David Fuller: Independent Inquiry

Maria Caulfield Excerpts

Wednesday 23rd February 2022 Written Statements

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

Following my statement on 16 December 2021 I wish to update the House about the independent Inquiry which is investigating the circumstances surrounding the offences committed by David Fuller at Maidstone and Tunbridge Wells NHS Trust. The inquiry will help us understand how these offences took place without detection, identify any areas where swift action is necessary and consider wider national issues, including for the NHS.



Sir Jonathan Michael, who chairs the independent inquiry, developed draft terms of reference in January 2022 which set out the scope of the inquiry. He has since sought the views of affected families on the draft terms of reference.



The Inquiry has today, 23 February 2022 published its final terms of reference which can be found at: https://fuller.independent-inquiry.uk/terms-of-reference.

I have placed a copy of the Inquiry’s Terms of Reference in the Libraries of both Houses.

[HCWS625]

Organ Donation and Transplantation Strategy

Maria Caulfield Excerpts

Wednesday 23rd February 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, Ms McVey. I thank my hon. Friend the Member for Totnes (Anthony Mangnall) for securing this debate and for being such a passionate champion for organ donation and transplantation. Having helped the hon. Member for Barnsley Central (Dan Jarvis) with the legislation, my hon. Friend is not just sitting on his laurels, but continuing with the campaign, because, as has been said, the legislation on its own is not enough to make a difference.

I also thank all those donors and their families who, at a very difficult time in their lives, have to make incredibly tough decisions. Even with the changes in legislation, it is an incredibly difficult time for them. Hon. Members will know that the 6,000 patients across the UK who are today waiting for lifesaving transplants are incredibly grateful for those who donate. The estimate is that every donor can save around nine lives, so it really does make a difference. More than one person a day sadly dies on the waiting list, so it is crucial that organ donation continues to be a high-profile issue.

It is nearly two years since the introduction of deemed consent for organ and tissue donation, known as Max and Keira’s law. All donors are now considered potential organ and tissue donors after death unless they make a decision that they do not want to donate. As my hon. Friend has said, among all the families approached since May 2020, the consent rate is about 66%. It could be higher. It is a good figure—much better than where we were—but there is still a lot of room for improvement. However, it has led to 296 organ donors and resulted in 714 organs being transplanted: we cannot overestimate the difference that has made to the individuals who received those organs and to their families.

If people wish to opt out, they can do so: currently, 27 million people have opted into the UK organ donor register and 2 million have opted out, so there is flexibility there. However, for many people, there is still a lack of awareness that a register exists, and very often they have not had those conversations with family members. Should the time come when, unfortunately, an incident happens and organ donation needs to be considered, families play a crucial role throughout the donation process, both helping NHS staff understand the wishes of the deceased and ensuring their organs are suitable for transplantation. As my hon. Friend the Member for Totnes has pointed out, it is really important that we continue to have national conversations about organ donation, so that if the time comes, the family of the deceased person are aware of what the issues are. Even with an opt-in and opt-out system, that conversation should take place well in advance.

At difficult moments, both families and NHS staff who may be working in A&E or in different clinical units may not feel comfortable having that conversation. When the family are struggling to come to terms with the fact that their loved one is on the register, but they are not happy about that, those are very delicate conversations to have, and it is important that staff are supported as well. The views of the family will always be taken into account: even though they cannot revoke legally valid consent, they will have an influence; as we heard from my hon. Friend, that is having an impact and meaning that some donations are not happening.

The role of the specialist nurse in discussing the matter sensitively and helping to understand some of the family’s concerns is important and that role needs to be facilitated wherever possible, because that can make the crucial difference between the family accepting the decision of their loved one and not coming to terms with it. We need to make that conversation routine and build awareness, because a 32% impact on the loss of organs into the system for donation is a very high figure.

NHS Blood and Transplant, which is responsible for organ and tissue donation across the UK, has launched the new UK-wide organ donation strategy, the main aim of which is simply to increase organ donation and transplantation. My hon. Friend the Member for Totnes asked what work is being done to raise awareness: we have organ donation week in September, and last September that led to the Leave Them Certain campaign. That campaign aimed to reinforce the role of the family and normalise people sharing their organ donation decision with family members so that, if that discussion needs to happen, it does not come as a shock. We are also introducing organ donation and transplantation into the school curriculum, because it is important to start that conversation early on, and aiming to promote awareness in young people about not just their own decision, but that of their other family members.

There was a multimedia campaign on Valentine’s day this year—my hon. Friend might have been busy on Valentine’s day; I do not know—to encourage families to have a heart-to-heart discussion about organ donation. There were 300 people waiting for a heart transplant on Valentine’s day, including more than 40 children, so it was thought crucial to raise awareness on that day, but we can all do our bit when it comes to promoting the need for organ donation. World Kidney Day is 11 March, which will provide us with another opportunity, but I am very happy if my hon. Friend wants to apply for another debate this coming September to hold our feet to the fire in making sure that we are driving up organ donation numbers.

I want to touch on health disparities, because some communities are struggling more than most when it comes to organ donation. Black and Asian communities face significant shortages and significantly longer waits—around 10 months longer than the general population—and much of that disparity is due to the lack of donation in those communities. There is a whole host of reasons why that is and, as my hon. Friend the Member for Totnes has said, this is not about judging those who do not donate: it is about increasing awareness of the difference that organ donation can make to people’s lives. Alongside other stakeholders, such as the National Black, Asian and Minority Ethnic Transplant Alliance and all the main faith organisations in England, we are actively trying to tackle some of the concerns of particular groups and communities around organ donation. We are raising awareness and promoting the work that can be done.

I am particularly concerned about the point that my hon. Friend mentioned about provision for living donations in the south-west, and the logistics that sometimes lead to donations and transplantations failing. If someone is willing to donate an organ, we should make every effort to ensure that it becomes a successful transplant. I will take away his point and look at some of the factors that might be influencing that situation.

Covid has had an impact on the service. As we heard from the hon. Member for Barnsley Central, the waiting list is higher than it has been in past, but I am pleased to say that organ donation and transplantation has now mostly returned to pre-pandemic levels, although there is a backlog of people to get through.

[Jim Shannon]

In my intervention, I referred to the need for co-ordination between the four regions, so that no organ could or would be lost. There was some discussion in the newspapers, although I am not sure of the evidential basis for it, that said that some organs had been lost during the covid pandemic. Let us make sure that does not happen.

[Maria Caulfield]

The hon. Gentleman is absolutely right. We need to ensure that we tackle any practical or logistical issues; I am happy to look at that. If there are particular regions where the centres are difficult to access because of the distances involved, then we absolutely need to consider that.

I take on board the points made by my hon. Friend the Member for Totnes about improving the ability of people to sign up for the register, whether through the electoral roll or through other mechanisms; we want to make that as easy as possible. I am convinced that there are groups of people who would be very happy to donate, but we need to make it as easy as possible for them to do so.

I will look at international comparisons. If there are lessons to be learned from other countries, let us not reinvent the wheel but gain some knowledge from them.

I thank all hon. Members for taking part today, particularly my hon. Friend the Member for Totnes, and I thank the Meredith family, who are driving this campaign forward and are the reason for the debate today. We are making huge progress. The legislation has made a big difference, but there is lots more we can do to ensure that people are not waiting on the transplant list any longer than they need to.

Question put and agreed to.

Health and Social Care

Maria Caulfield Excerpts

Monday 21st February 2022 Ministerial Corrections

The following is an extract from the Adjournment debate on the Dentist Industry and NHS Backlogs on 7 February 2022.

[Maria Caulfield]

For most of last year, dental teams were allowed only up to 40% of normal activity. It was not until the end of last year that they could go up to 65%, and just around Christmas time that they were able to go up to 85% of normal activity. Even today, they are still not allowed to go back to 100% of normal activity, simply because infection control measures make it important that space, intervals between patients and cleaning between patients continue…I reassure my hon. Friend that when we were at 20%, 40% and 65%, dentists were getting paid 100% of their contract value; it is only since the Christmas period, when we went to 85%, that they have not been paid the full 100%. Throughout most of the pandemic, even though they were seeing fewer patients than their contract allowed because of infection control measures, they were getting 100% of their contract value.

[Official Report, 7 February 2022, Vol. 708, c. 778.]

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

Errors have been identified in my response to my hon. Friend the Member for Warrington South (Andy Carter).

