Oral Answers to Questions
Maria Caulfield Excerpts(8 months, 3 weeks ago)
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Tulip Siddiq (Hampstead and Kilburn) (Lab)
The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)
Improving maternity care is a year 2 priority in our women’s health strategy for this year. Any decisions around maternity services need to be focusing on improving outcomes for mums and babies. However, decisions on the local reconfiguration of services are made by local integrated care boards and local trusts.
Tulip Siddiq
The maternity unit at the Royal Free Hospital in my constituency is facing closure. Last week, I met with doctors from the unit who told me that the Royal Free is uniquely placed to help mothers with diabetes, pregnant women with HIV, and mothers who require interventional radiology. The Royal Free is the only local provider that offers this life-changing treatment 24 hours a day, seven days a week. Does the Minister agree that the Royal Free maternity unit has to stay open for the sake of those vulnerable groups of women?
Maria Caulfield
I thank the hon. Lady for raising her concerns, but as I said, this is a public consultation. It runs for 14 weeks and will close on 17 March. I urge her to raise her concerns as part of that consultation. It is absolutely crucial that we keep expertise in our maternity services, but I understand that the local proposals by the trust and the integrated care board outline plans for £40 million of significant additional investment into maternity services. Those decisions are for the local ICB and the local trust. The deadline is 17 March, and I urge the hon. Lady to ensure she takes part in that process.
Sir Charles Walker (Broxbourne) (Con)
Remaining in north London, can I bring to those on the Treasury Bench my concern over the quality of nursing care at Barnet Hospital? An elderly constituent of mine, who is in her 80s, was admitted there recently. She asked to use the lavatory but was told no one could take her, and was handed a nappy; she waited three hours until someone could actually take her to the loo. She is a coeliac, but was not offered any food for coeliacs during her 10-day stay because nobody had read her notes. She was also moved around her bed by her arms despite having a broken shoulder, which nobody knew as nobody had read her notes.
Maria Caulfield
I am very sorry to hear about the experience of my hon. Friend’s constituent. That level of care is absolutely unacceptable. I know he has raised this particular issue with the Patient Safety Commissioner, Henrietta Hughes, but I am very happy to meet with my hon. Friend and his constituent to discuss those complaints, because that care is not acceptable.
Sarah Green (Chesham and Amersham) (LD)
Olivia Blake (Sheffield, Hallam) (Lab)
The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)
I put on record my thanks to the members of the pre-legislative scrutiny Committee, which scrutinised our draft Mental Health Bill. We are looking at the recommendations and will respond to the Committee’s report shortly.
Olivia Blake
It is now over a year since the Joint Committee report on the draft Mental Health Bill was published. Despite repeated promises of reform, the Government have failed to act. More than 50,000 people are held under the Mental Health Act 1983. It is an outrage to them and to campaigners that reform has been de-prioritised. Will the Minister confirm when the Government plan to bring a formal Bill to Parliament and what conversations they have had with the Chancellor in the run-up to the Budget to ensure the reforms are properly resourced?
Maria Caulfield
As I have said, we have published our draft Bill, it has undergone pre-legislative scrutiny and I shall respond to the Committee’s recommendations shortly, but this is not just about legislative reform. As a result of the £143 million that we have invested in crisis support, we have already seen less use of the Mental Health Act 1983 because people are being seen earlier: our crisis cafés and crisis telephone services, for example, have led to a 15% reduction in the use of the Act.
Dame Jackie Doyle-Price (Thurrock) (Con)
It is a number of years since we promised to reform mental health legislation that reflects a time when people with severe mental ill health were viewed as problems to be managed rather than as individuals. I believe that we on these Benches, as Conservatives, should be doing everything we can to empower people and respect their liberties. It simply is not right that in the 21st century people’s health conditions are being managed through the forced administration of drugs, which pays no respect to their liberties. May I reiterate the urgency with which measures should be introduced, particularly as people with lived experience have relived their trauma to provide the benefit of their experiences?
Maria Caulfield
I absolutely entirely agree. That is why the Government published the draft Bill in January last year, and why it underwent pre-legislative scrutiny. I gave evidence to the Committee, and we are working our way through its detailed recommendations and will publish our response shortly. However, that is in addition to our significant reform of mental health services, particularly earlier intervention and crisis cafés. We have seen the impact of that: 15% fewer detentions under the Mental Health Act, 8% fewer admissions to hospitals and 12% fewer admissions from our mental health crisis telephone centres, which are now available across England 24/7.
Rachel Hopkins (Luton South) (Lab)
It is imperative that we tackle the scourge of mental ill health in children and young people. Labour will ensure access to mental health support in every school and establish an open-access mental health hub in every community, paid for by charging VAT on private school fees. Why will the Government not adopt that plan?
Maria Caulfield
I have a news flash for the hon. Lady: we are already doing all that work. Mental health support teams are being rolled out in schools—44% of pupils now have access to a mental health support team, rising to 50% shortly. Over 13,800 schools and colleges now have a trained senior mental health lead. Only last week we announced 24 early support hubs for 11 to 25-year-olds—they will not need a referral; they can drop in. There are 24/7 helplines available that can be accessed through 111. That is what we are doing.
Priti Patel (Witham) (Con)
Mid and South Essex integrated care board is seeking to remove vital community health services from St Peter’s Hospital in Maldon. Will the Minister meet me and our right hon. Friend the Member for Maldon (Sir John Whittingdale) to discuss the proposals? They will affect both our constituencies and are causing a great deal of concern.
Oral Answers to Questions
Maria Caulfield Excerpts(10 months, 1 week ago)
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Sarah Edwards (Tamworth) (Lab)
The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)
We are investing an extra £2.3 billion a year to expand mental health services in England, with the aim of enabling 2 million more people to access mental health support, including 345,000 more children and young people.
Sarah Edwards
Many constituents in Tamworth are coming to me in desperate need of support for their children. Those constituents include Kate, whose daughter is at crisis point and has been without a psychiatrist since November; Roger, who has been waiting 18 months for an autism referral for his daughter; and Jess, who has been waiting for an attention deficit hyperactivity disorder assessment for her son. Will the Minister explain what action she is taking so that children, parents and families in my constituency can get the support they need?
Maria Caulfield
Through the investment we are putting in, particularly in the hon. Lady’s local area, there are a number of initiatives to help support children and young people with their mental health. The Sandbox scheme, which is a funded NHS service, supports those in the south Staffordshire area; Malachi provides family support across Tamworth and east Staffordshire; and Combined Wellbeing, which is an online resource, covers north Staffordshire. There is also the Family Wellbeing Service, Action for Children for those aged five to 18 with mild to moderate mental health needs, and the Staffordshire Emotional Health and Wellbeing Service for those aged five to 18. I would recommend that the hon. Lady’s constituents look up those services, because we are funding them to improve mental health care for children in her local area.
George Freeman (Mid Norfolk) (Con)
The agony and damage of undiagnosed and untreated mental health conditions is nowhere more acute than in rural areas, where we see an epidemic of silent suffering. The Norfolk and Suffolk NHS Foundation Trust has long struggled with a series of management problems. I am sure the Minister has seen the recent report highlighting that between 2019 and 2022, we saw over 8,500 avoidable deaths—that is nearly 45 a week. Will she agree to meet me, other Norfolk and Suffolk MPs, and those affected to look at what is really going on here and make sure that we turn that trust into a beacon of the best mental health services, rather than the worst?
Maria Caulfield
I thank my hon. Friend for raising this issue. We were holding regular meetings with Norfolk and Suffolk MPs, the trust, the Care Quality Commission and NHS England, and with the new management team, that trust did appear to finally be turning things around. However, I am concerned to hear the points that my hon. Friend has raised. I am very happy to restart those meetings and will ask my office to arrange them as quickly as possible.
Clive Efford (Eltham) (Lab)
Sir David Evennett (Bexleyheath and Crayford) (Con)
The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)
I assure my right hon. Friend that this Government are committed to improving men’s health. That is why, in November, we announced a suite of measures, including a £16 million fund for a new prostate cancer screening trial, and the recruitment of a men’s health ambassador. We have also launched our men’s health taskforce to tackle the biggest health issues facing men.
Sir David Evennett
I thank the Minister for that answer, and I would urge her to continue to make men’s health a top priority. In particular, can she look at how we can detect prostate cancer better and sooner? It is the most common cause of male cancer in the United Kingdom, and anything that can be done to reduce that number will be most welcome.
Maria Caulfield
I thank my right hon. Friend and male colleagues on the Government Benches, including my hon. Friend the Member for Don Valley (Nick Fletcher), who are fighting so hard to improve men’s health. He is absolutely right: 12,000 men a year die from prostate cancer. That is why we are investing in the £16 million prostate cancer trial called Transform, using methods such as MRI to detect prostate cancer rather than PSA, which can be inaccurate. Thousands of men will be recruited. We are hoping that the trial will start in the spring, with recruitment in the autumn, including the recruitment of black men, who are disproportionately affected by prostate cancer.
