Women's Health Ambassador

Maria Caulfield Excerpts

Monday 20th June 2022 Written Statements

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

In December 2021 when we published “Our Vision for the Women’s Health Strategy for England”, we announced that we would be appointing a Women’s Health Ambassador.

I am pleased to announce the appointment of Professor Dame Lesley Regan DBE MD DSc FRCOG as the first ever Women’s Health Ambassador for England.

The Ambassador will focus on raising the profile of women’s health, increasing awareness of taboo topics and bringing a range of collaborative voices to implement the Women’s Health Strategy. The Ambassador will develop networks across and outside Government to champion women’s health and break down stigmas which surround particular areas of women’s health, such as the menopause, endometriosis and PCOS, and mental health and wellbeing.

We will also appoint a deputy Women’s Health Ambassador to maximise the positive impacts of the role. The deputy ambassador will work collaboratively with the Women’s Health Ambassador to help increase awareness and build relationships with community groups and women and girls across the country.

Dame Lesley Regan is Professor of Obstetrics and Gynaecology at Imperial College’s St Mary’s Hospital Campus, and Honorary Consultant in Gynaecology at the Imperial College NHS Trust. She is also Honorary Secretary of the International Federation of Gynaecology and Obstetrics (FIGO) and the Immediate Past President (2016-2019) of the Royal College of Obstetricians and Gynaecologists (RCOG), only the second woman to ever hold this role and the first in 64 years. As President of the RCOG, she oversaw the publication of the ground-breaking Better For Women report, the findings and recommendations of which have informed the development of our Women’s Health Strategy.

When we set about recruiting the Women’s Health Ambassador, we heard from many highly qualified candidates who were interested in the role. I am very grateful for their interest in the role.

Next steps on the Women’s Health Strategy

The Women’s Health Strategy will set out an ambitious and positive new agenda to improve the health and wellbeing of women across England and reduce disparities, focusing both on the priority healthcare issues for women and key thematic priorities across the life course. I look forward to announcing the publication of the new Women’s Health Strategy shortly and to working with the new Women’s Health Ambassador to deliver real change for women in England.

[HCWS114]

Professional Medical Indemnity Insurance

Maria Caulfield Excerpts

Thursday 16th June 2022 Commons Chamber

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

I thank my hon. Friend the Member for Mole Valley (Sir Paul Beresford) for securing this important debate. It is a niche area, but it is also a very important one relating to patient safety. Indemnity cover supports professionals in carrying out their practice. Even in the safest healthcare system in the world, mistakes will happen and it is important that patients are covered. Like my hon. Friend, I declare an interest: as a practising nurse, I have to have indemnity cover in order to maintain my registration.

Patient safety is the priority. Our focus is on making the NHS the safest healthcare system in the world. We are redoubling our efforts to deliver that, including in underpinning quality and safety. The national patient safety strategy, which was published in 2019, sets out exactly how we aim to do that. It is also important to learn the lessons when things go wrong. We want to make, and are making, changes to the culture of the NHS, to learn from mistakes and to be honest and open when mistakes happen.

There are legal requirements in place. All regulated healthcare professionals in the UK must hold adequate and appropriate indemnity to be able to practise. Healthcare professionals both in the NHS and in the independent sector need to have that in place. As my hon. Friend has said, the type of indemnity varies: it could be discretionary or it could cover all eventualities. Sometimes, when a claim is made where discretionary indemnity is in place, it is not paid out.

Most staff in the NHS benefit from state indemnity for clinical negligence. Decisions about state indemnity arrangements are a devolved matter, and they vary across the four nations. Broadly speaking, however, where state indemnity is in place in primary and secondary care, it provides cover for NHS professionals carrying out NHS work. Patients can be assured that, if something goes wrong, it will cover them, and cover is available to provide compensation where needed.

For work that is not covered under a state indemnity—many professionals, including dentists and GPs, provide NHS services under an NHS contract rather than being direct employees—discretionary indemnity is available. There have been problems with that, which the Paterson review very much highlighted. Although the Government did not accept all the recommendations in the Paterson review, we accepted a number of them partially. I am concerned about some of the issues that my hon. Friend raised in his speech, so we will be reviewing the Paterson recommendations shortly. I am keen that, where we have introduced measures in the NHS to improve an indemnity, the independent sector takes them up. We want to give the independent sector a chance to make those changes, but if it does not, we will have no hesitation about taking action.

[Sir Paul Beresford]

The Minister is absolutely right that every medical practitioner has to have indemnity. If a case arises in which there is a challenge to the clinician, if the indemnity is covered by a society that has discretion, and if that discretion is exercised, the cover that is insisted on by law is annulled.

[Maria Caulfield]

My hon. Friend is absolutely right. We have looked into reform: between 2018 and 2019, we consulted on whether to change the legislation to require all healthcare professionals to hold regulators’ insurance, rather than the discretionary indemnity. Unfortunately, covid came along and disrupted much of that work, and the response to the consultation was not published, but I am very happy to look at it again.