The correct response should have been:

[Maria Caulfield]

For some of last year, dental teams were delivering only up to 40% of normal activity. It was not until the end of last year that the threshold went up to 65%, and just around Christmas time that they were able to go up to 85% of normal activity. Even today, many are still not able to go back to 100% of normal activity, simply because infection control measures make it important that space, intervals between patients and cleaning between patients continue…I reassure my hon. Friend that when we were at 20%, 40%, and 65%, dentists were getting paid 100% of their contract value; it is only since the Christmas period, when we went to 85%, that there is no lower-level threshold, and they may not be paid the full 100%. Throughout most of the pandemic, even though they were seeing fewer patients than their contract allowed because of infection control measures, they were getting 100% of their contract value.

Access to NHS Dentistry

Maria Caulfield Excerpts

Thursday 10th February 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, Ms Ali. I congratulate my hon. Friend the Member for Waveney (Peter Aldous) on securing the debate and I am pleased that he is seeing a local improvement after we met recently. I also thank the hon. Member for Bradford South (Judith Cummins) for securing the debate.

I agree with my hon. Friend the Member for Stroud (Siobhan Baillie) that we have seen a level of interest in and concern about the matter across the Chamber, and that we need to ensure that we take some of the politics out of it because there are some difficult steps to take to improve dental services across the board. I welcome the contribution from my hon. Friend the Member for Mole Valley (Sir Paul Beresford), whose clinical experience is so helpful in the debate. I reassure colleagues on both sides of the House that since I came into post in September, dentistry has absolutely been a priority for me. I have been working night and day to try to make some short and long-term improvements, because I am live to all the concerns that have been raised.

We have set up some joint working, which was not happening before, between NHS England, the chief dental officer and the Department, and I meet the BDA regularly because we are serious about reform. I say to any dentists watching the debate that I absolutely understand the problems that make delivering an NHS contract unbelievably difficult. The contract is the No. 1 long-term issue that we have to deal with, and we are starting progress on that as soon as possible. I will come to some specifics shortly, but first let me mention covid.

I know that there has been some concern that covid is a lame excuse but, as my hon. Friend the Member for Mole Valley said, it has had a significant impact on access to dental services in the past 18 months. When lockdown happened, services were immediately reduced; only urgent services were allowed. That continued for a significant period. It was not until 8 June 2020 that practices were allowed to open for up to 20% of normal activity and it was not until last year that that went up to 60% and, towards the end of the year, to 65%. Although dentists were compensated for their loss of income during that period, the backlog that that generated is shown in all our postbags right now.

I place on record my thanks to dental teams up and down the country. Urgent appointments went back to pre-pandemic levels in December 2020, but with only 85% of activity allowed the backlogs will only grow. We need to be honest about that; the impact is significant. I completely understand the pressures that that is putting on dentists. We are keen to support dentistry where we can to get it up to 85%. It has been difficult during omicron with staff sicknesses and patients having to cancel when they become covid positive, and I absolutely recognise the stress and strain that covid has put on the system, but we have to be honest. I think it was the hon. Member for Bootle (Peter Dowd) who mentioned this, and I am happy to accept the difficulties we face. There were problems before covid and there are those same problems post covid, and we are absolutely focused on starting to tackle them.

Let me make a couple of points. There is no patient registration system for dentistry—that is one of the myths. It is not like GP practices, where someone signs up and is then on the list. Patients can go from dentist to dentist if there is one available, and we are making sure that we open up capacity where it exists.

We have written to all dentists to ask them to update their capacity so that we can put it on the website mentioned by the Father of the House, my hon. Friend the Member for Worthing West (Sir Peter Bottomley), and we have also asked them to run a cancellation list. If someone cancels, the practice will be able actively to contact the next person on the list. Capacity is being generated by that, but I am aware of the problems with capacity across the board. We have talked about many parts of the country, such as Norfolk and Devon, that are experiencing capacity issues, but all parts of the country have experienced a squeeze in the number of appointments available.

A couple of weeks ago, we announced £50 million to help with some of those issues. I know that some Members have been quite dismissive of that this afternoon, but we know that it will cover the period to the end of this financial year to buy some urgent capacity for the system and to help deliver more than 300,000 appointments that currently cannot happen. There has been good uptake, even in the few weeks since the money was announced. Regions across the country are signing up and because the payments to dentists are much better than under the current contract, there is an appetite among dentists. That shows that if we remunerate dentists adequately they have an interest in taking on NHS work.

I encourage Members from all parties to contact their local commissioners, because we want to ensure that that money is used. If there is no interest, or if they are struggling to spend the money, they should let us know. NHS England has been in contact with local commissioners to get that feedback so that we can make the best use of the money and buy as much capacity as possible.

[Kevin Hollinrake]

Does the Minister think that it is acceptable for commissioners to take 20 months commissioning a service when we have dentists who want to take that work and take on that surgery?

[Maria Caulfield]

Absolutely. I will come on to that point, which is valid. We want to increase capacity and there are dentists who want to take on NHS work. When contracts are handed back, we have to do the whole procurement process, and when there is an interested party, even when they are ready to sign on the dotted line, that takes a considerable amount of time. In the Department, we are looking at how we can change the procurement process. It often falls in the lap of local commissioners, but they are stuck with the procedures they have to follow. I am keen to see how, when someone is willing to take up a contract, we can enable that to happen as quickly as possible.

We have also relaxed the upper tolerance threshold and increased activity from 104% to 110% of dental activity. The current contract penalises dentists if they go over their contracted work, which is a perverse disincentive when dentists have capacity and want to take on extra work.

Before I touch on the nub of the problem, I will mention prevention. I am pleased that prevention is being considered and that the Government’s proposals on water fluoridation are part of the Health and Care Bill. I hope Opposition Members will support us when the Bill comes back from the Lords. We are also looking at options for how to introduce supervised tooth brushing in parts of the country where there is the greatest need. I reassure hon. Members that the prevention and oral health element is as key as getting dental procedures done.

The dental contract is the crux of the matter, and we are absolutely committed to reform. I met the BDA this week to start negotiations. We are looking at some quick wins over the next 12 months and some long-term contractual reform to the UDAs. We have started informal negotiations, and the formal negotiations will start in April. We all—the BDA, patients, MPs and the Department —know the urgency. It cannot be a long, protracted negotiation. However, we are working well with the BDA. We are keen to get negotiations under way and to reach a resolution as quickly as possible. We have to make the NHS a better and more attractive place to work, because dentists have other options; I cannot remember which Member said it, but dentists are voting with their feet when it comes to where they want to practice.

On the recruitment, retention and training of dentists, Health Education England published its “Advancing Dental Care Review” in September. It is working through how we can train not just more dentists but the whole dental team, and on how we can upskill dental technicians and dental nurses. We will bring forward legislative changes to enable other members of the dental team to take on more roles. We are setting up centres of dental development in those areas of the country with the biggest shortages, which tend to be coastal and rural. I take the point made by my hon. Friend the Member for Broadland (Jerome Mayhew) about Norfolk—I think I heard that several times. We are looking at where in the country those dental deserts are and whether we can match them to centres of dental development.

Members may not realise that this week the Department announced a consultation with the General Dental Council on the registration of international dentists and whether we can put in place a process to recognise the qualifications of dentists from around the world, as my hon. Friend the Member for Mole Valley mentioned. The overseas registration exam, which they have to take, was suspended throughout the whole of covid, so we have a backlog of around 700 dentists waiting to take it. The first exams started a couple of weeks ago, and there are exams in place for the rest of the year to try to get through that backlog. We are confident that we can do that.

We need to work on how we recognise existing qualifications to remove the barrier of having to do an exam. Again, I encourage colleagues to respond positively to the consultation on the GDC website and to the developments it is making. My hon. Friend the Father of the House has written to me about international dentists having to take the exams within five years of their first attempt, and whether those rules can be relaxed. That is also part of the consultation. We very much recognise that covid has had an impact on those rules too.

I reassure colleagues that I am working on bringing NHS England, dentists and the BDA together so that we can make a difference as quickly as possible. The changes in the Health and Care Bill on integrated care systems and having accountable people for commissioning locally are crucial. Integrated care boards will be statutory from 1 July, and will have accountable officers. I strongly urge colleagues to speak to their ICBs or CCGs, because there are differences in practice across the country. Some commission dentistry really well, some not so well. Very often, if the money allocated to dentistry is not ringfenced, and if it is not spent locally, it goes into other healthcare provision and is lost from dentistry. I encourage Members to hold the feet of their local commissioning bodies to the fire on what they are doing with the money given to them. We are here to support them, and work will be done on dentistry commissioning going forward.