Tim Farron (Westmorland and Lonsdale) (LD)
Does the Minister agree, however, that the information she has just given about why screening for prostate cancer does not happen for men is based on a study that is 20 years old? There are 12,000 deaths a year—it is the biggest killer among men, and the second biggest killer among all people—yet here is this evil cancer for which there is no screening programme whatsoever. Will she take steps to update current NHS guidance to ensure that all those at high risk of prostate cancer receive a targeted early detection service? I think she has hinted that she may be doing that, but will she finally introduce mass screening for prostate cancer? It is the only cancer without specifically commissioned early diagnosis work, and men are dying unnecessarily because of the failure to bring this in.
Maria Caulfield
We have more than hinted: we have just announced a £16 million pilot study of prostate cancer screening. We have a plan to tackle those 12,000 deaths a year, and it will work, because until now we have not had a diagnostic test. PSA is not a sensitive test in all prostate cancers: there are many men with prostate cancer who do not express PSA. That is why the Transform study, using detection tools such as MRI, will be trialled, and if they are effective, such tools will be rolled out across the country.
Kerry McCarthy (Bristol East) (Lab)
Jeff Smith (Manchester, Withington) (Lab)
The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)
We are investing a record amount in NHS mental health services, committing £2.3 billion extra a year for the expansion and transformation of services in England, which will enable 2 million more people to access mental health support.
Jeff Smith
If only the reality was that rosy. The entire sector is calling out for reform of the Mental Health Act 1983. With our mental health services in crisis, why did the Government scrap the long-awaited and overdue mental health Bill, which could have started to alleviate pressures on trusts by reducing the numbers of people detained inappropriately and making services more fit for purpose? Is it not true that we need a Labour Government to take action on this issue?
Maria Caulfield
I have news for the hon. Gentleman, because we have a plan and it is working. Our investment of £143 million into crisis support is showing early evidence of reducing admissions—admissions are 8% lower. With the crisis telephone services, which are available 24/7, we have admissions down 12%. More importantly, detentions under the Mental Health Act are 15% lower. We have a plan, and it is working.
Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (Con)
Kerry McCarthy (Bristol East) (Lab)
The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)
As the hon. Lady will know, we are investing more in mental health services for young people in particular and, indeed, for those with eating disorders. We are seeing more young people more quickly than ever before, but if the hon. Lady wishes to raise a local issue with me, I shall be happy to meet her and discuss it.
Kevin Foster (Torbay) (Con)
The opening of a new block of operating theatres next month marks the latest investment in Torbay Hospital, but it is, of course, a prelude to the major rebuilding work. When does the Secretary of State plan to deliver the next update on the progress of that project?
Oral Answers to Questions
Maria Caulfield Excerpts(11 months, 3 weeks ago)
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Michael Fabricant (Lichfield) (Con)
The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)
Lessons from covid-19 have been incorporated into our planning for any future pandemics across a range of areas. That includes the need to prepare for infections through all five routes of transmission, and for the health and social care sectors to have flexible capabilities that can adapt to a range of health threats.
Michael Fabricant
My hon. Friend may have heard that news is emerging from China of yet another respiratory disease spreading through that country. What mechanisms are in place to learn from the covid inquiry when it finishes its work, so that if mistakes were made, we do not make them again in the event that, God forbid, we have another pandemic?
Maria Caulfield
First, early indications show that the respiratory illnesses in China are likely to be due to increasing levels of endemic infection. These are normal infections but at a higher level.
Secondly, we are not waiting for the covid inquiry before we implement lessons learned. One of the key changes we have already made is the introduction of the UK Health Security Agency, which carries out surveillance on both national and international threats. A good example of its work is last year’s strep A outbreak, which it managed and contained very well. This year, the identification of a new covid variant—not a variant of concern—meant we brought forward our autumn vaccination roll-out.
Jim Shannon (Strangford) (DUP)
For all of us who lost loved ones, covid-19 is still very raw. I have been following the covid inquiry, and two recommendations have so far come forward. The first is that the lockdown should have been earlier, and the second is that those with covid should not have been sent to care homes—covid went through care homes and cast death everywhere. Has the Minister taken those two lessons on board?
Maria Caulfield
I know the hon. Gentleman had a personal loss to covid, and he is absolutely right to highlight those lessons learned. We are learning lessons, but each pandemic or increase in infection is different. It may have been appropriate to have lockdowns for covid-19, but lockdowns may not be appropriate for other infections, such as strep A or other respiratory illnesses. We set up the UKHSA to provide expert advice. We are learning lessons from the covid inquiry, and we are already taking action.
Wendy Chamberlain (North East Fife) (LD)
Feryal Clark (Enfield North) (Lab)
The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)
Since 2021, we have invested an additional £165 million a year to improve maternity neonatal care; next year, that figure will rise to £186 million. That investment is leading to progress on outcomes: stillbirths have reduced by 23%, and neonatal mortality rates are down by 30%.
Feryal Clark
Women continue to be failed by maternity services across England, as has been highlighted by a string of scandals including East Kent, Nottingham and Morecambe Bay. The Care Quality Commission’s maternity inspections over the past year downgraded many maternity units, branding two thirds of them as dangerously substandard and highlighting shortages of staff, among other problems. What additional steps is the Minister taking to ensure that a woman can go into maternity services knowing that she and her baby will come out alive, and can she tell us whether the recommendations of the Kirkup and Ockenden reviews have been fully implemented?
Maria Caulfield
The hon. Lady has touched on three inquiries. The Ockenden inquiry covered the period from 2000 to 2019, the Kirkup review covered the period from 2009 to 2020 and the Morecambe Bay inquiry covered the period from 2004 to 2013, so the Labour Government were also responsible for parts of all those periods.
We are introducing radical changes. We are increasing the number of midwives, which is up 14% since 2010, and the number of midwifery training places has increased by 3,650. We have introduced the maternity disparities taskforce to improve outcomes for those women who face the poorest outcomes, and have also introduced a maternity support programme for those trusts that do badly in CQC inspections—32 trusts are going through that improvement programme right now. Those are some of the things we are doing to improve maternity services.
Theo Clarke (Stafford) (Con)
As chair of the all-party parliamentary group for birth trauma, I recently commissioned a survey of mums across the UK via Mumsnet on this issue. I was shocked to discover that one in five mothers was not being offered a six-week GP check post-birth. That means that many women with physical injuries or mental health problems are unfortunately not being diagnosed or offered support, which is very troubling. Will my hon. Friend include birth trauma in the future update to the women’s health strategy, and ensure that all mums receive a post-birth six-week check-up with their GP? That check-up must include both the physical and mental health of the mum, not just focus on the baby.
Maria Caulfield
I pay tribute to my hon. Friend’s work in this place. She will be pleased to know that we are rolling out perinatal pelvic health services in every part of England, which should be in place by the end of March next year. In addition, we are rolling out obstetric anal sphincter injury bundles, which my hon. Friend raised in her debate on birth trauma; those have the potential to reduce the number of tears by 20%. She is absolutely right to be driving this issue forward. It will be covered in the women’s health strategy, but we are not waiting for the second year: we are already making progress in this place.
Abena Oppong-Asare (Erith and Thamesmead) (Lab)
The Care Quality Commission now says that almost two thirds of England’s maternity services are rated inadequate or requiring improvement in safety, up from 55% last year. The Government have been told time and time again to recruit more midwives, and to value midwives so that they do not want to leave the profession in the first place. As a result of ministerial failure, mothers—especially those from black and ethnic minority groups—do not get the safe, good-quality maternity care that they deserve. What is the Minister’s plan to properly improve maternity care?
Maria Caulfield
The hon. Lady may not have listened to my first answer. We have increased the number of midwives—it is up 14% since 2010—and increased the number of midwifery training places by 3,650. We have also introduced a maternity support programme that is providing intensive support for the 32 trusts that are going through it. The hon. Lady may want to speak to her ministerial colleagues in Wales, where Labour runs the health service, because Healthcare Inspectorate Wales recently issued an immediate improvement notice to Cardiff and Vale University Health Board for its maternity services.
Lloyd Russell-Moyle (Brighton, Kemptown) (Lab/Co-op)
The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)
We are improving mental health services, transforming them with an extra £2.3 billion a year. We have already seen some improvements in the delivery of those changes from giving mental health services parity of esteem with physical services.
Lloyd Russell-Moyle
The Minister will know, because it covers her constituency as well, that the Sussex Partnership NHS Foundation Trust does vital work in mental health, but there simply is not the resource, and I am afraid that parroting about parity of esteem does not tackle the issues. Wait times are 190 days for children and young people in her constituency and mine. I recently spoke to a mother in Peacehaven whose son is waiting for an attention deficit hyperactivity disorder diagnosis. His performance at school is in rapid decline, but because of the wait times he is not eligible for support in school via any education, health and care plan to start to turn things around. What assurances can the Minister give my constituents, and indeed her constituents, that the wait times for mental health will come down and that resources will be given to these partnerships, rather than just empty words?
Maria Caulfield
The hon. Member is absolutely right: we know that in Sussex we have higher rates of mental health illness than in many other parts of the country, with a 15% increase in Sussex A&E attendances. He might not be aware of them, but multiple schemes are available in Sussex. Health in Mind is offering psychological support to those suffering stress and anxiety, which can be self-referred. We have the Sussex mental health crisis line, now open 24/7, which is accessed via the 111 service. We have mental health professionals rolling out the blue light triage service in Sussex, and we have the Brighton and Hove mental health rapid response service, open 24/7, to which anyone can refer themselves urgently. Perhaps if he looks at some of the services provided locally, he will be able to reassure his constituents.
