, who are more likely to have greater treatment needs, because the fee-per-item system was replaced with a system in which the same is paid for one filling as for 20.

[Maria Caulfield]

indicated assent.

[Paul Blomfield]

As the Minister is nodding, let us review the position as regards the contract. Back in 2008, the Select Committee on Health declared the system not fit for purpose. The then Health Secretary, Alan Johnson, responded by ordering a review of the system. In 2009, the Steele inquiry reported, and in 2010, we committed to reforming the contracts, but 12 years on, nothing has happened.

Ministers also blame covid. Clearly, it has had an impact; there was a backlog of 3.5 million courses of dental treatment after lockdown, and patients are inevitably presenting with bigger problems and increased need, which means longer appointments and extra work, for which dentists get no remuneration. The Ministers sitting on the Front Bench have presided over this flawed system. In quarter 4 of 2021-22, 57% of practices faced financial penalties for being unable to meet the targets that those Ministers effectively imposed; the problem is due to the additional infection prevention control requirements and the lack of adjustment to the remuneration system.

We have reached a tipping point for NHS dentistry. Unless the Government act, the number of complaints that all Members of Parliament are getting will only grow. More practices will move to a private model, which will add to the difficulties, because the system does not work for them.

--- Later in debate ---

[Daisy Cooper (St Albans) (LD)]

The Conservatives have been running our health and social care system into the ground for years. Covid has made an already bad situation worse, but it was already bad, and my constituents—patients and healthcare professionals—can really feel it. A constituent who is a professional chauffeur needs to provide regular medical assessment certificates to keep his job, but his GP is not doing them right now, so my team have had to work hard to make sure that his employer will not sack him.

Some of my constituents have managed to see their GPs. One has had a referral for chronic back pain, another for a diagnosis of breast cancer that needs treatment, but having had those appointments they then discovered weeks later that the referral letters were never sent. Another constituent who had a contraceptive implant has had some very severe side effects and wants to have it removed, but she cannot get an appointment. A constituent who contacted her GP to say that she was having suicidal thoughts was asked to fill out a form.

I was so concerned about these reports that I have been to visit our GP surgeries in St Albans. From the other end of the spectrum, it is incredibly shocking. The very second the phone lines open in a GP surgery, there are flashing lights on its big screen. At one minute past the time that its phone lines open, there are hundreds and hundreds of calls on the electronic board. Many of those phone calls are from very distressed callers who are in pain and very concerned. Many of the people at the counter—the receptionists at the other end of the phone—are receiving verbal abuse, and we know that GPs are receiving abuse in their surgery rooms behind closed doors as well. The BMJ suggests that violent incidents in GP surgeries have doubled in the last five years.

One of the GP surgeries in my constituency has now employed somebody on a full- time basis to do one job: to chase the local hospitals to send the letters so that the GPs can get the results that their patients need. We have heard Members across the House talk this afternoon about how fantastic it would be if we could use big data and if our constituents could become expert patients and use all the information collected on their phone, but frankly, at the moment, we are starting from a basis where we cannot even get a letter from a hospital to a GP surgery. It feels as though the entire system is creaking at the seams, and that is even before we get to the postcode lottery of the number of patients each GP has, or the length of appointments.

Members across the House have talked about the planning system and the fact that lots of new homes are often built in areas without the infrastructure to go with them. I wholeheartedly sympathise with the calls for new homes, but it seems crazy in the circumstances that clinical commissioning groups are not even statutory consultees for planning applications, for local plans or even for permitted development. It should be a priority for this Government to change that and make sure that CCGs have the right resources to respond to planning proposals.

Then we have the problems with dentists. Like many other Members use, I have constituents who have raised these problems. I have mothers with MAT-B certificates who cannot get dental treatment. I have parents whose children are developing gum disease, but they cannot get an appointment with their dentist. I have couples who have moved to St Albans and, because they have moved, cannot get an appointment with the dentist. The list goes on and on.