In the short time I have had, I hope I have been able to provide assurances that dealing with the situation is not without its challenges. There is no silver bullet that will resolve all the problems. There is not a quick-fix solution, but I am working at pace, as is the Department, to reform the contract. Work is starting in April on the formal negotiations, and I hope that will improve recruitment and retention in dentistry. We value the work that dentists do, which for too long has gone unrecognised and has been a Cinderella part of the service. The people who have suffered are not just the dentists, but the patients.

Special Educational Needs and Children’s Mental Health Services

Maria Caulfield Excerpts

Wednesday 9th February 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, Ms Fovargue. I thank my hon. Friend the Member for Newbury (Laura Farris) for securing this important debate on special educational needs and children’s mental health services. As we can see by the number of Members who have attended the debate, this is clearly a significant issue across many parts of the country. Unfortunately, the Minister for Care and Mental Health, my hon. Friend the Member for Chichester (Gillian Keegan), is unable to be here today because she is self-isolating, so I will do my best to answer hon. Members’ questions. I am sure we can follow up on anything that I am not able to cover in my remarks.

I thank the hon. Member for Sheffield, Hallam (Olivia Blake) for sharing her personal experience, which illustrates some of the struggles that people face. She outlined the positives and negatives in her remarks. I also thank my hon. Friend the Member for Bury North (James Daly) for sharing his son’s experience, which is unfortunately not uncommon.

My own postbag reflects many of the comments that have been made in the debate. Children are often not getting the help and support they need at the early stages, which often leads to more difficult interventions later that could have been avoided if the support was in place. The collaboration locally between health and education is often not where it should be. I am here not to deny any of the remarks made in debate, but to set out what is being done to address these issues, which have been in place for many years. I agree with my hon. Friend the Member for Bury North that funding is not necessarily the only factor here; it is also about how services are brought together. As my hon. Friend the Member for Newbury said, it is about accountability for how those services are delivered.

In March last year, we published the covid mental health and wellbeing recovery action plan, which includes £31 million to improve autism and learning disability services. There is £42 million to continue funding projects to support young people and families with special educational needs. There are funding pots available, but we are hearing that they are not making it to the families who need them or to the services being provided. In the short time that I have, I hope to be able to set out how we aim to resolve some of those issues.

The demand for services has increased. There is no doubt that the demand for CAMHS, ADHD assessments, autism assessments and diagnosis has increased over time, but waiting times are also dismally short of where they should be. According to the National Institute for Health and Care Excellence, which provides evidence-based guidance on many of these areas, children and young people who are referred for an autism diagnosis should have a diagnostic assessment within 13 weeks. We have heard from many colleagues, including my hon. Friend the Member for Newbury, that it takes around two years. My hon. Friend the Member for Bracknell (James Sunderland) cited three years. Of course, my hon. Friend the Member for Bury North cited his son’s experience, and the hon. Member for Vauxhall (Florence Eshalomi) also spoke about this issue. We can see that it is a problem across the country.

For ADHD diagnosis, NICE guidelines do not recommend a specific waiting time, but they set out recommendations for how services should support and manage children who need a diagnosis and their families, for how such children should be supported through education, and for general support as well. We want every area of the country to meet NICE guidelines but, sadly, that is not happening in many places. To make sure that we get on top of the situation and reduce the delays, we want to work towards providing an assessment within the recommended 13 weeks in order to deliver a timely diagnosis—not just so that they get a diagnosis, but so that the interventions are there to help and support young people and their families.

There are three key areas where I think we can improve things. The SEND review, which was touched on a couple of times in the debate, is a joint collaboration between the Department for Education and the Department of Health and Social Care. It is in progress, and we expect its findings to be announced fairly soon—I am talking about weeks, rather than months. Following the recommendations from that, a Green Paper will be published. It will follow a 12-week period in which I encourage all Members to take part in the process and to highlight many of the experiences that we have heard today. We have talked about the funding that is being announced, but often that goes to health and does not get into schools. I met representatives from one of my schools only last week, and the joined-up working locally between education and health just is not happening. That reflects the point made by my hon. Friend the Member for Newbury that accountability for who is responsible for doing what, and the joint working, is currently not happening.

[Layla Moran]

Will the Minister comment on access to funding for third-sector organisations, which are often more expert at offering advice and support that families need?

[Maria Caulfield]

Absolutely. Services are commissioned locally. Part of the issue is that there is no accountability for when services are not commissioned. The funding that is put forward needs to look at all service providers, and the third sector is often well placed to provide those services.

To touch on long waits, NHS England is working to ensure that CAMHS have embedded diagnostic pathways for autism and ADHD as a core part of their work. A sum of £13 million is going in to improve those pathways and identify those at risk of crisis; £2.5 million of that funding will test different approaches to diagnostic pathways and ensure that they are backed by research and are evidence-based. In addition, NHS England wants to develop a single point of access to ensure that referrals are triaged, and that individuals do not stay on lengthy waiting lists. We have heard today of the difficulties caused by not having a single point of access. I have met families in my constituency. As the hon. Member for Oxford West and Abingdon (Layla Moran) said, we are the last refuge and point of contact when they cannot get anywhere else.

We know that school settings can provide an invaluable opportunity to identify autistic children early in life. We are investing £600,000 in significantly expanding an autism early diagnosis pilot in Bradford. That will test at least 100 schools over the next three years to assess whether new approaches to achieving a faster diagnosis can be rolled out across the country. The early findings from that pilot are positive. Education staff report that they are better able to identify children and put in place the support they need to thrive in education. Local areas will look to upskill mainstream staff to better identify children’s needs. In Manchester, a project to support early identification and diagnosis in young children involves health visitors identifying those who show signs associated with autism and fast-tracking their assessment, with additional post-diagnostic support for families.

The issue for many years has been the lack of a national strategy, but that is changing. What we want, when pilot studies show good initial results, is to roll them out across the country. In the next year, on top of the £1.5 billion spent in the past two years, we are providing an additional £1 billion of high-needs funding for the education of children with more complex needs. The aim of that funding is to reduce waiting lists and variations in practice, make navigation pathways less complex, and improve the speed and quality of diagnosis.

Those points tackle some of the issues around waiting lists, but accountability was the main thread of the introductory remarks of my hon. Friend the Member for Newbury. At the moment, no one is held accountable locally if services are not commissioned. The integrated care system will be put on a statutory footing from 1 July, if the Health and Care Bill goes through on time, and ICS boards will be the accountable bodies for commissioning services. Their chief executive officer will be the accountable officer for the NHS locally and will be responsible for bringing those services together and will be accountable if that is not happening.

Since November 2019, NHS Digital has reported on waiting times for autism assessments, trying to ensure transparency in how services are delivered and highlighting areas where improvements are needed. It is incredible that, up until now, we have not had the data to hold people’s feet to the fire when services are not provided.

[Steve Brine]

On accountability, can the Minister shed any light on the issue of CAMHS in Hampshire telling parents not to ask how long, or will she take it away? It means that they cannot plan, for instance, decide to sell the car. Those are the choices that people are facing. They cannot plan for what is next. Does that sound right to her, that people have been told not to ask?

[Maria Caulfield]

No, that does not sound right. That is exactly why we want to bring some accountability to local services, so that when such statements are made, we can look at what the problems and the blocks in the system are to try to overcome them.

Local authorities also need to be held to account for how they support schools, because schools do a huge amount of work, going above and beyond in most cases to support children with special educational needs. That is why we continue to work with Ofsted and the Care Quality Commission to develop a new area of SEND inspections, which will look at how services and support are delivered in practice on the ground. That will hold local areas to account, so that there is no gap in oversight before full implementation of any new reforms resulting from the SEND review. It also recognises the importance of inspections in SEND services by highlighting areas of good practice and areas to improve on.

I reassure colleagues across the Chamber that that is an area of high priority. The SEND review will be published shortly, and the Green Paper will follow swiftly on from that. I encourage all colleagues to share their powerful experiences in that process, as they have today, so that we can improve services for the children and their families who at the moment are not getting the service that they deserve.