James Morris (Halesowen and Rowley Regis) (Con)
The Minister mentioned the importance of parity of esteem, and she is quite right, but it is disappointing that the Government had a manifesto commitment in 2017 and 2019 to reform the Mental Health Act 1983, which they have not fulfilled, with no such Bill in the King’s Speech. Would the Minister agree with me that the issues that existed prior to 2017 in relation to the Mental Health Act still exist today with the disproportionate number of black and minority ethnic people being sectioned under that Act, and people with learning disabilities and autism kept in inappropriate settings? Can she give any encouragement to those of us who want to see that reformed, particularly in relation to the appointment of a mental health commissioner to oversee changes to the Act and to advocate for the parity of esteem that she is looking for?
Maria Caulfield
It remains our intention to bring forward a mental health Bill when parliamentary time allows. We have the draft Mental Health Bill, which we have put through pre-legislative scrutiny. We are looking at the report from the Joint Committee and will be responding to that shortly.
Marion Fellows (Motherwell and Wishaw) (SNP)
The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)
We are acutely aware of the impact that the cost of living has on mental health, which is why this Conservative Government spent over £350 billion during the pandemic on protecting people’s jobs and over £60 billion during the recent cost of living pressures to pay for their energy bills.
Marion Fellows
The Centre for Mental Health, the British Psychological Society and others have raised serious concerns about the UK Government’s new back to work plan, warning that the increased threat of applying benefit sanctions or coercing people into jobseeking will be detrimental to claimants struggling with their mental health. Does the Minister share my concern about this, and has she made any representations to her Cabinet colleagues about the mental health impact of these measures?
Maria Caulfield
That is the difference between the SNP and the Conservatives: we have aspiration for people, and we absolutely want to support people with mental health problems and illness to get into work. They should have the same opportunities to get into work, and not just to get a job, but to get a good job and get a career. If we look at its website, Mind supports people getting into work, saying that it is not just a source of income, but provides a “sense of identity” and “structure” as well as support, confidence and ambition.
Sally-Ann Hart (Hastings and Rye) (Con)
A recent study by Magic Breakfast and the British Nutrition Foundation found that eating a healthy breakfast can improve the nutritional intake of the most vulnerable children, improving their physical and cognitive development and their mental health. Will my hon. Friend work with colleagues in the Department for Education to consider expanding school breakfast provision in order to reduce the health impact of child food insecurity?
Maria Caulfield
We want a more cross-Government approach to mental health provision, and that is why in our suicide prevention strategy we are working with multiple Departments. My hon. Friend asks about support for nutrition in schools, and I will certainly raise that with colleagues in the Department for Education to see what more can be done.
Amy Callaghan (East Dunbartonshire) (SNP)
I welcome the Secretary of State to her new role. Research by the Mental Health Foundation found that the cost of living crisis has left a third of UK adults feeling anxious, more than a quarter feeling stressed, and almost one in 10 feeling hopeless. What representations has the Minister made to Cabinet colleagues regarding the impact of the cost of living crisis on health outcomes since she took up her post?
Maria Caulfield
I have outlined some of the financial support that the Government have given during covid and the cost of living pressures. I also point to schemes that the Treasury has rolled out, such as the Breathing Space programme, which sees enforcement action from creditors halted, and interest frozen for people with problem debt who are experiencing mental health issues, and covers a 60-day period. That is the sort of practical help that this Government are giving to people.
Madam Deputy Speaker (Dame Eleanor Laing)
We now move to topical questions. We are running late because questions have been too long, as have answers. I often make this plea. In any case, Members should not be reading their questions—questions are not meant to be read; they are meant to be questions. Can everybody please cut out those bits that say their constituency is beautiful, for example, and just ask a question? We all believe that our constituencies are beautiful, and none more so than mine.
Amy Callaghan (East Dunbartonshire) (SNP)
Brexit broke Britain and it is continuing to wreak havoc on supply chains. The shortage of ADHD medication is now set to drag on into next spring. The shortage has seen 70% of patients forced to ration their supply of ADHD drugs, with 62% reporting an increase in suicidal thoughts. What steps is the Minister taking to ensure that supplies of these vital medications are reaching pharmacies across the UK?
The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)
The shortage of ADHD medication is a global issue; it is not Brexit-related. We are hoping to have some positive news over the coming weeks.
Dr Luke Evans (Bosworth) (Con)
Liz Twist (Blaydon) (Lab)
Maria Caulfield
May I pay tribute to the hon. Lady for her work on the all-party parliamentary group on suicide and self-harm prevention? She knows that financial difficulty is a priority area in the suicide prevention strategy, because we know it is a high risk factor. That is why suicide is now everyone’s business—not just the Department of Health and Social Care, but our colleagues at the Department for Work and Pensions, His Majesty’s Revenue and Customs and all Government Departments. Anyone who has financial stress and pressure will be given support to reduce their risk of suicide.
Miriam Cates (Penistone and Stocksbridge) (Con)
My constituent Dan Archer runs the highly successful Visiting Angels care agency, which has an annual staff turnover rate of just 13%, compared with an industry average of 60%. The secret to his success is very straightforward: paying decent wages, investing in training, valuing staff and prioritising client satisfaction. As a consequence, an enormous amount of money is saved on recruitment and invested into training and retention instead. Would the Minister meet my constituent to learn more about the success of Visiting Angels and how it can be shared more widely to help solve the shortage of workers in the care sector?
Siobhan Baillie (Stroud) (Con)
Stroud Maternity Hospital is doing a great job, but the post-natal beds are still not open. We have been chasing a ministerial meeting about that for some time. Will my hon. Friend meet me and the Gloucestershire NHS scrutiny chair, Andrew Gravells, to discuss the issue? We think that we need some help with the Care Quality Commission.
Maria Caulfield
I am happy to meet my hon. Friend to discuss that specific issue. We are doing a piece of work on a capital survey of all maternity units as well as working with the CQC on how capital infrastructure—beds and so forth—are impacting on maternity performance.
Vicky Foxcroft (Lewisham, Deptford) (Lab)
Maria Caulfield
As I said in an earlier response, there is a global shortage of ADHD medication. As we set out in our response to her written question, we expect that to be resolved shortly.
Jeremy Quin (Horsham) (Con)
Lobular breast cancer treatment must be improved. Will the Minister meet my constituent and me to discuss how?
Jonathan Gullis (Stoke-on-Trent North) (Con)
In response to a written question that I submitted, I was told that the Department of Health and Social Care holds no central data for diagnosis and treatment of those with eating disorders and has no idea how many mental health nurse appointments are available in GP surgeries, despite all the funding. Do Ministers agree that that is a disgrace?
Maria Caulfield
NHS England holds some of that data. Central data is one of the things that we are introducing right now to improve our access to data. It makes it difficult to plan services when we do not have that dataset, but we are working to resolve that as quickly as we can.
Sarah Dyke (Somerton and Frome) (LD)
Farmers face many serious mental health challenges, including the financial precipice that this Government have led them to. According to the Farm Safety Foundation, 95% of young farmers in this country identify poor mental health as their biggest hidden challenge. Will the Minister meet me and the Secretary of State for Environment, Food and Rural Affairs to discuss how we can best support farmers and farm workers to develop robust mental health strategies?
Maria Caulfield
I attended the National Farmers Union session in Westminster just before the launch of our suicide prevention strategy. We recognise that isolation and loneliness in rural communities is an issue. I am happy to meet any hon. Members who wish to discuss how we can better support farmers, improve their mental health and reduce suicide rates.
Richard Fuller (North East Bedfordshire) (Con)
Will the primary care Minister join me in congratulating the Conservative Mayor of Bedford borough for proposing council money to invest in primary care facilities in Great Barford, Wootton, Wixams and Kempston? Will she condemn Labour and Liberal Democrat councils for voting it down?
Building an NHS Fit for the Future
Maria Caulfield Excerpts(1 year ago)
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Wes Streeting
I thank my hon. Friend for her intervention. As I make progress through my speech I will come back to the breath-taking complacency about mental health we heard from the Minister a moment ago.
Given the scale of the crisis and given that the Prime Minister has made fixing waiting lists one his five priorities, hon. Members might have expected something in the King’s Speech to deal with it. Instead, we got nothing on the NHS as it heads into its most challenging winter yet and we got nothing on social care, just kicking the can down the road and delaying reforms until after the election. There was nothing on dentistry, despite even Conservative Back Benchers crying out for a rescue plan, and nothing on mental health, despite the Conservative party committing to reform, not just in its last manifesto but in its last two manifestos.
It was the longest King’s Speech in almost a decade, with the fewest Bills. Does that not just sum up the modern Conservative party? Plenty of slogans, but no solutions. What we got was a Bill that will not come into effect until after the general election and a sack-the-nurses Bill. On the tobacco and vapes Bill, the question is not whether Labour will support it, but whether the Conservative party will support it. Government Members will remember that I first proposed that smoking ban back in January. I say they will remember, because they made their feelings known in newspapers at the time. They called it “nanny state” and
“an attack on ordinary people and their culture”.
They accused me of “health fascism”. Well, they can now make their considered and nuanced views known to the new Secretary of State—I am sure she is looking forward to receiving them. It just demonstrates that where Labour leads, the Government follow.