My hon. Friend is right that there is a gap in the system, not only for patients who may need compensation to deal with whatever outcome has happened as part of their care, but for healthcare professionals who need cover for a specific reason. Publication of the consultation that we ran in 2018 and 2019 was delayed, initially because of Paterson and then because of covid, but we hope to publish it fully this year. I will take the response very seriously; I hope to work with my hon. Friend on it so that, if changes to legislation are needed in relation to discretionary indemnity, we can make them.

The gap in the market that means that discretionary payments may not pay out will sometimes affect healthcare professionals admitting when mistakes have been made and learning from them. It does not help patients either. I very much take on board my hon. Friend’s points and am happy to work with him, because we remain committed to supporting healthcare workers across England in the clinical negligence sphere.



In 2019, in our response to concern about the rising costs of clinical negligence we touched on fixed recoverable costs—the second point my hon. Friend talked about. We recognise that costs are a significant part, albeit not the largest part, of lower level compensation payment to patients. Very often, legal fees make up a large percentage of the cost, and although we are improving patient safety we are not seeing clinical negligence costs fall in parallel. There is no correlation. To manage the rising costs of clinical negligence, we have consulted on fixed recoverable costs and capping them for the lower level of compensation payments. Such measures would not cap the compensation paid to patients, but they would cap the cost of the lawyers. We would do this in part to reduce costs, so the money could be spent on frontline services for patients instead, and in part because we recognise that legal costs can increase the cost of insurance for healthcare professionals who need indemnity cover.

The consultation on fixed recoverable costs finished recently and we are working our way through the responses. We hope to introduce measures fairly soon, and I will set out the detail as soon as I can. The Health and Social Care Committee carried out a review of patient safety and the cost of clinical negligence, and this is one area where, when I was before the Committee a few months ago, we promised reform. I am very committed to doing that.

We are also committed to acting on the recommendations of the Paterson inquiry, which looked at discretionary indemnity and highlighted the points my hon. Friend made about potential gaps in clinical negligence indemnity, in particular in the independent sector. I am committed to ensuring that lessons are learned from the inquiry, that the report is taken up and that we address those gaps. We have to look across healthcare, both the national health service and the independent sector, and consider a range of options. We will build on the work that we were doing before the inquiry and the consultation we started then, but also take forward the inquiry findings.

I hope that I have reassured my hon. Friend that by introducing the changes to fixed recoverable costs for clinical negligence with a value up to £25,000, we will not affect the payments to patients when claims are made, but instead tackle rising legal costs. I am happy to look into the indemnity issue he raises, because there is a gap and I recognise the points he made.

Question put and agreed to.

Business of the House

Maria Caulfield Excerpts

Thursday 16th June 2022 Commons Chamber

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

I thank the hon. Lady for raising those points. As she said, I am not the Minister responsible for the Bill, but I am happy to respond. This is a crucial piece of legislation and, as she said, there is urgency in getting payments out. There is a complicated set of requirements, so officials have taken some time to ensure that they get the details right.

The hon. Lady is right that the Bill will be debated on Wednesday and, given the short notice, the Leader of the House has made arrangements for Members to be able to table amendments as flexibly as possible. She slightly contradicted herself by saying that there has been a delay and that now the Bill is being rushed. It is important to get these things right, but, given the factors out there in the economy, it is also important that people can access these payments as quickly as possible. Of course, I will feed her thoughts back to my ministerial colleagues and to the Leader of the House, but I hope she can appreciate that the Government are trying to be as efficient and flexible as possible in helping Members when we come to debate the Bill next week.

Question put and agreed to.

Oral Answers to Questions

Maria Caulfield Excerpts

Tuesday 14th June 2022 Commons Chamber

[John Penrose (Weston-super-Mare) (Con)]

2. What steps he is taking to improve the availability of and access to routine NHS dental care services in (a) Weston-super-Mare constituency and (b) England.

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

The best way to improve access to NHS dental services nationally is through our reforms of the NHS dental contract, which will aim to pay dentists more fairly for their work. Specifically on Weston-super-Mare, a number of measures are taking place in Somerset to open up dental access there, including a nurse-led dental helpline to open up the available appointments.

[John Penrose]

I thank the Minister for her answer. Even before the pandemic, the NHS commissioned enough dentistry to cover only about half the population of England. Covid has massively increased backlogs and inequalities in Weston-super-Mare and many other parts of the country. Dentistry is now the No. 1 problem raised with Healthwatch, and four in five people say that they cannot find timely care. I agree with her that reforming the NHS dental contract is absolutely essential and urge her to redouble her efforts to fix it as fast as possible.

[Maria Caulfield]

My hon. Friend is absolutely right that the nub of the problem is the dental contract. Negotiations have started and the details are with the British Dental Association as we speak. We expect to make an announcement before the summer recess.