I have challenged the Minister before about the Government’s announcement earlier this year that they were going to give £50 million to dentists to create some emergency catch-up appointments. When the Secretary of State was challenged on this earlier this afternoon, he said that that £50 million had resulted in tens of thousands of new appointments. That was news to me. Earlier this year, I submitted a number of written parliamentary questions. I asked the Government how many dental practices had achieved the quarter 3 targets to make them eligible for this £50 million. The answer was that the Government did not hold that information centrally. I asked the Government how many expressions of interest had been received by the deadline of 3 January. The answer was that the Government did not hold that information centrally. I then asked the Government how many of those who had offered to carry out this urgent dental practice had been accepted. Again, the Government said that they did not hold that information centrally. So what has happened to that £50 million? How much of it has been drawn down?

[Maria Caulfield]

The hon. Lady will know, because she raised this in oral questions, that dentists return that data in quarters. We will have that data from the dental community by the end of June, and we will then be able to answer her questions. She knows that; she is making a political point here.

[Daisy Cooper]

I am genuinely incredibly grateful for that answer, because when I challenged the Minister on this last week I did not receive that answer. I am grateful to receive that response. I submitted a letter to the Minister—I think it was in April—and attempted to come to some drop-in events that were cancelled, so I am pleased to hear that that data will be provided by the end of June. However, my constituents in St Albans have seen absolutely zero appointments created from that money. Every dental practice has said that because of the way the funds have been set up, it has been impossible for them to apply for them. A number of other Members have raised that point.

The truth is that the Government have failed to recruit the GPs that we need. We have a retirement time bomb among our general practitioners, and we know that dentists are leaving NHS work as well. We need to see a serious plan from the Government so that everybody who needs to see a GP or a dentist can actually see one.

--- Later in debate ---

[Imran Hussain]

I absolutely agree with my hon. Friend, who makes the point that I was coming on to raise. Her Luton constituency is not dissimilar to mine. With a single GP having 2,800 patients, it is obvious why those patients are not getting to see their GP. I could spend a long time in this Chamber going through constituency cases that I have recently dealt with. Indeed, I have done that in the past and those cases are on the record. Let me cite just one case today. An elderly lady in her 90s had to go to hospital and was then told to go to see her GP. Her son tried day after day to make a simple GP appointment for her. She had multiple health needs. My office had to intervene and even we were unable to secure a GP appointment for her. People are having to go through this ping-pong of not getting a GP appointment and then going to A&E as they have nowhere else to turn.

I am grateful because I did ask the Health Secretary about Bradford and urgent treatment centres, and he did favourably say that he would arrange a meeting with the Minister for Health, the hon. Member for Charnwood (Edward Argar), who joins us now, at precisely the right time. I look forward to that meeting because that is a way through and I am grateful for that offer. But the reality remains that the Government’s promise—or the points the Secretary of State made earlier today—is not apparent on the streets. People continue to suffer, they cannot get GP appointments and they have nowhere else to turn. That point has been made eloquently by a number of Members.

At least, after days and weeks of trying, people are able to get an appointment with a GP. Many Members have talking about issues with joining an NHS dentist. There is more chance of finding gold bricks on the street, or of finding the parallel universe that Government Ministers live in, than there is of getting on to the list of an NHS dentist. People simply cannot get NHS dentists, and we have heard accounts today of how they are being forced to carry out DIY operations at home, without anaesthetic or any medical care—I have come across such cases in my own constituency—because they have no other option. Frankly, as the fifth largest and richest economy in the world, it is shameful that people are having to resort to DIY treatment at home. Again, that is happening on this Government’s watch.

I have been in this place since 2015, and every time we have a debate about NHS dentists or GPs, Tory Members refer back to the Labour Government of 12 years ago. I remember that when I was growing up, under a Thatcher Government, GP practices were back-to-back houses on terraced rows without adequate facilities. The last Labour Government brought in record investment, gave us state-of-the-art health centres, and reduced health inequalities and child poverty. That was all under a Labour Government, but Tory Members cannot pretend that the Labour Government of 12 years ago are somehow responsible for the issues we face today. The Whips are not in their place, but I say to the Tory Whips, “Please do your Members justice and remove that line from the long-standing script you have for them”, because it is becoming embarrassing when Tory Members stand up and say, “12 years ago, there was a Labour Government, so it must be all their fault.” They can use that line for a year or two, but unfortunately, in nobody’s world can they use it for 12 years. Tory Members need to start understanding that.