The Prime Minister may be too weak to whip his Back Benchers to vote that crucial measure through, but on the Opposition Benches we will put country first and party second. Labour MPs will go through the voting Lobby and make sure that the legislation is passed, so that young people today are even less likely to smoke than they are to vote Conservative.
I am afraid to disappoint the Government, but we will not be supporting the other Bill in the King’s Speech that relates to health. Most people look at the crisis in the NHS and think it needs more doctors and nurses. The Conservative party looks at the health service and concludes that we need to sack more doctors and nurses. The Government are saying that public servants should be sacked for failing to provide minimum standards on strike days, but the Government have not met the four-hour A&E standard since 2015; they have not met the standard for treatment within 18 weeks since 2016; and they were doing so badly on meeting cancer waiting time standards that they have simply got rid of the standards altogether. If the Conservatives are proposing to sack doctors and nurses for failing to provide minimum service levels, can we now sack Ministers for failing to meet minimum standards on non-strike days?
The new Health and Social Care Secretary has an opportunity to break with the past year. Strikes are crippling the NHS and they are putting patients in harm’s way. Her predecessor may have thought that they were a useful excuse for his failure, but they were, and are, a misery for patients and staff alike. The Government must stop the scapegoating of NHS staff, go into these negotiations with good faith, work at finding a solution, and, finally, bring these strikes to an end. There will be no progress on turning around our national health service until the Government make some progress.
When summing up I hope the Minister will explain why action was not taken on the Mental Health Act 2007, because, I am afraid, the Minister’s opening remarks were entirely unsatisfactory. The Bill has gone through Committee. It has cross-party support. It is ready to go, so where is it? The treatment of people with learning disabilities and autism under the current Act shames our society. The disproportionate impact on black people, who are four times more likely to be sectioned than white people, is appalling. Prisons and police cells are no place for people with mental ill-health. Surely that is not controversial in 2023. It is, as the former Prime Minister, the right hon. Member for Maidenhead (Mrs May), said, “a burning injustice”. I cannot understand why the Government have broken their promise to address that matter finally.
It is long past time that mental health was treated with the same seriousness as physical health. Labour will not only reform the Mental Health Act in our first King’s Speech, but recruit thousands more mental health professionals, provide hubs in every community, and set up mental health support in every school, so that young people can get the help they need when they need it. [Interruption.] The Minister says that they have done that. What planet is she living on? This is the problem with these Ministers. Even when the faces change, the lines remain the same. The Minister has not changed, but she is still reading from the same failed script. This is the problem with the Conservative party. Its message to the country is simple: “You have never had it so good. Everything is going really well. The reason we are churning all the Ministers in our Cabinet is that they are doing such a good job. It is job done and time to give someone else a chance.” I am afraid that that is why these Conservatives are so out of touch and will struggle at the next general election if their message to the country is that it has never had it so good.
Furthermore, unlike this Government, who crashed the economy in the most reckless way, we will pay for our policies, making sure that they are fully costed and fully funded—in this case, by ending tax breaks for private schools and private equity fund managers. Politics is about choices: Labour chooses the wellbeing of the many, not the interests of the few, and we will fight the election on those lines any time. I say call the election tomorrow, because we are ready.
When it comes to dentistry, I should also say farewell to two former Ministers, the hon. Members for Colchester (Will Quince) and for Harborough (Neil O’Brien). As the hon. Member for Harborough departs Government, I hope that he does not take with him his pledge to bring forward a recovery plan for NHS dental services. It has been seven months since he announced that such a plan would be forthcoming, yet it is now nowhere to be seen. Indeed, last week, integrated care systems were given permission to raid their dentistry budget underspends and to remove the ringfence. That follows a pilot in Cornwall, trialling making NHS dentistry available only to children and the most vulnerable. It is the managed decline of NHS dentistry before our eyes. If people want to know what the future of the NHS would look like with five more years of the Conservative Government, they need only look at the ghost of Christmas past in NHS dentistry. The Conservatives blame the previous Labour Government, but they have been in power for 13 years. In 2010, we stood on a manifesto committed to reforming the NHS dental contract. They have had 13 years to do it, and they have failed again and again, leaving us in the situation that we are in today, with Dickensian stories of desperate people performing DIY dentistry and tooth decay being the most common cause of children aged six to 10 being admitted to hospital. It did not need to be this way.
I say to the new Secretary of State and her team that she may not have a plan, but Labour does, and she is more than welcome to nick it. We will deliver 700,000 more urgent appointments a year, recruit dentists to the areas most in need, introduce supervised toothbrushing in schools to prevent children’s teeth from rotting, and reform the NHS dental contract so that everyone who needs an NHS dentist can get one—
Wes Streeting
The Minister says, “Is that it?”. It is 700,000 more NHS dentistry appointments than her Government are providing. It is ridiculous. The extent to which Ministers continue to parrot these ridiculous lines is embarrassing. If they want to intervene, make my day. I am perfectly prepared to confront any Member with their own Government’s record. Of course, they do not want to defend the Government’s record; they have a hard enough time doing that on the doorstep.
Turning back to His Majesty’s Gracious Speech, there may not have been any Bills for the health service last week, but we did see the white flag being waved on the Prime Minister’s pledge to cut waiting lists. Hospitals received a letter telling them to cut the number of operations and appointments they are aiming to offer this year. At the same time, an extra funding pot was announced, so we are literally paying more and getting less. No wonder the NHS is in such a state. No wonder waiting lists have trebled since 2010. No wonder hundreds of thousands more patients are waiting for treatment today than when the Prime Minister first made his pledge.
Oral Answers to Questions
Maria Caulfield Excerpts(1 year, 1 month ago)
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Scott Benton (Blackpool South) (Ind)
The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)
Last month, we published a cross-Government five-year suicide prevention strategy. It sets out our pledge to reduce England’s suicide rates within two and a half years, with over 100 measures aimed at saving lives and providing early intervention for those at highest risk of suicide, including new mums and middle-aged men.
Paul Howell
Like many others, I dropped into the campaign event for “One Million Lives”, developed by Jacobs and supported by R;pple, and I was impressed by its efforts to interfere with the online risk of suicide-centric websites. The Minister may be aware that my wife is a long-term volunteer with Darlington and district Samaritans, which has raised with me the “Saving Lives Can’t Wait” campaign. It asks the Government to review local funding for suicide-safer communities, which is due to end. Could I ask the Minister to support the “One Million Lives” campaign, and to push for the renewal of local funding to support suicide-safer communities?
Maria Caulfield
I thank my hon. Friend for his hard work in this area and for his mental health campaigning overall, and also his wife and all who selflessly give their time to volunteer with the invaluable mental health charities. We fully recognise that, and that is why when we launched the suicide prevention strategy we also launched our £10 million suicide prevention grant fund.
On my hon. Friend’s point about wider funding beyond 2024-25, that is subject to a future spending review, but our commitment and record in delivering record investment of £15.9 billion in mental health services just in this financial year, which is 28% more funding than in 2018, should give him confidence that this Conservative Government deliver on mental health services.
Scott Benton
Is the Minister able to provide an update on the suicide prevention grant, and particularly on when the money is expected to reach the successful organisations?
Maria Caulfield
We have had a huge response to the opening of the grant, with over 1,800 applications from voluntary groups and organisations. We are assessing those bids and hope to make an announcement before the end of the year.
Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)
Campaigns such as 3 Dads Walking and Just 3 Mums Walking have worked incredibly hard to raise awareness of suicide prevention. Has the Minister had time to meet with either of those campaigns yet?
Maria Caulfield
I have met with 3 Dads Walking; I have not met the mums group but am very happy to do so. Because of their intervention and campaigning, we were able to successfully put their campaign about improving mental health awareness in the school curriculum into our suicide prevention strategy. It is a cross-Government strategy, and the Department for Education has very much taken their points on board.
Dr Rosena Allin-Khan (Tooting) (Lab)
Over 1.8 million people languishing on mental health waiting lists, black people five times more likely to be detained under the Mental Health Act 1983, and over 2,000 people with learning disabilities detained in hospital, all while the Government are dragging their feet on mental health and suicide prevention. You will be interested to know, Mr Speaker, that we had cross-party support to tackle these burning injustices through the draft Mental Health Bill, yet since the Joint Committee on the Draft Mental Health Bill published our report in January we have heard nothing from the Government, so will the Minister today commit to including reform of the Mental Health Act in the King’s Speech?
Maria Caulfield
I was going to pay tribute to the hon. Lady for her work on mental health campaigning, and she will know we have done a huge amount. The suicide prevention strategy is a cross-Government piece of work, which makes sure suicide is everyone’s business, not just that of health and social care. Whether by supporting families bereaved by suicide or rolling out mental health support schemes in schools, it is this Government who are delivering on mental health services.
Abena Oppong-Asare (Erith and Thamesmead) (Lab)
The House of Commons Library says there has been no statistically significant change in the rate of suicides in England since 2015. Suicide remains the biggest killer of men under 50 in the UK. Why has it taken so long for the Government to bring forward a strategy, and why do they continue to drag their feet over reform to the Mental Health Act? Can the Minister give the House a firm timetable today?