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

Like the hon. Member for Weston-super-Mare (John Penrose), I have a number of constituents who have had real problems reaching dentists before and since covid, but there have been some particularly distressing cases since covid. There has never been the right package to pay dentists to do the work, which is driving them out of the business, but the inefficiencies of having to go through the central NHS systems for an emergency appointment are costing the taxpayer dear. When will we see proper certainty around the measures that the Minister just described, so that dentists know that it is worth their while sticking with NHS patients?

[Maria Caulfield]

As I said, the contract is the nub of the problem; it is currently a perverse disincentive for dentists to take on NHS work. We are serious about reforming it, we are in discussions with the BDA, and we will make the announcements before the summer recess.

[Simon Fell (Barrow and Furness) (Con)]

I thank my hon. Friend for her work on pushing that contract reform through, because it is key to shifting the dial. In areas such as mine, where people are waiting to get on to waiting lists for dentists, there is a huge dearth of dentists to provide treatment. Can she speak about the recruitment challenge that we will have to meet when the reform comes through?

[Maria Caulfield]

My hon. Friend is right that the issue is not just about the contract, although that is a key aspect of trying to get more dentists to take on NHS work. We are working on a number of incentives to increase recruitment, including working with Health Education England on centres for dental development to train more dentists in those hard-to-reach areas, which tend to be coastal and rural areas.

We are also looking at how we can reform the overseas dentist policy. We are working with the General Dental Council on that and may be bringing legislation forward towards the end of the year to improve that, too.

[Mike Amesbury (Weaver Vale) (Lab)]

Kathryn Townsend got in touch with me about her son Max, who has severe complex sensory issues and learning difficulties. He waited up to two years for an appointment. In that time, several rotten teeth have had to be removed. Conservative Governments have had 12 years now to get things right. When will the Minister get an urgent grip of the situation?

[Maria Caulfield]

The hon. Gentleman says that we have had 12 years, but he may recognise that, during the pandemic—two of the years that he talks about—routine dental appointments were not available because of the type of aspiration procedures that they involve. Only urgent appointments were available. We are now enabling 95% of the usual activity to take place, and that will soon be 100%. That means that there is still quite a backlog to get through, but we are in a better place than we were this time last year.

[Kate Griffiths (Burton) (Con)]

Like colleagues, I have many constituents struggling to access an NHS dentist. I recently met with Uttoxeter Dental Practice, which has significant concerns about the UDA—units of dental activity—system, as it is not working for dentists or patients. I understand that a review has been promised for many years. Can my hon. Friend update me on when it might take place?

[Maria Caulfield]

My hon. Friend is right: there is a perverse disincentive in the current contract in that under the UDA dentists are not paid in relation to the level of activity or work they have to do for an appointment. That is the nub of the problem and we are in discussions with the British Dental Association right now; it is reviewing our proposals and we hope to have news very soon.

[Ms Marie Rimmer (St Helens South and Whiston) (Lab)]

People with dementia deserve to be treated with dignity and respect. There are ways to enable those living with dementia to lead the lives they want. This is what the all-party group on dementia inquiry is currently investigating. Will the Secretary of State commit to attending the all-party group’s inquiry—

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[Feryal Clark (Enfield North) (Lab)]

Members across the House have been calling on the Minister to fix the crisis in NHS dentistry, but she seems intent on burying her head in the sand. The Government have no plan, with the Minister running scared from even talking to dentists at a conference last week. Patients are suffering as a result, with a third of adults and half of all children not having access to an NHS dentist. In Wakefield alone, a child under 11 is admitted to hospital every day for tooth decay. Does the Minister agree that the people of Wakefield should bear this in mind next Thursday?

[Maria Caulfield]

I am sure the people of Wakefield are as frustrated as I am that the Labour dental contract, put in place in 2006, is the nub of the problem. If the hon. Lady were to meet with dentists, she would hear loud and clear that the dental contract is causing the problem. [Interruption.] She might not have listened to my previous answers because she is not listening now, but we will be announcing changes before the summer recess.

[Daisy Cooper (St Albans) (LD)]

At the start of this year the Government announced £50 million to create some new dentistry appointments, but that money resulted in exactly zero new appointments in my constituency. I wrote to every single dental practice in my constituency and they said that was because the funding offer was too limited in scope and time and they were given only a week to reply.

On 25 April, I wrote to the Minister asking how many appointments had been created from this money across England and where that money had gone. I have not received an answer. Will we get one today?

[Maria Caulfield]

I am very disappointed: that £50 million of funding was for dentistry to access and be able to afford more appointments, and if local commissioners in an area did not bid for that money or ask dentists to take that money on, that is extremely disappointing—those in other parts of the country certainly did. We are putting £3 billion a year into dentistry. Local MPs have a role to play in this: if there was a problem, I would have expected the hon. Lady to have come and seen me before now to lobby for more funding for her local area.