Can we expect any more from this Government? This is a Government who believe people choose to be poor—they have said so in this very House and on TV. This is a Government who believe people should work extra hours and do more, and that those who are forced into poverty are not forced, but have chosen poverty. The reality is that this is a Government who could not care less about people in Bradford who continue to suffer. [Interruption.] The Minister chunters from the Front Bench; she will have time to address those points when she responds.

[Maria Caulfield]

I would be interested to hear the hon. Gentleman’s opinion on the position in Wales, which was set out in the Secretary of State’s opening remarks. Wales faces exactly the same pressures, and its waiting times are actually worse than England’s. What is the hon. Gentleman’s reason for why the Welsh Labour Government are in exactly the same position as this Government?

[Imran Hussain]

Again, the first defence is “Labour 12 years ago”; the second defence is “Labour in Wales”. The point about Labour in Wales has already been appropriately addressed, but the Minister’s job is to address those issues in England. Rather than address those issues, she thinks that saying “What about Labour in Wales?” somehow provides a cover, an umbrella, and a defence against the incompetence that exist across our health sector. That does not wash with the British public, because they have not been asleep for the past 12 years. They have noted the devastation that the Tory Government have caused in our communities, and the back-door privatisation and ideological agenda they have brought to our health service. I have said it before, and I will say it again: people will repay them with interest at the ballot box.

--- Later in debate ---

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

It is a pleasure to close this debate after a wide range of speeches. First, I will put my hands up and acknowledge that there are challenges and difficulties in primary care and dentistry. We heard that from Members from Scotland, Northern Ireland and Wales, which shows that all the devolved areas of healthcare are facing exactly the same challenges.

I start by thanking all those in primary care and dentistry for going above and beyond, and not just during the covid pandemic but as we are coming out of it, whether that was dentists providing urgent treatment under difficult infection control measures, or GPs delivering millions of vaccinations while continuing to see patients. We are now seeing not only the routine number of patients we would usually see, but the two years’ worth of patients who stayed at home and protected the NHS, as we asked them to do.

Despite the Opposition’s protests, we are making progress and record numbers of patients are being seen—higher than ever before. We are seeing 1.3 million patients per working day in primary care. That is a 44% increase since last year, and 63% of those are seen face to face. As my hon. Friend the Member for Wantage (David Johnston) said, that is 2 million more face-to-face appointments than this time last year.

There are record numbers of GPs, despite what Opposition Members have said—nearly 36,000 full-time equivalents, which is 1,400 more than in March 2019. We are going further, with 4,000 more trainees taking up GP training this year, providing more GPs for the future. We have delivered 30 million extra GP appointments, as part of our manifesto commitment to deliver 50 million more GP appointments. As an indication of the scale of the record numbers of patients coming through the system, we are seeing 11,000 cancer referrals a day, which is a record high.

How are we supporting GPs? We had the £250 million winter access fund, which helped deliver a cloud-based telephony system that some practices took up, which is transforming how patients can get through to their practices. If practices did not take up that offer, NHS England is rolling out the system across the country, so I urge them to look into it because it delivers better capacity, allowing patients to get through to make their appointments. It bought extra hours to pay for staff to do more shifts and see more patients, and it paid for more physical space in practices.

We have delivered 13,000 of the additional 26,000 roles pledged in our manifesto—paramedics, practice nurses, primary care pharmacists, physios and OTs working in primary care. We are tackling the bureaucracy that GPs face, and laid a statutory instrument to address fit notes to allow professionals other than GPs to return people to work. We have developed the pharmacy consultation system, whereby 111 or GP receptionists can refer people directly to a pharmacy for first-line care. We are developing a renewed GP contract, opening up access at weekends and in the evening. We are expanding community pharmacy with our work on Pharmacy First to deal with minor ailments, blood pressure checks and discharge medicine services.