Maria Caulfield
The hon. Lady is not quite right in her statistics. Just before covid we had seen a 20% reduction compared with two decades ago in suicide levels in England. She might be interested to know that in Labour-run Wales suicide rates are higher than in England, and its suicide prevention strategy expired last year. Mental health has been demoted on the shadow Front Bench, too, as we saw from the resignation of the hon. Member for Tooting (Dr Allin-Khan) when the role of shadow mental health Minister was removed from the Opposition Front Bench.
Ian Lavery (Wansbeck) (Lab)
Under-age Vaping
Maria Caulfield Excerpts(1 year, 4 months ago)
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The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)
I thank the many right hon. and hon. Members who have made a valuable contribution to this afternoon’s debate. I will respond to the issues they have raised throughout my remarks.
I will start, without dismissing many of the concerns we have heard, by reiterating the importance of vapes in helping smokers move to healthier alternatives than cigarettes. Vapes are helping us to reach our smokefree 2030 target. There are currently about 3.5 million vapers in England, 47% of whom are ex-smokers and 39% of whom are dual users. The best thing, obviously, is for a smoker to stop smoking completely, but as shown in the recently published “Nicotine Vaping in England” report, there is clear evidence that vapes are substantially less harmful to health than smoking. With around 3 million users, vapes have become the most popular quitting aid in England and evidence indicates that they can help smokers to quit, particularly when combined with additional support from local stop smoking services.
That is why, in April this year, the Government announced a range of new measures to meet our smokefree 2030 ambition and reduce youth vaping. We have 1 million smokers who will be encouraged to swap their cigarettes for vapes through a new national “swap to stop” scheme, the first of its kind in the world. Pregnant women will be offered financial incentives, in the form of vouchers, to help them to stop smoking, alongside behavioural support. We will also consult on introducing mandatory cigarette pack inserts with positive messages and information to help people quit smoking. It is important to point those out, as the hon. Members for North Tyneside (Mary Glindon) and for Ealing, Southall (Mr Sharma) did.
Mary Glindon
Will the Minister confirm that the statement made in the 2015 evidence update by Public Health England, that vaping is 95% safer than smoking, remains valid today?
Maria Caulfield
I thank the hon. Lady for that point, which my hon. Friend the Member for Sleaford and North Hykeham (Dr Johnson) also raised. The 2015 evidence study was indeed conducted by Public Health England. The most recent evidence we have, from 2022, does not give that precise figure; it does emphasise that vaping is safer than smoking, but does not indicate by how much.
As the debate has made clear, despite vaping’s effectiveness as a tool to quit smoking, illegal under-age vape sales are a growing concern for many parents and teachers across the country, and vaping has increased rapidly among under-18s in the past 18 months. The recent rise in teenage users shows that vapes are being used beyond their intended audience. As my right hon. Friend the Member for Romsey and Southampton North (Caroline Nokes) highlighted, there are multiple reasons for that, but whether it is packaging, naming or flavouring, the unintended consequences are clear. As my hon. Friend the Member for Broadland (Jerome Mayhew) pointed out, these consequences are not necessarily easy to deal with, as there may be unintended consequences of doing so—for example, tax increases on vapes might prevent people who want to give up smoking from doing so. There are no easy solutions, so we need to take our time before making further decisions. That is why in April we launched a call for evidence on youth vaping. It closed last month, and officials at the Department have begun to examine the responses. We will set out our response in the autumn.
Other speakers, such as my hon. Friend the Member for Erewash (Maggie Throup) spoke about why it is so important that we consider going further. My hon. Friend the Member for Sleaford and North Hykeham, who speaks with considerable experience, pointed out that this not a party political issue, but a cross-Government matter, with the Department of Health and Social Care dealing with safety, the Department for Education providing advice to children, the Department for Culture, Media and Sport dealing with the role of advertising, and the Department for Environment, Food and Rural Affairs dealing with the disposable products element. To stop children buying vapes, we also need businesses to comply with existing regulations and to abide by the standards we have set. To help enforcement of the regulations, we have teamed up with enforcement agencies to fund a new illicit vaping unit, which will remove products from shelves and at our borders, and stop the sale of vapes to children.
In May, the Prime Minister announced further measures, including closing a loophole that allows industry to give out free samples; increasing education and supporting designated school police liaison officers’ work to keep illegal vapes out of schools; and reviewing the rules on issuing on-the-spot fines to shops selling vapes to under-18s, as well as the rules on selling nicotine-free vapes to under-18s, to ensure that the rules keep pace with how vapes are being used. To respond to a point made by my hon. Friend the Member for Eastbourne (Caroline Ansell), we are also looking at adding lessons on the health risks of vaping as part of the current RSE curriculum review. Those measures will help headteachers and other school leaders to manage vaping on school premises and inform young people about the risks of vaping, with a view to reducing the number of young people who are currently vaping or might be tempted to try it in the future.
As a number of speakers pointed out, we must of course be wary of the environmental impacts, in particular of single-use disposable vapes. Increasing use of these products is leading to their improper disposal. That is why DEFRA is soon to consult on reforming the Waste Electrical and Electronic Equipment Regulations 2013 to ensure that more of this material is properly recycled. We shall continue to work with the sector and industry to help businesses to understand their responsibilities, both to ensure that their environmental obligations are met, and to ensure that products are not marketed to children, are produced to the highest UK standards, and are compliant with our regulations.
I emphasise that until recently our vaping regulations have been effective in keeping rates of vaping among under-18s low, but of course we acknowledge that there are problems and that we have seen an increase in usage, which is why the consultation is about looking into what more we can do.
Mark Eastwood (Dewsbury) (Con)
I welcome the consultation to tackle this problem, but will the Minister confirm that any appropriate measures that the Government take to reduce youth access to vapes will not harm our pragmatic science-led approach to ensuring that adults have access to the full range of alternatives to help them to quit cigarettes for good?
Maria Caulfield
That is the balance we have to create. We do not want unintended consequences whereby we reduce the use of vapes in under-18s but also stop their use among those who are quitting smoking. We know from our evidence that vaping is much safer than smoking. For those communities, very often in deprived areas, where there are higher rates of smoking, we do not want the cost of vapes to be prohibitive and for people not to switch to them instead of smoking.
Our current laws protect children by restricting the sale of vapes to over-18s and limiting nicotine content, and there are regulations on refill bottles, tank sizes, labelling requirements and advertising restrictions. It is important that we remember that regulations are in place, and it is important that they are enforced.
Dr Caroline Johnson
The Minister is talking about evidence that vapes are much safer, but I notice that she has not used the 95% figure that is used by the industry. Clearly, the absence of evidence of harm and evidence of the absence of harm are different things, so will the Minister clarify whether she has evidence that vaping devices are much safer? Or does she just not have evidence yet, because they are so new, that they are not dangerous?
Maria Caulfield
The evidence is there that vapes are considerably safer than smoking, and that was borne out in the 2022 report. The 95% figure was not used then, but I think there is a general consensus that, as the chief medical officer has said, vaping is a much safer alternative to smoking cigarettes.
It is important to remember that regulations are currently in place; it is about enforcing them, which is why the Government have introduced the illicit vape enforcement squad to tackle under-age vape sales, as well as the illicit products that young people can access. We are funding that with £3 million of Government funding.
Alex Cunningham
Will the Minister give a timescale for when the Government will introduce plain packaging for vaping products?
Maria Caulfield
As I just said and as the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Harborough (Neil O’Brien) said earlier in the debate, the consultation closed only recently. Officials are going through the evidence and will come forward with the results in the autumn and take them forward.
Rachael Maskell
I raised the issue of addiction; although the Minister has said that vaping products are safer, does she agree that if they are drawing more children into addiction, they are clearly not safe in that field?
Maria Caulfield
We have to consider the evidence and that is not necessarily what the evidence says. NHS England is reviewing the number of admissions and incidents that it feels are caused by vaping, so we are gathering the evidence on that. We need to take an evidence-based approach and currently there is not the evidence that there is necessarily an addiction problem. But we do need to keep building the evidence base.
As we have set out today, we are committed to taking strong and assertive action to tackle youth vaping, and we are willing to go further as part of our evidence-based approach. We have to work with all parties and across Government. This is not just a health issue: it is an issue for the Department for Education, for the Department for Culture, Media and Sport in terms of advertising, and for DEFRA in respect of how single-use vapes are disposed of.
We are committed to effectively tackling the issue and driving down youth vaping rates, while making sure that vapes are available to smokers as an effective aid to quitting smoking. We are committed to doing all we can to prevent children from starting vaping and we are actively working on ways that we can go further. We will go further in not only protecting children but driving down smoking rates, so that we make a future where people are not damaged by smoking. To meet our smokefree 2030 ambition, we will do all we can to prevent people from starting smoking in the first place and to give people the support that they need to quit.
Question put and agreed to.
Resolved,
That this House is concerned that children are being inappropriately exposed to e-cigarette promotions and that under-age vaping has increased by 50% in just the last three years; condemns the Government for its failure to act to protect children by voting against the addition of measures to prohibit branding which is appealing to children on e-cigarette packaging during the passage of the Health and Care Act 2022 and for failing to bring forward the tobacco control plan that it promised by the end of 2021; and therefore calls on the Government to ban vapes from being branded and advertised to appeal to children and to work with local councils and the NHS to help ensure that e-cigarettes are being used as an aid to stop smoking, rather than as a new form of smoking.