[Ian Levy (Blyth Valley) (Con)]

3. What progress he has made on recruiting 50,000 nurses.

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[Michael Fabricant (Lichfield) (Con)]

9. If he will take steps to help ensure access to medicinal cannabis for NHS patients.

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

On 1 November 2018 this Government changed the law to allow the prescription of cannabis-based products for medicinal use by a specialist when clinically appropriate. Licensed cannabis-based medicines such as Sativex and Epidiolex are routinely available on the NHS.

[Michael Fabricant]

I am grateful to my hon. Friend for that answer, particularly as she mentioned 2018, because it was of course her boss, the Secretary of State for Health, who was the pioneer in all this when he was Home Secretary. But there is a “but” coming, and it is that young children are not getting this vital medicine on the NHS. Some are having to pay £2,000 a month, and in the last three years only three prescriptions have been issued on the NHS. How can we improve the situation?

[Maria Caulfield]

My hon. Friend has been campaigning on this issue for a long time, particularly on the tragic case of his constituent, Vicky Clarke. I have met the all-party parliamentary group on medical cannabis under prescription and we have had debates on the issue in this place and in Westminster Hall. The key is to get those products licensed, and we have been in discussion with the Medicines and Healthcare products Regulatory Agency on how to do this. It is about gathering the evidence base. I am pleased to say that NHS England and the National Institute for Health and Care Research have recently announced two clinical randomised controlled trials to try to build that evidence base to get more of these products licensed.

[Mr Speaker]

We now come to the Scottish National party spokesperson, Martyn Day.

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

The lack of evidence on the quality, safety and efficiency of cannabis-based products for medical use is the main barrier to their being prescribed by NHS clinicians, which is why the SNP continues to support the development of clinical trials. Without proper funding, the UK Government are holding back potential successful health outcomes, so what steps are they taking to increase the priority of medicinal cannabis in research funding?

[Maria Caulfield]

I met the responsible Scottish Minister in April to discuss this issue. There is not a lack of funding. The National Institute for Health and Care Research has funding available but we are not seeing bids, so this is a plea to the clinicians, researchers and groups for those to come forward. The NHRA is also happy to meet any groups considering undertaking clinical research to ensure that it is the type of research that will provide the evidence they need to licence these products.

[Mrs Emma Lewell-Buck (South Shields) (Lab)]

10. What recent assessment he has made of the availability of maternity services.

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

NHS England is making £127 million of investment in maternity systems in the next year to go specifically towards the workforce. This is on top of the £95 million already promised for the recruitment of 1,200 midwives and 100 more consultant obstetricians.

[Mrs Lewell-Buck]

South Tyneside District Hospital’s maternity unit was award winning. In 2019, despite widespread opposition, it changed to a midwife-led birthing centre. It has since been closed, since January. Recently, a whistleblower explained that midwives and expectant mums are being kept in the dark about the future of the unit, staffing levels and bed capacity across the trust. These changes are a direct result of this Government’s forced cuts, so what is the Minister going to do to make sure that babies can be born in south Tyneside?

[Maria Caulfield]

I have just been very clear that we are investing about £200 million in that workforce. In the hon. Lady’s area, there were staffing pressures during the omicron variant, with high levels of staff sickness, which meant that South Tyneside District Hospital had to make that difficult decision. My understanding is that those staffing numbers are much better, particularly for sickness absence. If she is struggling to find out from the trust when it hopes to reopen the unit, I am very happy to meet her and members of the trust.

[Wendy Chamberlain (North East Fife) (LD)]

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

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[Mohammad Yasin (Bedford) (Lab)]

When I wrote to the Minister recently about my concerns about NHS dentistry waiting times, I was advised that my constituent was not restricted by geography, which implied that he should travel for an appointment, but the whole of the east of England has been identified by the Association of Dental Groups as a dental desert. The Minister is well aware of this problem, the severe workforce shortages and the broken dentistry contracts. When will the Government stop blaming the dental practices, get on with the job and get the workforce this country needs?

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

This Government are not blaming dentists for the pressures they are facing. If anyone is to blame, it is the Labour Government for their 2006 contract. We are amending that contract, and will make an announcement before the summer recess.

[Kerry McCarthy (Bristol East) (Lab)]

Suicide prevention organisations such as the Campaign Against Living Miserably and Papyrus are, sadly, needed more than ever, yet in the current economic climate, because they tend to rely on charitable donations, they are struggling to provide the services to meet demand. What will the Government do to make sure they survive and provide the life-saving services that are so badly needed?

[Jim Shannon (Strangford) (DUP)]

As IVF treatment is incredibly time sensitive, will the Secretary of State consider increasing the funding available to allow couples to make use of private facilities on the NHS, to help families have the children that they so much want?