We are also tackling the infrastructure problem through the Levelling-up and Regeneration Bill whereby health and local government will work hand in hand to tackle the issues my hon. Friend the Member for North East Bedfordshire (Richard Fuller) raised. We are also delivering—

[Daisy Cooper]

Will the Minister give way?

[Maria Caulfield]

No, I will not.

We are also delivering zero tolerance to abuse through the Police, Crime, Sentencing and Courts Act 2022. Labour talk the talk, but it was those of us on the Government Benches who voted to double the maximum sentence for those who abuse our emergency care workers. Labour actually voted against giving the Bill a Third Reading. That tells us all we need to know.

With the time I have left—

[Holly Lynch]

Will the Minister give way?

[Maria Caulfield]

I will not give way. Members did not—

[Hon. Members]

Give way!

[Hon. Members]

Frit!

[Maria Caulfield]

I am not frit, but I am conscious that another debate follows this one. I did not want to play politics, but if Opposition Members want to, I will give them politics.

The Labour party is against everything and for nothing. We have not had one suggestion from Labour or the Lib Dems. They are full of complaints without a single solution. We know that the shadow Secretary of State was busy over the weekend deleting his past misdemeanours, but he cannot delete Labour’s misdemeanours with the NHS. As Davina McCall would say, let’s have a look at their best bits. There are the PFI contracts that they mysteriously introduced—£1.4 billion a year is still going to private investors because of the deals made under a Labour Government. Full Fact confirmed that £57 billion will be spent in total on those PFI deals.

Moving on to the 2004 GP contract negotiations, evening and weekend cover was taken away, handed to primary care trusts and given to private companies. Changes to the law in 2007, voted for by Labour Members, allowed bigger businesses to buy up GP practices, resulting in the evidence we saw on “Panorama” last week. The top hit is the 2006 Labour dental contract—

[Wes Streeting]

Oh, here we go.

[Maria Caulfield]

The hon. Gentleman may say, “Here we go,” but Opposition Members acknowledged this afternoon that the Labour contract was causing the problems. We are getting on with dealing with that.

My hon. Friend the Member for Waveney (Peter Aldous) asked what progress is being made. We put the negotiations to the BDA on 24 March and made a final offer—[Interruption.] They don’t want to listen, Madam Deputy Speaker; they don’t care. We put the final offer to the BDA on 20 May, and we are waiting to hear back. We are reforming the dental contract, which perversely disincentivises dentists to take on NHS work.

To correct the hon. Member for Portsmouth South (Stephen Morgan), he did not host that dental summit; it was my right hon. Friend the Member for Portsmouth North (Penny Mordaunt), who invited me. The summit came up with a solution, and I am meeting her team so that we can work on that and take it forward.

In addition to the dental contract, we are reforming how we take on dentists from overseas. We consulted the GDC, which recently ran a consultation, and we will be laying legislation to give it powers to allow dentists to come here more easily—[Interruption.]

[Madam Deputy Speaker]

Order. I can hear what Members are saying, and it is just not right. It is simply rude when we are supposed to be listening to the Minister.

[Madam Deputy Speaker]

Order. You are not saying anything while you are sitting down—nothing! I call the Minister.

[Maria Caulfield]

Thank you, Madam Deputy Speaker. Labour Members do not want to hear about the work that the Government have been doing. They are just too busy criticising.

My hon. Friend the Member for Sleaford and North Hykeham (Dr Johnson) also mentioned the work that we are doing on centres for dental development. We are already working in places such as Cornwall to start training more dentists in those areas. In Norfolk and Norwich, we have met representatives from the university. The meeting was led by local MPs who brought people together to set up centres. We have also been working in Lincolnshire as well.