Oral Answers to Questions
Maria Caulfield Excerpts(1 year, 4 months ago)
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The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)
NHS West Yorkshire integrated care boards have increased their investment in mental health services in line with their overall allocation increase. They have spent more than £591 million in the past financial year on their mental health services.
Fabian Hamilton
I thank the Minister for that answer. My constituent, Joanne Allotey, has custody of her young granddaughter, who has complex mental health problems, but local mental health services in Leeds are still chronically underfunded after 13 years of Conservative Government cuts. Will the Minister join me in commending Roundhay high school for the support that it has given the family—this is the same school that the former Prime Minister claimed “let down” children—and commit today to delivering truly effective children’s education, health and care plans?
Maria Caulfield
I absolutely pay tribute to the school in the hon. Gentleman’s constituency. I also point out that Red Kite View is a new unit specifically for young people in his constituency. That 22-bed mental health unit opened last year and aims to eliminate out-of-area placements for young children with mental ill health. I am sure that he would welcome that investment in his constituency.
Sir Charles Walker (Broxbourne) (Con)
The Joint Committee on the Draft Mental Health Bill reported back in January this year. One of the most important recommendations we made was about how people, during a period of wellness, could set out how they wish to be treated during a period of illness. The Government have yet to respond to the Joint Committee, but can we have a mental health Bill in the forthcoming King’s Speech, please?
Maria Caulfield
I thank my hon. Friend for raising that issue. There were many recommendations during pre-legislative scrutiny. We are working through those and we hope to be able to respond fully shortly after the summer recess.
Dr Rosena Allin-Khan (Tooting) (Lab)
As my hon. Friend the Member for Leeds North East (Fabian Hamilton) highlighted, all too often, children are stuck on long waiting lists for treatment. In West Yorkshire, 30,000 children are currently stuck waiting for mental health treatment, and more than 9,000 people have had their mental health referral closed without accessing treatment. Does the Minister find that acceptable? If the answer is no, what will her Government do about it? This picture is not unique to West Yorkshire, but replicated across England. This Government are letting patients down. When is the Minister going to act to tackle the crisis in mental health services?
Maria Caulfield
I thank the shadow Minister for her question. To highlight another initiative in West Yorkshire, the Night OWLS—Overnight West Yorkshire Living/Advice Service—helpline has been set up for children and young people. It is open between 8 pm and 8 am seven days a week for young people to access, in addition to the 24/7 helpline that is available. I am sure that the shadow Minister will also welcome the fact that we have more than 400 mental health support teams in schools in England, covering 3 million children, so that they can access mental health support directly at school.
Kate Osborne (Jarrow) (Lab)
Neale Hanvey (Kirkcaldy and Cowdenbeath) (Alba)
The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)
The vaccine development and evaluation centre, backed by £65 million for state-of-the-art facilities, at the Porton Down site has been operational since early last year. It supported the autumn vaccine roll-out and the spring vaccine roll-out earlier this year.
Neale Hanvey
In November 2021, Dame Kate Bingham rightly called the decision to withdraw support for the Valneva whole virus vaccine “inexplicable” because a broad portfolio of vaccines is important as we move forward against future variants. The British Society for Immunology states that there is an urgent need for second and third-generation covid vaccines, including universal mucosal vaccines with longer-lasting protective immunity. With growing public concern and mounting clinical and scientific evidence of vaccine injury from mRNA, why is the UK not seeking to harness the power of all technologies instead of establishing an inexplicable exclusive relationship with Moderna?
Maria Caulfield
I confirm to the hon. Gentleman that, in the recent spring campaign, we deployed four approved vaccines—Pfizer-BioNTech, Moderna, Novavax and Sanofi-GSK—as part of our roll-out. We are using a range of vaccines to protect us from the pandemic.
Sir Edward Leigh (Gainsborough) (Con)
The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)
We are working with a number of Government Departments, including the Department for Work and Pensions and the Department for Levelling Up, Housing and Communities, to tackle the effect of housing insecurity on young people’s mental health.
Sir Edward Leigh
The mental health of young people is being impacted by the fact that net migration is far too high and we are not building nearly enough houses. The Government need to take action on that, but young people worry that, with an ageing population, the health service will not be able to provide for them in future. May I commend to the Minister the excellent paper published by the former Labour Prime Minister Tony Blair, which suggests things such as co-payments and personalised apps? Would it not be ironic if a former Labour Prime Minister were more radical on reform of the NHS than a Conservative Government?
Maria Caulfield
Actually, under this Government, last year, the number of first-time buyers passed the 400,000 mark, which is the highest number in 19 years. I will not take any lectures from a former Labour Prime Minister because when Labour was in government it saddled the NHS with a £10 billion failed IT system that never saw the light of day, an £80 billion failed private finance initiative contract that NHS trusts are still paying for, and a GP contract that enabled opt-out at weekends and evenings, which patients still suffer from.
Sarah Olney (Richmond Park) (LD)
Today marks the three-year anniversary of the death of Tom Pirie, who tragically took his own life just days after being assessed as at low risk of doing so by his counsellor. Over the last few years, I have been working with Tom’s father Philip on his campaign to improve suicide risk assessment procedure, particularly in view of the upcoming 10-year suicide prevention strategy review. Will the Minister join me in paying tribute to Tom’s life and Philip’s excellent work in his memory by providing us with an update as to when we can expect the review to be published?
Maria Caulfield
I absolutely pay tribute to Tom and to his father. I reassure him that we have many campaigners. Only last week, we received the baton of hope at No. 10 from those campaigning to reduce the number of suicides in this country. We are working on the suicide prevention plan and hope to be able to publish it very soon.
Carolyn Harris (Swansea East) (Lab)
The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)
We continue to engage regularly with our suppliers to prevent and mitigate supply issues in the short term. We have over 70 HRT products. The vast majority are available. We have two that have serious shortage protocols attached to them, but we are hoping to improve supply on those very soon.
Carolyn Harris
Although shortages of Utrogestan are ongoing, there is no alternative progesterone product recommended on the serious shortage protocol. Taking oestrogen without progesterone can be dangerous. Provera is a synthetic progesterone alternative to Utrogestan, but it is not included on the HRT prepayment certificate. Will the Minister commit to placing Provera on the list of products covered by the prepayment certificate as a priority and issue a public health warning highlighting the risks of taking oestrogen without progesterone?
Maria Caulfield
We are in the process of issuing another bulletin to both GPs and pharmacists on the serious shortage protocols and to make clear the alternatives available. That is a clinical decision. I will certainly look at the issue of Provera because medicines have to tick off a number of criteria to be eligible for the prepayment certificate. I will certainly look into that particular drug on the hon. Lady’s behalf.
Sir Desmond Swayne (New Forest West) (Con)
Tim Loughton (East Worthing and Shoreham) (Con)
The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)
The consultation on giving powers to coroners to investigate stillbirths received 334 responses, including from bereaved parents, charities, the Chief Coroner, clinicians and a range of other organisations.
Tim Loughton
Mr Speaker, you are very familiar with the problems over the implementation of my Civil Partnerships, Marriages and Deaths (Registration etc) Act 2019, which passed this House in February 2019. Section 4 remains incomplete. The consultation was completed in June 2019. Mr Speaker, you are aware that I made six attempts to get a meeting with the Minister and a Justice Minister. Eventually, I got it in March, after the Leader of the House intervened. Four months on, I have heard nothing and the consultation remains unpublished. What will it take to get this legislation, which everyone wants and which was passed unanimously, into law?
Maria Caulfield
I thank my hon. Friend for his work in this space and I apologise for the delay in publishing the consultation. I met him along with a Justice Minister, and I assure him that we hope to publish it very soon.
Mrs Flick Drummond (Meon Valley) (Con)
Mental Health Treatment and Support
Maria Caulfield Excerpts(1 year, 5 months ago)
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The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)
Thank you, Madam Deputy Speaker.
What a shame it is that the Opposition have chosen to play politics with mental health, as we heard from my right hon. Friend the Member for Chelmsford (Vicky Ford) and my hon. Friends the Members for Watford (Dean Russell), for Runnymede and Weybridge (Dr Spencer) and for Penrith and The Border (Dr Hudson), because these are important issues. All countries are facing challenges with rising cases of mental ill health and capacity issues, but we have made progress in the last 10 years. It was in 2016 that David Cameron first talked about changing the stigma on mental health and, as my right hon. Friend the Member for Chelmsford put it so well, we want more people to come forward. The problem in the past was that people did not come forward, instead waiting until they became so acutely unwell that it was more difficult to support them.
Dr Hudson
A recurrent theme in today’s debate, on both sides of the House, has been the importance of prevention and breaking down stigma. Does my hon. Friend agree that the message should go out from Members on both sides of the House that it is okay not to be okay, that people should reach out and that more people in all walks of life should be first aid-trained to help when people do reach out?
Maria Caulfield
My hon. Friend is absolutely correct. As my hon. Friend the Member for Bosworth (Dr Evans) said, we had an event with the NFU yesterday, and that is exactly the point we wanted to make. It was my right hon. Friend the Member for Maidenhead (Mrs May) who set about changing the status of mental health, putting it on a level playing field with physical health, not just in the services we provide but in funding and staffing, with parity of esteem across the board.
Let us look at some of the progress that has been made over the last 10 years. The shadow Minister, the hon. Member for Tooting (Dr Allin-Khan), said in her opening remarks that she is bored of this figure, but it is true that £2.3 billion of additional funding is being put into frontline mental health services, supporting another 2 million people to access NHS-funded mental health services.