[Maria Caulfield]

I cannot comment on health in Northern Ireland specifically as it is a devolved matter. IVF will be a significant factor in the women’s health strategy, because we recognise the disparities that exist across the country in how couples currently access IVF.

[Hilary Benn (Leeds Central) (Lab)]

The site for the new Leeds children’s hospital and the adult hospital building, the Leeds General Infirmary, will be cleared by the end of this month. The trust is raring to go to build these wonderful new facilities. Can the Secretary of State tell me when the final go-ahead for the construction will be given?

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[Ronnie Cowan (Inverclyde) (SNP)]

As was pointed out by the hon. Member for Lichfield (Michael Fabricant), this Government promised medical cannabis on the NHS 1,183 days ago. Since then, a child with epilepsy will have experienced, at a modest estimate, 35,490 seizures. We have free NHS prescriptions, which proves that the medicine exists and is approved for use in the United Kingdom. How much longer must those children suffer?

[Maria Caulfield]

As I have said, I met the Scottish Minister on this. Scotland is facing exactly the same problem. Where medicinal cannabis is licensed, 9,631 prescriptions have been issued in primary care and 58,000 in secondary care, thanks to my right hon. Friend the Secretary of State who changed the law at the time.

Menopause

Maria Caulfield Excerpts

Thursday 9th June 2022 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Robertson. I congratulate the hon. Member for Swansea East (Carolyn Harris) on once again securing a debate on this important issue. It is good to see all four nations represented here this afternoon and both men and women involved in the debate. It is my wedding anniversary today, and it is a pleasure to share it with the hon. Member for Strangford (Jim Shannon) and to show our continuing working relationship—[Laughter.]

To reassure hon. Members, progress has been made since the debate held by the hon. Member for Swansea East last October. It was one of the first debates I took part in as a new Minister, and I can honestly say that virtually every day since then we have worked on many of the issues addressed in that debate to improve outcomes for women going through the menopause. This is an important issue for me not only because it is a key priority area in my portfolio, but because I went through an early menopause over 10 years ago. The hon. Member for Edmonton (Kate Osamor) described her struggle to get her GP to take her seriously, but for someone in their 30s it is even more difficult, and it can be a lonely experience if your peers are not going through the same thing. They are busy getting married and having children; they are certainly not talking about hot flushes and not being able to sleep. It can be a very difficult experience. So, for me, this is a personal mission as well as a ministerial one.

I want to reassure colleagues that I absolutely have a laser focus on delivering many of the pledges made in the previous debate. On the cost of HRT, we announced in that debate that we would accept the move towards reducing the costs. It only affects women in England, but it is an important issue. Around 89% of all prescriptions issued in England are free. People qualify for free prescriptions when they are on income support, universal credit, jobseeker’s allowance and pension credit, so the vast majority of people getting general prescriptions are entitled to free prescriptions.

However, women going through the menopause often do not meet those criteria. I fully recognise that the cost is very high, particularly for women who are on two hormones or who have multiple products that they need dispensing. That is why we are committed to introducing the bespoke prepayment certificate for HRT by April next year. It is very different from the prepayment certificates that exist for general medicine. However, there are steps that we have to take. We are expected to consult the professional bodies involved. There will be changes to both dispensing and prescribing. A statutory instrument needs to be laid to make those changes happen. IT changes are also needed to make these things happen in practical terms, so that when women turn up at the chemist, their prescriptions are actually there for them to collect. We are not making excuses, and this will happen by April next year, not from April next year. If we can do it any quicker, we will. The prescription will be £18.70 for all HRT products, whether that is for two hormones or multiple products, and that will be a considerable cost saving for women.

The supply of HRT has been a challenge. We have seen more than a 30% increase in demand, thanks to all the campaigners raising the profile of the menopause but also highlighting the benefits of HRT and breaking the taboos. GPs and doctors were often worried about the safety of HRT, but campaigners have explained that some of the research that was around 10 or 15 years ago is out of date and that HRT is a safe and effective product for many women. So there has been a huge increase in demand. We have met trade suppliers, manufacturers and pharmacists to discuss the challenges they face and to try to overcome them. Of the more than 70 products that are available, we are now down to pressures on three or four, and even with those we are seeing significant progress.

The hon. Member for Belfast South (Claire Hanna) asked for an update. Maddy McTernan, the head of HRT supply, updated the taskforce this week. We are making good progress. There is commercially sensitive information, which we cannot share, but manufacturers are stepping up to the plate to produce extra supplies. It is not about meeting the demand now. Demand will continue to grow, and we need to future-proof to ensure that we are not in the same situation in six months.

The prepayment certificate will also help. Women will no longer have to try to get a prescription for three or four months in order to keep the cost down. They will be able to get a monthly supply and not have to pay an increased cost for doing so. That will help manage supplies overall. We have also introduced three serious shortage protocols for the three products, so that we can manage the amount that is being dispensed and have better stock control. It will also give powers to pharmacists to give alternative products. That is not always ideal, because I know that some women notice instantly a difference in the effect of a drug, even if it is the same drug but with a change in manufacturer. It is not ideal, but it is helping us get through this acute period, and it will enable us to better control stocks in the longer term. We will be updating colleagues as we go through this, and Maddy and the team from BEIS have been helping us hugely with that.