We are empowering the dental workforce by changing and upskilling dental technicians, dental nurses, and dental assistants to be able to take on more work. We are also tackling the issue of clawback.

You would think, Madam Deputy Speaker, that this is just an issue in England. If we look at Labour-run Wales, we find that the Community Health Councils have acknowledged that Wales is also facing a crisis of access to GPs, and that patients are waiting more than an hour to get through on the phone only to find that there are no appointments left.

The number of dental practices in Wales has fallen—from 1,500 in 2019 to 1,389 last year. In the past year alone in Wales, there was a 71% drop in courses of dental treatment. Why is that happening under a Labour Government? [Interruption.] I have given the answer. Opposition Members are too busy talking, Madam Deputy Speaker. They do not want to hear the answers.

Opposition parties need to be honest with the public. Whether we are talking about Scotland, Wales or Northern Ireland, we are all facing the same challenges. [Interruption.] No! There is a Labour-run Government in Wales and an SNP Government in Scotland. [Interruption.] The Opposition continue to play politics, but we are getting on with the business of reforming and making those changes. They have no solutions, no answers and no ideas. It is this Government who are delivering the changes. We are being honest with the British public that we will face challenges, but we are making the changes to improve access to both dental and primary care services.

Question put and agreed to.

Resolved,

That this House notes that primary care is in crisis, with people across the country struggling to access GP services and dental treatment; believes that everyone should be able to get an appointment to see a doctor when they need to and has the right to receive dental treatment when they need it; is concerned by the Government’s failure to remain on track to deliver 6,000 additional GPs by 2024-25; and therefore calls on the Secretary of State for Health and Social Care to urgently bring forward a plan to fix the crisis in primary care, meet the Government’s GP target and ensure everyone who needs an NHS dentist can access one.

Community Pharmacies

Maria Caulfield Excerpts

Tuesday 21st June 2022 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Sir Gary. I thank the hon. Member for Bootle (Peter Dowd) for securing this debate. He is pushing at an open door, as I am a huge supporter of community pharmacists.

The evangelising of my right hon. Friend the Member for South Holland and The Deepings (Sir John Hayes) is definitely working. Community pharmacies are front and centre of the changes we want when developing primary care. Of course, they are already a central part of the NHS, delivering vital primary care services at the heart of every community throughout the country and ensuring that patients have timely access to medicine. That is one of the lesser elements of the services we have talked about, but it is an important element that keeps patients well and out of hospital, enables them to get discharged safely and prevents readmission.

Community pharmacies are offering more services and they are accessible to all. They are key in providing self-care support, thereby allowing individuals to manage their own healthcare needs and, in turn, increasing capacity for the NHS overall. Community pharmacists are an easily accessible and trusted part of the NHS: a team of highly skilled, qualified, experienced healthcare professionals. There are more than 11,000 community pharmacies across England, 80% of which are around a 20-minute walk from most people’s homes. I am committed to making the best possible use of their resources and talent.

As many Members said, we saw the clear difference that community pharmacies made during the covid pandemic. They stepped up to implement a medicines delivery service for shielding and isolating patients. They implemented Pharmacy Collect, making lateral flow tests widely available to the public. At the height of the vaccination programme there were more than 1,500 community pharmacy-led covid vaccination centres. There is no doubt that they stepped up to the mark and showcased what they could offer.

We have a clear vision for community pharmacy. In 2019, we agreed the landmark five-year deal, the community pharmacy contractual framework, which commits to £2.592 billion of funding for the sector. It also sets out a joint vision for the Government, NHS England and the Pharmaceutical Services Negotiating Committee for how pharmacy services will support the delivery of the NHS long-term plan. We are in negotiations for year 4 of that deal, so I am limited in what I can say about the funding, but I can reassure Members that the PSNC is negotiating hard and we want to work with it to expand services. Obviously, it is keen for funding to be attached.

[Sir John Hayes]

It is vital that, as the Minister described, the service is integrated. GPs must continue to offer out-of-hours services, weekend services and, most salient of all, face-to-face encounters with their patients. Services do a great job but that does not mean that GPs should not do all those things.