Dentist Industry and NHS Backlogs

Maria Caulfield Excerpts

Monday 7th February 2022 Commons Chamber

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

I congratulate my hon. Friend the Member for Warrington South (Andy Carter) on securing the debate and on raising such an important issue. I answered another Monday Adjournment debate on dentistry recently, and on Thursday there will be another debate on it in Westminster Hall, so it is obviously a significant issue for many hon. Members across the House. I also thank my hon. Friends the Members for Clacton (Giles Watling) and for Isle of Wight (Bob Seely) for raising issues on behalf of their constituents.

I am not going to stand here and say that there is not an issue around dentistry, because there absolutely is —it has been significantly affected by the pandemic. I will touch first on the short-term problems that the pandemic has created for dentistry and for patients, before going on to the longer-term problems around the contract, which my hon. Friend the Member for Warrington South raised and which have existed for a significant time.

A significant backlog has been created during covid. The majority of dental procedures are aerosol-generating, so covid creates a significant risk both for patients and for dental teams. When the lockdown measures initially came into force, only urgent dental procedures were allowed to go ahead. It was not until 8 June 2020 that non-urgent procedures were allowed, and only 20% of normal activity was allowed to go ahead at the time because of infection control measures. Even at that stage, we could see that a significant amount of work was backing up.

For most of last year, dental teams were allowed only up to 40% of normal activity. It was not until the end of last year that they could go up to 65%, and just around Christmas time that they were able to go up to 85% of normal activity. Even today, they are still not allowed to go back to 100% of normal activity, simply because infection control measures make it important that space, intervals between patients and cleaning between patients continue. Even with dentists working at pace and as hard as they can, a backlog is still accumulating nearly every day because those measures are in place.

[Andy Carter]

I thank the Minister for setting out very clearly how dentists have come back to operate in their surgeries. As she mentions and as I said in my speech, dentists were asked just before Christmas to deliver 85% of the UDAs for the three-month period from January to March. A number of small dentistry practices operating with one or two people are saying that we have increased the amount that they are required to deliver in order to be paid, at a time when covid is at its highest with the most infections ever. If a staff member, dentist or patient is unable to attend, the risk that the dentist will not be able to deliver is very significant, which means that they could be financially penalised. Does the Minister understand that the way the contract has been set up can really work against the current timeframe?

[Maria Caulfield]

I absolutely have a lot of sympathy for dentists. It is due to their and their teams’ hard work that, since December 2020, urgent care is back to pre-pandemic levels. I reassure my hon. Friend that when we were at 20%, 40% and 65%, dentists were getting paid 100% of their contract value; it is only since the Christmas period, when we went to 85%, that they have not been paid the full 100%. Throughout most of the pandemic, even though they were seeing fewer patients than their contract allowed because of infection control measures, they were getting 100% of their contract value.

[Andy Carter]

I understand what the Minister says. The way dentists are paid is not that dissimilar to the way MPs are paid: they get a chunk of money and have to pay their rent and pay their staff, as they have had to do all the way through the period. If they get to the point where they are required to deliver 85%, but where covid and the infection levels mean that they cannot physically deliver it because they are not there, they still have all those outgoings—they still have to meet their contractual requirements to pay the rent and pay their staff. That is the issue that I think many dentists are very concerned about.

[Maria Caulfield]

I take my hon. Friend’s point of view, but during the pandemic there has been significant support that many other sectors did not get. That is not to detract from the problems that dentists are facing, however, and no one is a bigger supporter of dentists than I.

I will just move on to some of the other points that my hon. Friend raised. We are not up to 100% of pre-pandemic activity simply because of covid, and that is taking a toll on access to NHS dentistry. A number of patients have waited and waited during the pandemic and now need urgent care, and we are seeing that reflected in A&E attendance and in surgical elective lists, because patients have got to a stage where they need surgery to rectify some of their problems.

I fully take on board many of the issues that have been raised in the debate this evening, but I reassure colleagues that we are trying to support dentistry as much as possible. NHS England is providing local commissioners with help and support to direct patients to where there is availability. It may have been my hon. Friend who mentioned this, but dentists have been asked recently to update their information on the NHS website that records where NHS dentists are, so that we can direct patients to those surgeries that are taking patients. Dentists have also been asked to operate a cancellation list, so that, should someone pull out, the next person on the list is proactively contacted to be offered that appointment. It is difficult for patients to navigate the system and find out where NHS dentists are.

Members may be aware—I hope they are—that just a few days ago, a one-off additional £50 million was secured for NHS dental services, the first pot of money that they have received in a long time. It is specifically focused on this financial year, so it has to be spent by April. It is targeted at those NHS dental teams to ask them what availability they have in increasing capacity, so that those waiting for treatment can start to access some of it. My hon. Friend’s area in the north-west has been allocated £7.3 million to be spent by April. NHS England is working at pace with local commissioners to deliver that and to try to tackle some of the backlog.

The difference between that funding and the contract is that the rates of pay are significantly different, and we are seeing huge uptake from dentists who are keen to do NHS work when they are rewarded accordingly. That additional £50 million will secure up to 350,000 additional dental appointments and will be targeted at those in most urgent need of dental treatments, whether it is oral pain, disease or infections, to help them get the care they need. Children, who a couple of Members mentioned, are being prioritised, as are other vulnerable groups. We are seeing some take-up of that offer, and I hope that shortly we will be able to update colleagues on where exactly that take-up has happened and the difference it has made in accessing NHS dental provision.

I will move on to some of the longer-term dental issues, which have been eloquently set out this evening.

[Bob Seely]

I do not want to interrupt my hon. Friend as she goes on to these important long-term structural issues. There were a bunch of short-term ideas to get dentists into this country in the next year or two to help with the immediate crisis and the lack of NHS dentists. Can she assure us that she and her Department are looking at some of those options, rather than looking purely at the long term?

--- Later in debate ---

[Maria Caulfield]

If my hon. Friend will allow me, I will touch on some of those measures, too. If we move on from just the covid-related problems that have fallen on dentistry, there is no doubt that the UDA method of contract payments is a perverse disincentive for dentists. The more they do, the less they seem to be paid. I for one certainly do not underestimate the problems that that causes dentists, and I can see why many hand back their NHS contracts.

That is why we have started work on dental contract reform. I am meeting the BDA again tomorrow, and officials are starting contract negotiations, looking at both short-term change, which may give some immediate relief, and long-term reform of the contract, because that is the nub of the problem as to why dentists are not coming forward to take on NHS work, or are handing back their contracts because they no longer want to do NHS work. At the moment, the contract simply does not value the work that dentists do, and I want to reassure hon. Members that we are working as fast as we can to reform it and to make improvements.

We also need to work with local commissioners, because the feedback that we get is that some parts of the country are much better at commissioning local dentistry services than others. That is something we need to address, and part of how the £50 million is spent across the regions will be about helping us to identify those areas that need more support in commissioning services.

Our joint aim is to make patient access better and to reduce health inequalities for patients, while making the NHS a more attractive place for dentists to work. Making NHS dentistry more attractive to professionals will help with recruitment and retention and will provide us with NHS dentists across England. Hon. Members may be aware that Health Education England published its “Advancing Dental Care” review report in September last year and is working to implement the proposals to reform dental education over the next four years. The aim is to modernise training and education and to widen access to and participation in training to ensure that not just dentists are coming through the system but a whole range of dental professionals can be more effectively used in NHS dentistry. Legislative changes may be needed to upskill dental nurses, dental technicians and dental associates, and we are looking at whether we can tackle that later this year so that it is not just dentists who are able to do a significant amount of work. There are highly skilled, highly educated and highly experienced professionals working in dentistry who we could upskill and use to provide more dental support.

Although we are keen to expand dental training, the results of the establishment of new dental schools in regions or the training of more dentists would not necessarily be seen for four to five years. That is not to say that we will not do those things, but there are some immediate solutions, one of which is to create centres of dental development in localities where there is a shortage of provision and we can bring together education and services. My hon. Friend the Member for Warrington South is right that not just dentists but GPs are more likely to stay where they train, so it is important that we look at where the shortages are and try to bring centres of dental development to those areas.

The Government recognise, as my hon. Friend the Member for Isle of Wight pointed out, that the registration process for some internationally qualified dentists can be bureaucratic and inefficient. The overseas registration exam that currently has to be taken was suspended throughout covid. The first exams took place last week, so some overseas dentists are starting to take their exams. The sessions booked in for the rest of the year will cover roughly 700 overseas dentists. They may not all pass the exam, but at least they are starting to get through the system.