The UK menopause taskforce that has been set up was one of the asks from the hon. Member for Enfield North (Feryal Clark); it was not a Government suggestion. We agreed to it and have had our second meeting. There are four key areas where we want to make recommendations. Those include education—for women, men, boys and girls, and healthcare professionals too. The taskforce will also look at the workplace, health provision, and research into areas such as testosterone, where we need to be breaking some barriers.

In the short time I have, I would like to touch on the workplace issue, which is crucial. One of the key things about the taskforce is that it is not just about health. We have a BEIS Minister and an employment Minister, and we are going to invite, as was suggested earlier, a Minister from Justice as well so that we reach out to all women affected by the menopause. I am really pleased that the civil service led the way this week when we signed Wellbeing of Women’s menopause workplace pledge. That will not just help women in the civil service who are going through the menopause it is to show other employers the sorts of small changes, such as the pink fan mentioned by the hon. Member for Strangford (Jim Shannon), that can make a big difference. It will also enable women and employers to feel confident to have those discussions at work. As my hon. Friend the Member for Cities of London and Westminster (Nickie Aiken) said, these women are in the prime of life. We have women with extraordinary experience and talent who we should be harnessing, not letting go.

We are really serious about improving GP training. It has been difficult for GPs to get that specialist advice and support, as this is a growing area, but the General Medical Council will be including the menopause as part of its licensing assessment, so it will be a core part of training. The NHS England menopause programme will be producing resources for all types of healthcare professionals so that we can make sure that people are trained.

I know I have to let the hon. Member for Swansea East come back in—

[Mr Laurence Robertson (in the Chair)]

There is plenty of time.

[Maria Caulfield]

Okay. The NHS itself is setting up a training programme to make sure that at every point that a woman approaches the health service—when meeting GPs or nurses—they get the specialist training they need.

The women’s health strategy is coming forward. I would rather spend time getting it right than rush it through to meet a deadline. We are weeks away from publishing. We have already published our vision and the findings from the consultation, and the strategy will build on that. The menopause will be a priority area within that document. We will also be announcing a women’s health ambassador very shortly, who will be holding my feet to the fire, as will the hon. Member for Swansea East.

I hope I have reassured colleagues that we are doing so much work in this area. Debates such as this are not just about holding me to account. They are about breaking taboos and having lightbulb moments for women across the country, as my right hon. Friend the Member for Romsey and Southampton North (Caroline Nokes) said. I look forward to working with colleagues on both sides of the House and in all four nations to improve the experience for women.

[Mr Laurence Robertson (in the Chair)]

I call Carolyn Harris to wind up.

Medical Examiners

Maria Caulfield Excerpts

Thursday 9th June 2022 Written Statements

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

It is our intention to work towards commencing implementation plans for the statutory medical examiner system from April 2023, recognising the need for all relevant Government Departments to be ready and aligned to enable successful implementation. The statutory medical examiner system will be centrally funded in England. This follows the required amendment to the Coroners and Justice Act 2009, which has now been made through the Health and Care Act 2022, to host medical examiners in England in NHS bodies rather than local health authorities.

The National Medical Examiner has published the report for year 2021 which sets out the non-statutory medical examiner system progress to date. The medical examiner system will introduce an additional layer of scrutiny of the cause of death by the medical practitioner, improving the quality and accuracy of the medical certificate of cause of death and thereby informing the national data on mortality and patient safety. The medical examiner system will increase transparency and facilitate discussions with the bereaved about any concerns they may have, providing new levels of scrutiny to improve detection of criminal activity or poor practice.

After the statutory medical examiner system has been introduced, all non-coronial deaths will be scrutinised by a medical examiner, for both burials and cremations.

[HCWS85]

Cancer Care: Young Adults

Maria Caulfield Excerpts

Wednesday 8th June 2022 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Paisley. I thank my hon. Friend the Member for Hertford and Stortford (Julie Marson) for securing the debate, which as she said is not one we want to have but is one we need to have. I offer my apologies and condolences to Simon and Andrea, who are with us today. Nothing we say in the debate will make things easier for them, but if we can prevent a similar tragedy from happening to another family, we must do absolutely everything we can to make sure we do.

In Jess’s case, it is true that two factors did not help her diagnosis. First, cancer is not as common in children and young people as it is in the rest of the population. It is not unusual for a GP, or even a GP practice, to see only one or two cases across the lifespan of their service. Just under 4,000 young adults between 15 and 29 are diagnosed with cancer in England each year; across the country, those are small numbers, so GPs often do not have experience of dealing with young people who present with symptoms that—as the right hon. Member for Alyn and Deeside (Mark Tami) said—are often non-specific and can be attributed to other causes. The other factor is that if there is an unknown primary, those cases are more difficult to diagnose across the board for all age groups, because there is not an obvious breast lump, an obvious shortness of breath or an obvious mole that has changed. That often makes it difficult for GPs to get to the bottom of what is happening.