[Maria Caulfield]

Absolutely—it is not an either/or situation. We have enough capacity and patients to expand community pharmacy services, but that does not mean that we do not also need to support GPs and other primary care providers.

I thank the team at the Department of Health and Social Care; often, their work is not recognised, but they are working hard to develop some of the services that we have talked about. The community pharmacy consultation service went live in November. Patients can dial 111 and be directed to a community pharmacist for help with minor ailments or medication. We have extended that to GP surgeries, so now a receptionist can make an appointment at the local pharmacist for minor illness consultations.

It has been estimated that 20 million appointments in general practice alone do not require a GP—that does not mean we do not need GPs—and pharmacists can look after those conditions. The introduction of the scheme has been slightly slower than we would have liked, so there is work being done to help to overcome some of the barriers to referrals, because once they see their community pharmacists, patients have a positive experience.

In addition, the discharge medicines service enables hospitals to refer discharge patients to community pharmacists for support with their medicine. The evaluation of this service indicates that for every 23 consultations, one readmission is prevented. Where patients are readmitted, their stays are reduced by six days on average, which I think we can all agree is of huge value. We also have the blood pressure check service, which enables people with high blood pressure to be managed by their local community pharmacist, offering blood pressure checks.

We also have the stop smoking service to enable patients who started their stop smoking journey in hospital to continue with a community pharmacist, and we are looking at developing the role of community pharmacy teams, because it is not just the pharmacist who has clinical knowledge and skills. We are working in a number of areas to upskill the whole community pharmacy team so that they can deliver more and use their skills in a better way.

As has been mentioned, we now have NHS Direct cancer referrals, which community pharmacists will be able to take. Just to reassure the hon. Member for Bootle, we have 160 community diagnostic centres, which will be increasing the capacity to do some of those diagnostic tests, and we have already had 1 million visits to those centres. We are not just expecting pharmacists to refer into existing services; we are expanding the routes for diagnosis as well.

My hon. Friend the Member for Southend West (Anna Firth) beautifully told the story of Ask for ANI. It is so vital that a woman can go into a pharmacist, just say those few words and get help—they might not be able to go to a GP practice, because sometimes the help they are asking for might be more obvious.

We also have the minor ailments service, which is being rolled out throughout the country, so pharmacies are delivering more and more. The hon. Member for Coatbridge, Chryston and Bellshill (Steven Bonnar) knows that I am a pharmacy first supporter. I hate to admit it, but Scotland has taken the lead in that, although we are not afraid to learn lessons if that means learning from what Scotland has done.

On the Fuller stocktake and the future of primary care, just to reassure colleagues, we are not just looking at how general practice looks in the future; community pharmacy will also play a key part in that model. With the integrated care system set to go live on 1 July, we are working with those who will be making commissioning decisions in local communities to set out how that future will look.

We are considering all options for community pharmacy and how we build on the progress we have already made. It is important to say that although we have made progress, there is a lot more that can be done. We are developing new standards for the initial education and training of pharmacists, which are set to be implemented shortly, so that from 2026 all newly qualified pharmacists will be able to be independent prescribers—an essential skill that will help to deliver and develop the service further. For those who are not currently prescribers but would like to be, Health Education England is supporting the existing pharmacy workforce to undertake the required training and upskilling, and £15.9 million of funding support has been made available.

We are also looking at the use of patient group directions, because pharmacists have specifically asked for that, so there are a number of measures in place. We are listening to the community pharmacy community, and where we can make changes quickly and easily, we will.

Just to touch on the issue of violence, I want to be really clear that there is zero tolerance for abuse and violence against community pharmacists—and, indeed, against all primary care staff, whether receptionists, GPs or community pharmacists themselves. I also want to put on the record our thanks to the hon. Member for Coventry North West (Taiwo Owatemi) for her work in the NHS as a pharmacist and the experience she has brought to this debate. I reassure hon. Members that we are on a clear journey and we will be supporting community pharmacy going forward.