The Department is currently working with the GDC on legislative proposals that will allow greater flexibility to expand on the registration options that are open to international dentistry applicants. My hon. Friend the Member for Isle of Wights is right that some experienced qualified dentists currently cannot practise in this country. I am pleased to say that the consultation on the changes with the GDC launched today. Subject to the results of that consultation, we hope to bring forward changes later this year. That will really open up dentistry to those who trained overseas. That is not to say that they will choose to work in the NHS once they qualify, but we are working on plans to encourage as many of them to do so as possible.

Although I am unable to present a quick fix to the House, I hope I have been able to reassure colleagues not only that are we working through short-term measures in respect of covid to open up dentistry and to get on top of the backlog created by covid, but that the long-term plans in respect of dental contract reform, training measures and the opening up of access for overseas dentists will increase access to NHS dental services and hopefully open up access for patients throughout the country.

Question put and agreed to.

Essex Mental Health Inquiry: Indemnity

Maria Caulfield Excerpts

Friday 4th February 2022 Written Statements

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

It is normal practice, when a Government Department proposes to undertake a contingent liability in excess of £300,000 for which there is no specific statutory authority, for the Minister concerned to present a departmental minute to Parliament giving particulars of the liability created and explaining the circumstances; and to refrain from incurring the liability until 14 parliamentary sitting days after the issue of the minute, except in cases of special urgency.

I have today laid a departmental minute proposing to provide an indemnity that is necessary in respect of a Department of Health and Social Care established non-statutory, independent inquiry into the care and treatment pathways and the circumstances and practices surrounding the deaths of mental health inpatients in Essex.

The Essex Mental Health Independent Inquiry has been established to investigate deaths which took place in mental health inpatient facilities across NHS Trusts in Essex between 1 January 2000 and 31 December 2020. It will draw conclusions in relation to the safety and quality of care provided locally and nationally to mental health inpatients.

In January 2021, the Minister of State for Patient Safety, Suicide Prevention and Mental Health announced the establishment of the inquiry—HCWS729, 21 January 2021—to be chaired by Dr Geraldine Strathdee CBE. The indemnity will cover the entire duration of the inquiry’s work, from January 2021 until when the inquiry submits its final report, expected in 2023, and for an unlimited period after that date. However, we believe there is a low risk of the indemnity being called upon beyond five years of the inquiry having reported. The indemnity will cover the chair and all other members of the inquiry team, against any liability, including any legal or other associated costs, arising from any act done, or omission made, honestly and in good faith, when carrying out activities for the purposes of the inquiry in accordance with its terms of reference.

The indemnity will only apply to acts done or omissions made during the course of the inquiry and will exclude personal criminal liability, negligence or reckless acts. There will be no cap placed upon the indemnity, so the maximum exposure is strictly unlimited. However, any losses are not expected to exceed a value of £3 million based upon the best estimate currently available at this stage of the inquiry’s work. If the liability is called, provision for any payment will be sought through the normal supply procedure.

The Treasury has approved the proposal in principle. If, during the period of 14 parliamentary sitting days beginning on the date on which this minute was laid before Parliament, a Member signifies an objection by giving notice of a parliamentary question or by otherwise raising the matter in Parliament, final approval to proceed with incurring the liability will be withheld pending an examination of the objection.

[HCWS589]

Cumberlege Report

Maria Caulfield Excerpts

Thursday 3rd February 2022 Westminster Hall

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

I congratulate my right hon. Friend the Member for Elmet and Rothwell (Alec Shelbrooke) on securing this important debate on Baroness Cumberlege’s review. I was not present for the debate six months ago, so I cannot comment on many of the points that were raised then, but I am keen to update hon. and right hon. Members across the Chamber on the progress that has been made, because I am passionate about improving outcomes for the affected women. Not only do I have a huge amount of respect for Baroness Cumberlege, with whom I am working extremely closely on the results of her report, but she is a constituent of mine. I assure hon. and right hon. Members that she is holding my feet to the fire on all her recommendations.

The findings of the review laid bare the consequences of a healthcare system that has failed to listen and has disregarded the experiences of women. We have heard that movingly in many of today’s contributions, and in many debates in the House, on issues such as painful hysteroscopies, the delay in diagnosis for endometriosis or polycystic ovary syndrome, or women being ignored for years while experiencing symptoms of the menopause. There is a running theme.

My right hon. Friend the Member for Maidenhead (Mrs May) is exactly right that women often call for change on these issues for many years before their voices are heard. That is why I am pleased that we have England’s first ever women’s health strategy; we set out the vision document before Christmas and we will set out the full strategy very soon. It includes the appointment of a women’s health ambassador, who will look specifically at the issues and priorities in the strategy. We are recruiting at the moment and should have someone in post very soon. That is to make sure that women’s voices are not just heard but acted upon, so that in years to come we are not in a position where women and the MPs representing them are saying, “We have spoken every six months, but the situation hasn’t changed.” I reassure colleagues that I take all these points very seriously.

[Alan Brown]

It is good to hear the Minister’s commitment to listening to women’s voices. Will she listen to these women and, in particular, her constituent Baroness Cumberlege about the need to provide redress for the women who have been harmed by these drugs?

[Maria Caulfield]

I will come to that point. The Government have apologised on behalf of the health and care sector for the time it took to listen and respond. We are doing more than apologising: we are changing the healthcare system so that it responds to women in a much better way.

As the hon. Gentleman has just raised the issue of redress, I will touch on it now. It is not just these cases where it is often difficult for patients to get redress and compensation. I gave evidence to the Health and Social Care Committee this week on the issue of clinical negligence. This week, we announced a fixed recoverable costs scheme, meaning that, for low-value claims, we can speed up the claims process, reduce legal costs and ensure that, whatever clinical negligence they have experienced, patients are able to get compensation as quickly as possible. The findings of the Cumberlege report highlight mesh, Primodos and sodium valproate. However, across the board, it is very difficult for patients to get redress, regardless of the clinical negligence they have suffered.

[Caroline Nokes]

I do not want to be too difficult, but I do not think it is any excuse to say that because it is difficult for everyone to get compensation, we should not try here.

--- Later in debate ---

[Maria Caulfield]

I want to reassure my right hon. Friend that changes have already been made. When women were experiencing these problems, particularly with sodium valproate, compensation was mainly run by NHS trusts and individual organisations, which was very difficult and cumbersome.

We have introduced the duty of candour, which a number of Members have raised this afternoon. That duty means that when a mistake happens, hospital trusts and GPs have to be up front, own that mistake and explain it to patients. Very often, women did not realise that the problem was the sodium valproate or the Primodos; they thought something else had happened. The duty of candour means that hospital trusts and GPs are up front, that that apologise and that the process of redress is started as soon as possible.

Now that NHS Resolution has been set up, the process is as easy as possible for anyone with a claim of clinical negligence to come forward. As a result of the new system, between 70% and 80% of claims—I will correct the record if I am wrong—are now settled out of court, which is quicker and helps patients get the compensation they need. They have a fundamental right to that if clinical negligence has happened.

[Alec Shelbrooke]

I am listening closely to what my hon. Friend is saying. Is that data independently audited, and will it be made available? The reality on the ground is that although these things are in place, there are plenty of examples of people who feel that that is not the case, and that doctors and professionals are carrying on doing the same thing and not feeding back in. I welcome what she has said, but could an auditable trail be published to show what is happening and those who perhaps are not taking any notice?

[Maria Caulfield]

There are absolutely processes in place, including bodies such as the Care Quality Commission, which audit and inspect to ensure that the processes that have to be in place are being used. NHS Resolution is clear about the work it does, and its chief executive also gave evidence to the Select Committee this week on how the process should work. Of course, if patients feel that it is not working for them, we need to hear about it. We set up these mechanisms specifically to make compensation easy, quick and representative of the needs of those who are claiming, to make sure that they get the compensation they need as quickly as possible. That has not happened in the past; we fully acknowledge that.

The Secretary of State will announce a consultation on wider reforms to clinical negligence very soon, because we recognise that the system has not worked for people. It has been too bureaucratic, and the legal position and fear of going to court has put many people off. It does not need to be like that. We want to make it as easy as possible for people, whatever their clinical negligence claim.

[Mrs May]

I want to press the Minister. I apologise about that, but she will recognise from the debate that there is real concern about this. I have concerns about NHS Resolution and the way it operates. There are systems elsewhere, in countries such as Australia and Canada, where, at a very early stage, an independent medical expert, who is completely separate from the institution where the negligence has taken place, is brought in, and there is much more of a sense of no-fault compensation and of not needing to go to litigation. NHS Resolution gets involved in litigation, and it can take many years before that is resolved.