Despite that, it is very clear from Jess’s case that there were many opportunities where further investigation could have revealed what was going on. She should not have had to go back so many times with the same symptoms without being investigated further. That is precisely why the Government have put a lot of funding—£2.3 billion—into the roll-out of community diagnostic centres, so that patients with non-specific symptoms that GPs cannot get to the bottom of can be referred straightaway. They do not need a hospital referral to an oncologist or a surgeon to investigate: GPs can refer those patients directly to the community diagnostic centre, where a range of tests is available, including MRI scans, ultrasounds and CT scans, to get that early diagnosis as quickly as possible. If it is not cancer, those patients can then pop back to the GP for further referrals elsewhere, but if it is, they can get started with treatment as quickly as possible. We are also introducing non-specific symptoms pathways, in order to do exactly what my hon. Friend the Member for Hertford and Stortford has said: bring together diagnostic equipment, expertise and support, so that discussions do happen about patients who are coming back on a frequent basis and for whom a diagnosis has not been helpful.

To mention two additional things that the Government are doing, my hon. Friend is absolutely correct that the nub of this issue is getting people diagnosed as early as possible, so we have now set a target that, by 2028, 75% of all cancers should be diagnosed at stages 1 or 2. Doing that means diagnosing people as early as possible. Screening will help, although it would not have helped in Jess’s case. However, the rapid diagnostic and community diagnostic centres definitely will help. This is about enabling pathways through which, if GPs are not able to find the source of a problem, they can get some extra expertise or diagnostic tests that will help them to do so.

Meeting that 75% target means addressing all cancers, not just the ones that are easier to spot, either because they have screening tests in place or because they give rise to more obvious symptoms. It includes the rarer cancers and those that have no known origin, so I hope that that gives some reassurance that we are absolutely focused on trying to diagnose people as early as possible. We are also piloting a nurse specialist route into pathways, so if someone like Jess was meeting their GP regularly and still not feeling that they were getting to the bottom of their problems, they would be able to phone the cancer nurse hotline. If the cancer nurse feels that that person needs to be seen by a cancer specialist or to go into the cancer pathway, they can do so as quickly as possible. Again, this is not about blaming GPs, but it will be another route through which patients can access specialist services.

Turning to Jess’s law, the Secretary of State is currently formulating the 10-year cancer strategy. We are looking at that in detail, and I can reassure my hon. Friend the Member for Hertford and Stortford that the strategy will contain a section on children and young people, because they have specific needs, particularly around diagnosis but also around treatment. I am very happy to discuss a flag-style system with the Secretary of State, as my hon. Friend has. There may be some technical difficulties with that: I am doing work with GPs on a flag system for gun licensing, and the issue we have, from a purely practical point of view, is that most GPs have their own independent IT system—they are not part of a national IT system—so if we introduce one nationally it will be quite difficult for each GP practice to implement it. My hon. Friend has made some suggestions, and it is not beyond the realms of possibility to introduce a system that ensures that, if a young person is seen four times and is still coming back with the same symptoms, that is raised to another level—a red flag level, as my hon. Friend said—to indicate that interventions need to take place.

Many of the points that my hon. Friend made, particularly on named GPs, are very important and I will certainly follow them up with her. In terms of the timing of this debate and the 10-year strategy, including some of work she has done within the cancer strategy would be a real opportunity.

[Julie Marson]

The Minister makes a really important point about the practicalities and technicalities of implementing something such as Jess’s law, and I absolutely appreciate that. The example she gave of IT systems being different across GP practices illustrates how important it is to standardise procedure. Patients should not be reliant on whether a GP has a particularly efficient or good procedure; practice should be standardised across the board.

[Maria Caulfield]

My hon. Friend is absolutely right. We are introducing non-specific pathways so that if someone does not have a specific, clear diagnosis and the GPs are not sure what to do, there is a pathway to follow, consistent across every GP practice throughout the country, and people do not slip through the net. Early cancer diagnosis is one of the priority areas in the Core20PLUS5 approach, which we introduced last year to reduce health inequalities across the country. It is crucial that we use that opportunity to flag some of the issues that my hon. Friend raised.

Crucially, GP training across the board is important. Because many GPs will not have come across a young person with cancer in the course of their practice, Macmillan Cancer Support, CLIC Sargent and Cancer Research UK are doing work to roll out training with regular updates—it is not just one-off training—for GPs and other members of the primary care team. It is much more common now for people to be seen by the practice nurse, the paramedic or the physio if they have back pain or joint problems. It may seem like a physio problem, but there could be an underlying cancer diagnosis. It is important that we educate and keep up to date the whole team, not just the GP.