We are already doing much of what shadow Ministers have set out this afternoon. We are already recruiting 27,000 additional staff into mental health services, with 20,000 of them already in place. My right hon. Friend the Member for Chelmsford highlighted the difference that is making in her local area. We are removing dormitory accommodation across the country through a £400 million capital programme, and 29 schemes have already gone through—that is 500 beds that are no longer in dormitory-style accommodation.
My hon. Friend the Member for Runnymede and Weybridge highlighted the difference that funding is making in his constituency. We are moving to a system of community crisis support and early intervention so that people do not get to a point where they need to be admitted. Our £190 million of capital funding is being used to build community crisis facilities up and down the country. We are investing in mental health ambulances: 20 are already in place, 40 will be in place by the end of the year, and 47 will be in place next year. The shadow Minister laughs about this, but when somebody is going into crisis, it is more appropriate that a mental health specialist team visits them in a mental health ambulance than an ordinary paramedic, who will inevitably take them to A&E.
Suicide is the leading cause of death in new mums, which is completely unacceptable. That is why we are investing in perinatal mental health services in every part of England—these services saw 31,500 women last year.
As we remove the stigma, it is important that we have the services to deal with the rising number of people who come forward and ask for help, as we want them to do. We have introduced three targets, the first of which is on access to talking therapies, where 75% of people should begin treatment within six weeks. Currently, 90% of people are doing so and we are meeting that target. When children and young people are referred for eating disorders, the target is that 95% should be seen within one week. We are currently at 77%, whereas last year’s figure was 61%, so despite the rising numbers we are seeing more children with eating disorders—
Vicky Ford
I was incredibly upset by the shadow Minister’s suggestion that I do not care about mental health. As someone who has suffered with mental ill health in the past and spoken in the Chamber about how hard it is to speak about that, I found that very upsetting. Mental health suffered greatly during the pandemic, especially that of children and young people—I was the children’s Minister at the time. We all know that we need to do better, which is why it is important that we learn about what is working now and about new innovations. On eating disorders, I particularly thank the Minister for getting the waiting list time down.
Maria Caulfield
I thank my right hon. Friend for that. It is important that we take the politics out of this argument, because no one in this Chamber, on either side, does not care about mental health.
The psychosis target we have introduced is that 60% of people should start treatment within six weeks, and we are currently at 72%. We are overperforming on many of those targets. NHS England has five new targets that we hope to introduce soon—
Maria Caulfield
Unfortunately, given the time I have left, I will not give way any more.
As for the challenges we face, we are seeing rising numbers, but we are seeing that in all parts of the country. The shadow Minister, the hon. Member for Denton and Reddish (Andrew Gwynne), talked about not judging Labour on its track record on health in Wales, where Labour has produced smaller funding increases for its health service; its 7.8% increase compares with the 8.6% increase that we have given in England. Mind Cymru has said that hundreds of people across Wales are currently waiting more than a year to access psychological therapies. The target is supposed to be that 80% of people in Wales access therapies within six months, but that target has never been met. It gets worse, because since 2020 the number of people waiting longer than a year in Wales for mental health support has increased by 17%. Labour talks a good game, but its actions speak louder than its words. I urge shadow Ministers to acknowledge that these problems exist in all countries and that we all face these pressures. A grown-up conversation would be about sharing best practice and working together to make that happen.
Many Members talked about preventive and early intervention therapies. My hon. Friends the Members for Bosworth and for Devizes (Danny Kruger) talked about that and about moving away from the medicalisation of mental health. That is why we are investing in talking therapies. For anyone who has not been on the Every Mind Matters website, let me say that it provides practical support for people who are anxious, distressed or not sleeping. It also provides for self-referrals to talking therapies. Since we introduced that, more than 1.2 million patients have accessed NHS talking therapies in the last year, helping them to overcome anxiety and depression. More than 90% of those people have had their treatment completed within six weeks.
Many Members talked about schools, and we are introducing mental health support teams in schools. We have almost 400 now, covering more than 3 million children, and about 35% of schools and colleges. More than 10,000 schools and colleges have trained a senior mental health specialist, including more than six in 10 state schools. That work is happening already and it is making a difference right now. My hon. Friend the Member for Newcastle-under-Lyme (Aaron Bell) highlighted how we need to move that into universities, and I would be happy to talk to him about how we can do that further.
On in-patient services and the quality of care, we have recently conducted a rapid review of mental health in-patient settings. The Secretary of State will announce the results of that soon. We have also introduced a three-year quality transformation programme, which seeks to tackle the root cause of unsafe, poor-quality in-patient care, particularly for those with learning disabilities and autism.
On suicide prevention, our forthcoming strategy will target high-risk groups and locations of concern. We will also provide £10 million of funding for charities that do so much good work in this space. I say to my hon. Friend the Member for Penrith and The Border that I would be very happy to meet the 3 Dads Walking, Andy, Mike and Tim. I know that they have met the Prime Minister.
Maria Caulfield
I am just answering a question on suicide. I would be very happy to meet the 3 Dads Walking to learn the lessons for our suicide prevention strategy.
Maria Caulfield
I will not give way. I only have a few minutes left.
It is disappointing that Labour Members cannot understand the progress that has been made and are determined to make political points, damaging the work that our NHS staff up and down the country do day in, day out, backed by record levels of investment that have never been seen before in mental health services.
It is true that we have tabled an amendment this afternoon, in which the Prime Minister acknowledges how much work we have done in this space. With a rising number of people accessing mental health support, which is a good thing and not something to be criticised, we are investing in those services and in 27,000 extra staff.
Maria Caulfield
Madam Deputy Speaker, I will continue if I may.
Despite the disingenuous motion proposed by the Labour party, it is my privilege to hear about the valuable contributions being made up and down the country. It is so easy to talk down our services, but if Labour Members are serious about improving mental health services, perhaps they should talk to their Welsh counterparts. Action speaks louder than words. Mental health services in England are performing better than those in Wales. We all know that this is not really about improving mental health services; it is about using mental health as a political football, but we on the Government Benches will not play that game.
Question put (Standing Order No. 31(2)), That the original words stand part of the Question.
Oral Answers to Questions
Maria Caulfield Excerpts(1 year, 5 months ago)
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Sarah Owen (Luton North) (Lab)
The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)
This is the first Government to produce a women’s health strategy in England. We are making huge progress on the eight priorities in our first year, from introducing the hormone replacement therapy pre-payment certificate, which is reducing the cost of HRT for women, to the £25 million roll-out of women’s health hubs across the country. We will be announcing our second-year priorities in due course.
Judith Cummins
Half of all women over 50 will experience bone fractures due to osteoporosis, and many of these will be serious hip fractures. As many women will die from these fractures as from lung cancer or diabetes. Can the Minister explain why not even one of the 63 key performance indicators set by NHS England for integrated care boards sets a target for fracture prevention?
Maria Caulfield
I thank the hon. Lady for her work in this space. She is campaigning hard on this issue. I reassure her that osteoporosis is in the women’s health strategy and is a priority area for us. We are already working to make sure that women’s vitamin D status is known, and to make sure that we fill gaps. NHS England is expanding fracture services for high-risk women with osteoporosis, and it is working to prevent falls. The women’s health ambassador is raising the profile of osteoporosis so that women who are at higher risk can take action to prevent fractures and falls in the first place.
Sarah Owen
Women too often struggle with needless pain through standard but invasive procedures, such as hysteroscopies and intrauterine device fittings, offered without any pain relief. Our pain is being misunderstood and ignored. How much unnecessary pain must Ministers see women endure before the Government finally deliver on the pain management promised in the women’s health strategy? And why is this a 10-year ambition instead of a more immediate one?
Maria Caulfield
I thank the hon. Lady for her question, and let me also pay tribute to the hon. Member for West Ham (Ms Brown), who has campaigned hard in this space. I met a group of women to discuss painful hysteroscopies just a few weeks ago. This is a priority in the women’s health strategy, as the hon. Member for Luton North (Sarah Owen) said. We are working with the royal college to update its guidelines, because a lot of these issues are associated with women’s consent, the provision of information before these procedures, and women knowing that they can have them under a local or general anaesthetic and can also ask for pain control. This is not working in practice, which is why it is a priority in the women’s health strategy.
Steve Brine (Winchester) (Con)
Women living with HIV of course have the right to healthcare on the same terms as anyone else, except that now they do not when it comes to starting a family. Many people living with HIV are currently excluded from accessing fertility treatment, both by law and by the Government’s microbiological safety guidelines. So will the Government now follow the scientific evidence, particularly on undetectable viral load, and remove what are surely discriminatory restrictions on the basis of HIV status?
Maria Caulfield
I thank the Chair of the Health and Social Care Committee for his question, as he raises an important point. Last year, we asked the Advisory Committee on the Safety of Blood, Tissues and Organs to reconsider this specific issue. It set up a working group in June last year to look at it and we expect its recommendations this month. We will take them seriously and address them swiftly once we have its advice.
Siobhan Baillie (Stroud) (Con)
So many women’s health issues begin with birth and pregnancy, as health is often dependent on the care and aftercare that women receive. Will my hon. Friend give the House an update on the recruitment of midwives and maternity teams, as Gloucestershire NHS is working so hard on that, in order to fully reopen Stroud Maternity Hospital?