[Maria Caulfield]

Yes, absolutely. Part of the consultation we will announce shortly will look at international comparisons. One concern we have about some of the no-fault schemes is the caps on the amount of compensation that can be given. I think some countries have a £1 million cap. I am not an expert on how much compensation these ladies should be due, but we want to make sure that, if we set up systems like that—we are not closed to those ideas—they actually address the issues that these specific women face. We will look at those options in the round.

[Sir Mike Penning]

May I press the Minister and draw her back to the Cumberlege report? What she is talking about going forward sounds really good, and the proof will be in the pudding, as my grandmother would have said. But recommendation 4 of Baroness Cumberlege’s report for the Government talks about—this is my word—compensation. That is so important because, as we heard, some of these people have been caring for their loved ones for the last 50 years. They are not going to be here forever, and they feel enormously vulnerable that their loved ones, who they have looked after for all that time, will be left without their needs being met.

This is not all about the ladies who, for instance, took Primodos tablets. It is about the outcomes—in order words, their children, who are living with this today. We quite rightly concentrate when talking about sodium valproate, mesh and Primodos on what happened at the time, but the consequences of that are these people who are now in their mid-50s and 60s. What will happen to them? They will fall back on the state for PIP and other benefits when actually, recommendation 4 says in black and white that the Government should have sorted it out.

[Maria Caulfield]

I thank my right hon. Friend for making that point. Compensation can be claimed now. Our concern about setting up a specific body to oversee that is that that would not address the fundamental problem of why it is difficult to get compensation. However, it is a fundamental right of anyone who believes they suffered from clinical negligence to seek compensation, and we actively encourage that.

[Liz Twist]

This is really important. These people we have been talking about all afternoon are, as the right hon. Member for Hemel Hempstead (Sir Mike Penning) said, living with the consequences of those actions. Baroness Cumberlege is absolutely clear about setting up a redress agency to

“administer decisions using a non-adversarial process with determinations based on avoidable harm looking at systemic failings, rather than blaming individuals.”

Recommendation 4 is that:

“Separate schemes should be set up for each intervention…to meet the cost of providing additional care and support to those who have experienced avoidable harm and are eligible to claim.”

Going to the law is not an answer for these people. It is difficult, it causes anxiety and it is expensive. We need real action now to address the problem.

--- Later in debate ---

[Maria Caulfield]

I take the hon. Lady’s point, but the vast majority of claims that come through NHS Resolution are settled out of court. We want to make sure that patients get the redress that they are entitled to. There are mechanisms other than going to court in place right now.

[Sarah Green]

My constituent has approached several legal firms who will not take on her case because the two surgeons who operated on her also work for the law firms advising them on whether such cases will be successful, so that option is not open to her.

[Maria Caulfield]

If the hon. Lady writes to me about that specific case, I am happy to look at it.

The Government published their response to the review in July last year and accepted the majority of the recommendations for improvement. I want to update Members on those because we are absolutely committed to making rapid progress in all the areas in our response. We have committed to publishing an update on the progress of all the recommendations that we accepted, and we aim to publish that in the summer. If colleagues want to hold my feet to the fire, they will certainly get a formal update in the summer.

We have made strong progress on some of the changes.

[Sir Mike Penning]

It is fortunate that we have so much time because we can ask lots of questions. Marie Lyon, the Primodos campaigner, has effectively been told by the Minister’s predecessor, “See you in court”. I do not know about the experiences of the other conditions, but the Primodos campaigners do not have money. They have the will, but they are completely exhausted. They pinned all their hopes on the Government accepting the report’s recommendations. These people will not get a no win, no fee arrangement or a pro bono. They will have to try to fundraise, and they will, but is that morally right when the baroness’s report and its recommendations, published by the Government, say that they should not have to go through that?

[Maria Caulfield]

Specifically on Primodos, there is pending litigation so it is difficult for me to comment while that is in progress, but, depending on the outcome, the Government will respond to that.

[Caroline Nokes]

I will go for valproate, because there is not pending legislation about that. Have I understood the Minister correctly? Is she saying that if the Primodos case is successful, the Government will review it, and the women who have had mesh implants or who are the victims of sodium valproate will not be expected to have to go down that legal route?

[Maria Caulfield]

If I touch on the points in my response, hopefully I will be able to reassure colleagues on the progress being made.

[Alan Brown]

The point is that Baroness Cumberlege says the Government have an ethical duty to consider redress, so what does the Minister say to her constituents about that ethical duty that should be placed on the Government?

[Maria Caulfield]

I have addressed the points about redress, which is available. We are reforming the process of clinical negligence to make it easier for patients to get compensation without the need to go to court, and we are having some success in that. There is a very different system in place now compared with when many of these ladies were affected.

The patient safety commissioner was mentioned by some colleagues. The consultation proposed details for setting up the commissioner’s role. Baroness Cumberlege is on the recruitment panel for that position and will keep a close eye on the role of the commissioner. The advert and recruitment process is now up and running, and we expect to appoint someone very soon. I reassure colleagues that that appointment will be in place: the recruitment process has started, Baroness Cumberlege is on the panel to appoint the commissioner, and that commissioner will be independent—a point made by my right hon. Friend the Member for Maidenhead—of the Department of Health and Social Care, which will of course work closely with them. The commissioner will be able to scrutinise both the NHS and the Department itself.

On recommendation 5, about specialist mesh services, eight specialist centres are now operating in England, where women who have been affected by mesh implants can access treatment and mesh removal. A ninth is being set up in Bristol at the moment. I remain very open to colleagues’ experience of those mesh services. Women have the option to choose which centre they go to, but I recognise that that might involve great distances from where they live.

If women are not being referred to the centres, however, or if their experience of the centres is that their needs are not being met, I am keen to hear about that, because the whole point of setting the centres up was to ensure help for those women who have experienced mesh implants that have caused huge trauma—I take on board everyone’s points—to them, changing their lives and that of their families forever. If that is not working, the women’s health ambassador, the patient safety commissioner and I will look at that, because that was the whole point of setting up such services.

[Liz Twist]

Will the Minister say something about the specialist centres proposed for valproate and Primodos? They do not exist; I believe that the Government rejected them.

[Maria Caulfield]

Valproate should not be being used on women or girls able to have children, unless they have a pregnancy prevention programme in place. That is to ensure that patients are fully aware, if they need to take sodium valproate, of the effect on any potential pregnancy. The NHS also commissioned the paediatric neurosciences clinical reference group to support the development of pathways for care services, specifically to improve patient support and co-ordination on the pathway for sodium valproate.

Mechanisms are therefore being set up for those women and girls who need to take sodium valproate. I think my right hon. Friend the Member for Romsey and Southampton North (Caroline Nokes) pointed out that, in other settings, a huge amount of work is done to ensure that those women do not get pregnant. Also, a multidisciplinary expert group with experience in responding to exposure has been established. It will report its recommendations to NHS England in March this year. We will follow up on those recommendations, but a piece of work is being done specifically on sodium valproate, which will help to prevent such problems in the future.

Recommendation 6 was on MHRA reform. The review highlighted the need for the regulatory agency to undergo substantial revision, in particular on adverse event reporting and patient engagement. As many Members said, instances were flagged many times by many different people—the women themselves, MPs in this place, charities and other bodies—but people did not listen, although the MHRA has a duty to do so.

The MHRA has now initiated a substantial programme of work to improve how it listens and responds to patients and the public, developing a much more responsive system for adverse event reporting and supporting timely and robust decisions involving patient safety. It has been consulting on a new regime for medical devices that makes patient safety, engagement and transparency more prominent.

To strengthen its commitment to patient engagement, the MHRA recently established an enhanced customer service centre to make it easier for patients to express concerns, whether about medicine or devices that are being used. The MHRA has also appointed a chief safety officer, Dr Alison Cave, who will lead its ongoing commitment to the recommendations.

On setting up a database to collect details of all implantations of devices, which is recommendation 7, we have already legislated for that through the Medicines and Medical Devices Act 2021. The Act created a power for the Secretary of State to regulate for the establishment of a UK-wide medical device information system. Alongside developing those regulations, more than £11 million has been set aside for the work, involving partners across the healthcare system to scope, test and cost options for that workstream.

On transparency for payments, which I think was raised by the hon. Member for Chesham and Amersham (Sarah Green), who spoke about the conflicts of interest between doctors and pharmaceutical companies or providers of surgical mesh, recommendation 8a highlights the need for greater transparency for payments made to doctors. The recommendation calls for a register of doctors’ interests and for recognised and accredited specialisms to be held by the General Medical Council.

As the Government set out in our response to the review, we agree that lists of doctors’ interests should be publicly available. We continue to hold the view that that information will be most accessible to patients if it is published by healthcare providers rather than by the GMC. We are taking that measure forward and it should be in place by July this year.

We are also working with professional healthcare regulators to be clear that all regulated health professionals—not just doctors—must declare their interests, and that that information must be published by their employers. That approach will give not just women but all patients the reassurance that there are no interests involved in clinical decisions made about their care. We are working with the Care Quality Commission and equivalent organisations, and with the devolved Administrations, to ensure that implementation is monitored and that there is local accountability.

Recommendation 8b touches on the mandatory reporting of the industry. It calls for the pharmaceutical and medical devices industries to establish payments made to teaching hospitals, research institutions and individual clinicians. On 24 January this year—just a few days ago—an amendment to the Health and Care Bill was tabled to give the Government the power to deliver on that important recommendation. That legislation will, I hope, come into law fairly soon. The amendment will enable the Secretary of State to make regulations requiring companies to report information about their payments to the healthcare sector. That measure will benefit patients, who will see payments made to their doctors or hospitals, and it will build on proactive initiatives by healthcare regulators and the industry.

I very much take on board Members’ feeling that it took too long to acknowledge the problems that those women have faced, whether because of mesh implants, sodium valproate or Primodos. Although this may not be of any reassurance for women who have already been affected, we now have measures in place to flag problems in the system. For maternity care and clinical negligence, for example, we have an early notification system so patterns of events around neonatal care and foetal abnormalities are picked up at an earlier stage, to get on top of the causes quickly. We are seeing improvements in maternal and neonatal outcomes as a result of that early warning notification system

We very much recognise that such problems did happen in the past, but measures are being put in place to make sure that they do not happen in the future. I certainly want to make sure that the women affected are getting the care and support that they need. I very much take on board the points raised by hon. Members. I am very happy to keep Members updated on progress. I meet Baroness Cumberlege regularly to address the issues raised in her report.

I reassure colleagues that many of these issues will feature in the women’s health strategy, which we will publish shortly. The women’s health ambassador, the patient safety commissioner and I will be working hand in glove to make sure that women’s voices are heard in relation to their healthcare, and that we end the pattern of women feeling that they are not being listened to, that they are palmed off, and that their concerns are not taken seriously.

[Hannah Bardell]

Does the Minister recognise that this is not only about compensation, but about exposing the failures so that they never happen again? Eighteen members of the Primodos support group have died in the past two years. That gives an idea of just how long people have waited. They should not have to wait any longer. Those who have died will never see justice.

[Maria Caulfield]

I absolutely take that point—that is the crux of the matter. For too long in the health service, there was no duty of candour. The health service did not acknowledge when mistakes were made. That is changing; there is now a duty to declare when a mistake has happened. There is also support for staff. I cannot remember who mentioned the whistleblower on Primodos, but there is protection for whistleblowers now. There are freedom to speak up guardians to support whistleblowers in the workplace, and the Care Quality Commission is happy to take notification from patients and staff if there are worries about unsafe patient care. That will trigger an unannounced inspection to look at the data. It is all about creating a culture of learning in the NHS, rather than one of blame that pits patients against clinicians—that is what we want to change. That is how we learn from the mistakes of the past and prevent mistakes in the future.

[Alan Brown]

I thank the Minister for taking one more intervention. She talks about blame and not pitting patients against doctors or the NHS. Is that not the whole point of the redress agency that was recommended, to take away that adversarial approach?

[Maria Caulfield]

That is why we introduced NHS Resolution to facilitate a quicker method of getting compensation to those who have been harmed through clinical negligence. I encourage hon. Members to look at the work of NHS Resolution. We are doing more to ensure a better experience for patients, but we are fundamentally committed to ensuring that those who have been harmed get the support they need.

[Sir Mike Penning]

The Primodos victims—I am not allowed to talk about the court case—have had no choice. They are in court now because the Government would not take on Cumberlege recommendation 4. It is all well and good talking about what will happen in the future, but they are living with this now. They are in court today. Surely the Government should settle with them now. Like the Minister has said several times, these things get settled out of court. Well, settle with Primodos victims now and they will not have to go through that.

[Maria Caulfield]

I cannot speak on active litigation claims, but between 70% to 80% of claims are settled out of court because that is the avenue we want to go down. It is not in anyone’s interest to go to court. I am happy to keep hon. Members updated. There will be a formal review in the summer, but I am happy to have my feet held to the fire to ensure we deliver on the Cumberlege review for those patients who have suffered.

NHS Hysteroscopy Treatment

Maria Caulfield Excerpts

Monday 31st January 2022 Commons Chamber

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

I congratulate the hon. Member for West Ham (Ms Brown) on securing this debate. I thank her for all her hard work. I am very sorry that she has been speaking about this issue for nine years and is still having to share some of the stories and experiences of women who have contacted her, whether that is Jane, who was unaware of the potential for pain when having such a procedure—women being investigated for endometriosis often wait eight to 10 years to get a diagnosis, so if there is an offer of a procedure to find the cause of their problems, of course they will grab it and not necessarily ask questions about what is involved; or Sandy, who got no information on pain relief at all, or Penny. Penny was warned by the nurse—often nurses are attuned to these things—and was worried about what the outcomes were, but went ahead with the procedure. These are shocking tales that should not be happening in this day and age. I appreciate everything that the hon. Lady says, and I offer that I will be happy to work with her on this issue.

As Members will be aware, hysteroscopy is an essential tool to get to the bottom of many complaints. Whether that is cancer, endometriosis, vaginal bleeding or pelvic pain, it is a necessary test. While other tests can be used, they do not necessarily get to the level of clinical detail that a hysteroscopy can provide for clinicians. It is therefore important that the test is available for women, but in a way that does not create the problems we have heard about this evening.

Many women can have the procedure as out-patients in 10 to 15 minutes and it can be relatively painless, but many women, as we have heard today, experience great pain, which puts them off from coming back if they need further procedures, as the hon. Lady has said. If they share that story with other women they know, it can put them off from coming forward, too.

Unfortunately the NHS does not collect data on the number of women who experience pain during a hysteroscopy or the women who fail to have the hysteroscopy and then need to have either a general anaesthetic or further anaesthetic later on. I am aware that the Campaign Against Painful Hysteroscopy estimates that between 5% and 25% of women are affected and have reported severe pain, and frankly that is not good enough. I welcome that NHS England will be meeting the campaign group on 4 February. I look forward to hearing the outcome of that meeting, and I will be following up any recommendations after that.

The hon. Lady is right that for many procedures a man would undertake, anaesthetic is probably routinely provided or offered. We need to ensure that the same applies to those procedures that women have to go through.

There are guidelines in place, and I spoke only last week to the president of the Royal College of Obstetricians and Gynaecologists, because I knew this debate was coming up. Those guidelines were published back in 2011, and they need updating. The guidelines focus on minimising pain and optimising the woman’s experience, as well as making specific recommendations on how to reduce pain, but as the hon. Lady said, we do not have the information to know who is and is not following those guidelines. We are therefore not in a position to say whether, if those guidelines were followed, many women would not experience pain, and that is the difficulty we have. The data is therefore crucial.

In the last debate that the hon. Lady secured on this issue, which I think was in September 2020, my predecessor, the right hon. Member for Mid Bedfordshire (Ms Dorries), informed the House that to ensure the recommendations were robust and up to date, the royal college would be producing a second edition, in which it will assess whether the current guidelines are effective and are being used. The second edition is being jointly developed with the British Society for Gynaecological Endoscopy, and I am assured that patients’ voices will be at the heart of its development. The royal college has informed me that good progress is being made, and that it will have the updated guidelines by next year.

[Ms Brown]

Can I ask specifically that we involve the campaign, because that would be one way of assuring me that the voices of patients are being heard?

[Maria Caulfield]

I said to the president that I would follow up after the debate, so I can certainly make that request.

The royal college has also said that it is producing a good practice paper specifically on pain relief and how informed decisions should be made, particularly in out-patient hysteroscopy procedures. It is going through the peer review process next month and will be published shortly afterwards. Once it is published, I would be very keen to hear from campaign representatives about whether they feel that those guidelines would make a difference to them in a practical session.