Maria Caulfield
I thank my hon. Friend, who does a huge amount of work supporting her local midwives in Stroud. I can give her encouraging news: not only have we spent £190 million on midwifery services, but we are seeing an increased number of midwives coming through midwifery training. Excitingly, we have a nurse conversion course, which takes 18 months, with NHS England paying the tuition fees for nurses to convert to being midwives. We have had 300 in training this year and we are expanding that to 500 in the next academic year. We have encouraging retention rates too, which show that midwives are not only joining the profession, but staying in it.
Liz Kendall (Leicester West) (Lab)
There is a particular group of women whose health needs should be highlighted during Carers Week: women who look after an older or disabled relative. The majority of unpaid carers in their 50s and 60s are women. Eight million unpaid carers have seen their own health suffer, with those providing high levels of care twice as likely to have poor health as people without caring responsibilities. So will the Minister finally commit to a cross-Government national carers strategy, including health issues in it, as the last Labour Government did? That is a key demand during this year’s Carers Week.
Maria Caulfield
I thank the shadow Minister for her question. My colleague the Minister for Social Care is hosting an event today for carers, and £300 million for carers in the better care fund has also been released. I am a carer for my dad, who thankfully is well and spritely, so I understand the pressures of this. Recently, I met carers from Kinship; often they are grandparents, and older aunts and uncles, who look after young children. Work is going on between us and the Department for Education on how we can better support kinship carers, who do fantastic work in looking after young children. We fully recognise the issue, and the Social Care Minister is not just providing funding, but meeting those carers to see how we can better support them.
Neil Coyle (Bermondsey and Old Southwark) (Lab)
Sir Christopher Chope (Christchurch) (Con)
Has my right hon. Friend the Secretary of State read the report “Safe and Effective?” produced in April by a group of senior clinicians, which is very critical of the work of the Medicines and Healthcare products Regulatory Agency? If he has not yet read it, will he do so, please?
The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)
I thank my hon. Friend for his question. I feel that we had a very productive meeting yesterday with the all-party parliamentary group on covid-19 vaccine damage about the vaccines for covid and the issue of the MHRA. He raised a number of important points during that meeting, including that on the MHRA, and I will be responding to him shortly.
Ellie Reeves (Lewisham West and Penge) (Lab)
Stewart Malcolm McDonald (Glasgow South) (SNP)
My constituent Brian Murray lost his wife Roberta six years ago, following years of chronic health conditions after an infected blood transfusion. He wants to know: when will the Government enact all of the recommendations regarding compensation from the second report by Sir Brian Langstaff?
Maria Caulfield
I thank the hon. Gentleman for his question. We take this issue very seriously, and we have already made interim payments to those infected. The Minister for the Cabinet Office came to the Dispatch Box in April when Brian Langstaff’s review was published, and we are working night and day to respond to those recommendations and get that plan out as soon as possible. We recognise the impact on families, and on those infected and affected.
Dr Caroline Johnson (Sleaford and North Hykeham) (Con)
I refer Members to my entry in the Register of Members’ Financial Interests. Today Dr Mike McKean, a respiratory consultant and vice-president of the Royal College of Paediatrics and Child Health, said that vaping is “fast becoming an epidemic” among children. The Royal College of Paediatrics and Child Health said that we should ban disposable cigarettes—e-cigarettes—“without a doubt”. Will the Minister do all he can to prevent children from starting vaping, and will he back my ten-minute rule Bill, which was first introduced in this place in February, to ban disposable e-cigarettes?
Oral Answers
Maria Caulfield Excerpts(1 year, 7 months ago)
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Mr Ben Bradshaw (Exeter) (Lab)
The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)
NHS England does not routinely collect or publish data on waiting times for treatment for gender dysphoria, but I can tell the right hon. Gentleman that as of February this year 28,290 adults were waiting for a first appointment in England.
Mr Bradshaw
Four years on average for an initial appointment, and seven years at the south-west clinic in Exeter. With healthcare for trans people in effect non-existent, the Government planning to remove trans human rights from the Equality Act 2010, breaking their promise to ban conversion therapy and to reform the gender recognition process, and now threatening to force schools to out trans students to their parents, can the Minister see why this tiny and particularly vulnerable minority feels under attack by the Government, and that some who can afford to are even leaving the country for a less hostile environment?
Maria Caulfield
I can reassure the right hon. Gentleman that we are putting an additional £7.9 million into four new pilot gender identity clinics, because we want services to improve and waiting times to come down. The four new pilot services are now operating in Greater Manchester, Cheshire and Merseyside, East of England and London, and a new clinic will be opening in Sussex later this year. The four pilot studies have already removed 3,400 patients from the waiting list and I am hoping the fifth clinic will go further.
Rob Butler (Aylesbury) (Con)
Wera Hobhouse (Bath) (LD)
The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)
Accessibility and choice remain high in the south-west. All but one trust in the region have a minimum of three birth options.
Wera Hobhouse
In my local council area, birthing units were closed in 2020. My constituents were promised a new midwife-led unit at the Royal United Hospital in Bath, but three years on it is still not up and running. The Minister will say that it is a funding decision for the local area, but it is an NHS England funding decision and the Government are the paymaster, so when will Bath get its midwifery unit at the RUH?
Maria Caulfield
I am very happy to contact the hon. Lady’s local commissioners to find out the answer for her. However, I highlight the fact that the £7.6 million health and wellbeing fund is funding 19 projects across England to reduce health disparities in new mothers and babies. Two of those projects are in the south-west: the Trelya in Cornwall, a community-centred whole-family provision that takes a holistic approach to working with children and their families; and the Splitz Support Service in Wiltshire, which aims to improve community knowledge, access to and engagement with pre-conception and perinatal care. We are investing in the hon. Lady’s region, but if she has a local funding issue I am very happy to speak to her local commissioning group on her behalf.
James Gray (North Wiltshire) (Con)
I am very glad that the maternity unit at the Royal United Hospital in Bath is rated as outstanding—we actually have very good choices in our local area. Does the Minister agree that choice is an important thing in maternity services? I am very glad that we have a first-class birthing centre in Chippenham and another in Malmesbury. One of the most important things is allowing women the choice to have the birth at home. That requires first-class midwifery support thereafter, which we also have in our area.
Maria Caulfield
Absolutely; choice is important. Only last month we published the single delivery plan for maternity and neonatal services, which I am sure Members across the House will already have read. It puts women at the heart of decision making and learns from the Ockenden and East Kent inquiries, to ensure that women have better choice when giving birth.
Andrew Lewer (Northampton South) (Con)
Dame Caroline Dinenage (Gosport) (Con)
The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)
Annual health checks for people with a learning disability are important in addressing the causes of avoidable deaths and avoidable morbidity and in improving health.
Dame Caroline Dinenage
It is eight years since the Transforming Care programme started, with a target of halving the number of people with a learning disability and autistic people in in-patient mental health settings by 2024, yet according to the Challenging Behaviour Foundation, the number of children in those settings has nearly doubled since then, the average length of stay is 5.4 years and, 12 years on from the Winterbourne View scandal, reports of appalling standards of care are still too frequent. Does the Minister agree that people with learning disabilities and autistic people deserve so much better?
Maria Caulfield
I thank my hon. Friend for her work in this place. Our priority is always to ensure that children and adults with a learning disability and autistic people receive high-quality care. More than 2,000 people—children and adults—are still waiting to be discharged from in-patient facilities but that is a reduction of 30% and we are making progress. I am meeting individual integrated care boards—[Interruption.] Perhaps the shadow Minister would like to listen to this. I am meeting individual ICBs to go through their patients who are waiting to be discharged to see what more support we can give to make that happen as quickly as possible.
Richard Thomson (Gordon) (SNP)
Last year the Scottish Government announced £2 million-worth of funding and help for health boards to deliver health checks for all people with learning disabilities so that any health issues could be identified and treated as quickly as possible. What plans do the UK Government have to do similar across England?
Maria Caulfield
We also ensure that those eligible for safe and wellbeing reviews get one. Last year about 87% of those who were eligible did so.
Rachael Maskell (York Central) (Lab/Co-op)
Henry Smith (Crawley) (Con)
The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)
Successfully containing antimicrobial resistance requires co-ordinated action across all sectors. That is why the UK takes a “one health” national approach to AMR across humans, animals, food and the environment. Since 2014, the UK has reduced sales of veterinary antibiotics by 55% and has seen a decrease in antimicrobial resistance as a result.
Kim Leadbeater (Batley and Spen) (Lab)
Maria Caulfield
We are spending an additional £2.3 billion a year on mental health services, and we have recently announced £150 million for crisis community support, because we are trying to reduce the number of people being admitted in the first place by treating them at an earlier point in their mental health illness. That will free up beds, but it will take time. Community crisis intervention is the way in which we want to make progress.
Anne Marie Morris (Newton Abbot) (Con)
Investors need certainty and the British people need access to more medicines. The growth cap in the voluntary pricing agreement for branded medicines between the pharmaceutical industry and Government makes the size of the medicines rebate unpredictable. Will the Minister remove the growth gap from the 2024 voluntary scheme for branded medicines pricing and access, to supercharge investment that is currently leaking to Germany and Ireland?