It is crucial that women who are offered a hysteroscopy are given the information they need to make an informed decision, given that they have sometimes waited a long time for the appointment and that serious clinical conditions can be diagnosed from it. That should include information about potential pain, options for pain management and alternative procedures that could be used.

The Department and NHS England recommend that, as part of good practice, the royal college’s patient information leaflet, which was published in 2018, should be provided to patients to aid decision making. I think that should be provided in advance of the appointment, because it is often hard for someone to take in all that information in the midst of a consultation. Again, I would be interested to hear from the campaign whether that is happening in practice.

The House will also be interested to learn that the British Society for Gynaecological Endoscopy recently published a statement to clarify that from the outset women should be offered

“the choice of having the procedure performed as a day case…under general or regional anaesthetic”.

It further asserts that the procedure should be stopped immediately if a woman experiences pain.

I encourage any woman offered a hysteroscopy to read those valuable resources along with any additional resources provided by their clinician. I agree with the hon. Lady that women often do not understand what a hysteroscopy is or what is involved, and debates such as this highlight how important the procedure is, the options around pain relief and the different anaesthetics available.

The hon. Lady touched on the tariff. Previously, there was a different rate of payment for hysteroscopies carried out in an out-patient setting compared with in-patient procedures. I recognise that that is a concern for many hon. Members on both sides of the House because of how it affects patient choice and the choices that are offered to them. In the last debate on the topic, my predecessor announced a statutory consultation. I am pleased to say that as of 1 April, hysteroscopy out-patient procedures will no longer attract a higher tariff than elective procedures as an in-patient day case. That will hopefully make a difference to the choices offered to women.

[Ms Brown]

That is absolutely true and we are delighted about that; I welcomed it in my speech. The problem that we now have is that if a hospital offers an anaesthetic, it does not get compensated for the resource that it has used. We need to go one step further to ensure that there are no incentives for not offering women proper anaesthetic.

[Maria Caulfield]

I completely agree with the hon. Lady. She made a point about having the data to see how many hysteroscopies fail and whether that money could be better spent on offering an anaesthetic up front to many women. I do not have an answer to that, but it would be interesting to look at that information.

Alongside clinical guidelines and access to high-quality patient information, I stress the importance of the voices of patients, which are critical at every stage of the treatment pathway. Decisions should always be discussed and shared between clinician and patient. The Government are committed to ensuring that the voices of women in particular are more central in the healthcare system.

The women’s health strategy has been touched on several times. We have also taken key learnings from reports such as the Cumberlege review, where women were talking for a long time about the issues that they faced before anyone truly listened. We need to improve that so we are not learning from such incidents after nine years of raising them on the Floor of the House. The women’s health strategy will include gynae issues such as endometriosis and polycystic ovary disease, which are conditions that do need a hysteroscopy, so I am pretty confident that we will cover that in the strategy. We will also have a women’s health ambassador—they will be appointed in the coming weeks; applications are almost closed—with whom I will meet. I want them to lead on these issues, where they can be a real voice for patients, do a deep dive into what is happening at the coalface and speak up for women if it is not working. We have guidelines, but we do not know whether they are being used in clinical practice. From what the hon. Lady says, it sounds like there are clearly issues that need to be addressed.

I reassure the hon. Lady that I am happy to work with her on this issue. Improving the tariffs is one thing, but there are still women who are not getting the information that they need to make informed decisions about pain relief and anaesthetic that could be available. I welcome the new information from the Royal College of Obstetricians and Gynaecologists on pain relief specifically for this procedure, which will be out next month, and I will feed back to it on updating the guidelines to ensure that patients are involved in the process.

I thank the hon. Lady for raising this important matter. I hope that we have raised its profile and that women are more aware of their options. When they go to that clinic appointment, they can ask for pain relief, they can have it as an in-patient, and they do not need to have it right there, right then. I look forward to continuing to work with her and all Members across the House to ensure that women are offered a hysteroscopy and can access the information they need and the care they deserve.

[Madam Deputy Speaker (Dame Eleanor Laing)]

Genuinely, thank you.

Question put and agreed to.

Draft Health and Social Care Act 2008 (Regulated Activities) (Amendment) Regulations 2022

Maria Caulfield Excerpts

Wednesday 26th January 2022 General Committees

[The Chair]

I remind Members to observe social distancing and to sit only in places that are clearly marked. I also remind them that Mr Speaker has stated that masks should be worn in Committee. Hansard colleagues will be most grateful if Members sent their speaking notes to [e-mail].

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

I beg to move,

That the Committee has considered the draft Health and Social Care Act 2008 (Regulated Activities) (Amendment) Regulations 2022.

It is a pleasure to serve under your chairmanship, Mrs Murray.

The Health and Social Care Act 2008 requires all providers of regulated activities in England to register with the Care Quality Commission and to comply with the requirements and fundamental standards set out in regulations made under that Act. Schedule 1 to the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 sets out those regulated activities, and regulation 1(6) of the 2014 regulations provides that those regulations will cease to have effect from 31 March 2022. The draft regulations are therefore a priority, as they are needed to ensure that the 2014 regulations continue to apply, meaning that providers will continue to be required to register with the CQC and comply with fundamental standards.

The draft regulations amend the 2014 regulations, which are due to expire after 31 March this year, by extending the expiry date to 31 March 2025. That is the only amendment that the draft regulations make; they do not change any existing policy. The 2014 regulations set out the activities regulated by the CQC and the fundamental standards with which all CQC registered providers must comply. Those activity standards are not amended by the statutory instrument.

The extension of the 2014 regulations to 31 March 2025 will ensure that the current regulations relating to CQC registered providers, including which activities are regulated by the CQC, will continue to apply. There will be no change to how the CQC carries out its regulatory functions, and the Government see the CQC’s role as critical in ensuring that the care received by patients is of a high quality and delivered to standards that promote patient safety.

I highlight the fact that if we do not extend the expiry date in the 2014 regulations, they will automatically expire. There would therefore be no regulated activities for the CQC to regulate, and providers that are currently required to register with the commission would no longer be required to do so. Providers that are currently required to register with the CQC would also no longer be required to comply with the fundamental standards set out in the 2014 regulations. Not extending would risk patient safety and compromise the CQC’s ability to monitor providers against the fundamental standards.

In short, the draft regulations will amend the 2014 regulations by extending their expiry date by a further three years to 31 March 2025. This will mean that health and care providers in England that carry out any of the regulated activities set out in the 2014 regulations will continue to be required to register with the CQC and to be bound by the obligations and standards set out in those regulations.

The draft regulations will ensure that the CQC can continue to carry out its valuable role as the regulator of health and social care providers in England, and that services provided by CQC registered providers continue to be required to be carried out safely and to a high-quality standard. I commend the draft regulations to the Committee.

--- Later in debate ---

[Maria Caulfield]

It is a pleasure to respond. I am pleased to hear that the Opposition parties will support the statutory instrument this afternoon because it is crucial that the Care Quality Commission, which does an amazing job in maintaining patient safety, is able to continue to do so.

I see that Captain Hindsight has sent a lieutenant here this afternoon. The hon. Member for Bristol South would have had a reform package ready on the table and at the printer’s.

[Karin Smyth]

Will the Minister give way?

[Maria Caulfield]

I will continue, if I may. As my right hon. and learned Friend the Member for North East Hertfordshire pointed out, we have been through two years of a pandemic. Health care and social care staff and teams have worked so hard up and down the country but so has the CQC. It does do unannounced inspections; it has not been doing some of them during the pandemic as that puts extra pressure on an already overstretched group of professionals who are trying to keep their services going. There has been compromise with inspections between the sector and the CQC, but the commission very much does do unannounced inspections, which are an important part of the process.

There will be a time to reform and consider the regulations more fully. I have met the CQC. This morning I met the chief inspector for primary care and we were looking particularly at areas where there needs to be some change and reform. But it is important to do that properly. As the hon. Member for Sheffield South East said, it is important to involve all stakeholders in that process and not just rush through a process for the sake of it. The very specific scope of this statutory instrument is to extend regulations by three years so that the CQC is able to carry out its inspections and do its fantastic work to protect patients and support staff when they raise concerns. It does the inspections and makes recommendations to improve care.

I hope that Opposition Committee members will support us and that they will work with us on our reforms on social care or around the CQC to make sure that there are the best outcomes possible for patients across the board.

Question put and agreed to.