I am very happy to take away my hon. Friend’s suggestions and to see whether we can put in place some proper measures that will reduce the chances of this happening again. We will not necessarily be able to make sure that no one is missed, but my hon. Friend raises some flags that cause me concern and that suggest we are not where we should be. There are certainly things that we can put in place to stop cancer diagnoses being missed in young people with non-specific symptoms.

Question put and agreed to.

GPs and Primary Care (North East Bedfordshire)

Maria Caulfield Excerpts

Tuesday 7th June 2022 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Betts. I thank my hon. Friend the Member for North East Bedfordshire (Richard Fuller) for securing the debate and raising important points about the good work that is happening, as well as the substantial issues facing his GPs and constituents. I will not stand here and pretend everything is rosy: I want to work with him to address a number of the issues that he raised.

I start by thanking GPs, general practices and primary care for all their work during the pandemic, and for the work they are doing now, increasing their workload, such as dealing with people on elective waiting lists who need care because they are not able to get procedures done as quickly as normal, or helping with the covid vaccination booster. They are dealing with almost a tsunami of patients who are now coming forward to seek help, after we advised them to stay away and protect the NHS during the covid pandemic. We are seeing almost 11,000 cancer referrals a day, for example, and each one comes through a GP. On average, there are 1.6 million appointments nationally per working day, which is an increase of 5.3% on April last year, and 62.5 million covid vaccinations have been delivered by general practices.

That gives the scale of the work that has gone on, but I do recognise some of the issues raised. To reassure my hon. Friend, GPs—whether they are salaried or partners—are generally not directly employed by the NHS. They are independent practitioners who have a business of their own and have a contract to deliver NHS care. Some of those historical arrangements limit the interventions we can make, and some GPs want more integration than others—we have to be flexible in the support that we give.

My hon. Friend the Member for North East Bedfordshire is quite right to identify the issue of telephone access. I know from my own constituents that getting through to the GP is half the battle; once they have got through they usually have a positive experience seeing the GP, or other healthcare professional in primary care. We tried to help with this in autumn last year with the winter access fund. Part of that help meant that practices could bid for funding to introduce cloud-based telephony systems, which can transform the way that appointments can be made. My hon. Friend highlighted systems where GPs can see how many people are waiting on the line and how long they have been waiting for, and can divert resources to get calls answered quicker, even doing so remotely, with receptionists not having to work directly in the surgery to answer the phone, book appointments or organise prescriptions.

Cloud-based telephony is really transforming access to GPs. Unfortunately, some GPs are already signed up to contracts with other telephone providers that they cannot get out of, and some have signed up with other cloud-based telephony systems that are not as good as others, as my hon. Friend pointed out. NHS Improvement is working with GPs to drive full adoption of cloud-based telephony across the system. We are working with surgeries and sharing best practice of what really works. He is quite right that when patients are frustrated about not being able to get through they take it out on staff and GPs. To deal with the telephone access issue and make it easier to get through will transform the lives of both patients and staff.

We must also bust the myth around the 48-hour appointment model, which was in place under previous Governments, where patients had to be given an appointment within 48 hours. Patients had to phone up every morning and could only get an appointment within that 48-hour window. There is no need for that, and we are trying to say to GP practices that that is a historical model—they do not need to stick to it. Very often, a patient will be happy with an appointment next week, rather than having to phone up on the Tuesday, the Wednesday and the Thursday but still not get an appointment. There is a lot of work around practice management, and the systems in individual practices, that we are happy to help GPs with.

We are also working on the pharmacy consultation service, which has been used very successfully during the pandemic. If a patient phones 111, or the GP practice, there is a range of minor ailments that a pharmacy can deal with face-to-face, quickly and expertly. Those ailments, which range from sprains to colds and flu—even those patients with long-term conditions and on long-term medications, such as some diabetics or those with high blood pressure—can be well managed by a pharmacist. We want to go further with that and introduce more services provided by community pharmacists. We are in negotiations with pharmacy teams to see if we can do that. Scotland and Wales have a pharmacy-first system that works extraordinarily well; we are keen that patients in England have access to similar support.

We are introducing changes to the GP contract this year—some of those are more popular than others. For patients, one of the key elements is about extending opening times to evenings and Saturday mornings, to make it easier for patients to be able to see their GP if they need to. That comes on top of the point that my hon. Friend made about other healthcare professionals working in primary care. Primary care is changing dramatically. We have already recruited over 18,000 additional primary care professionals, such as nurses, physios, pharmacists and paramedics, who are often better placed than the GP to provide the care and support a patient needs. My hon. Friend is quite right that there is sometimes a reluctance from patients—a feeling that they are being palmed off on someone else rather than seeing the GP. However, we are finding that once they have seen the paramedic or the physio, they are very pleased to see that professional the next time an appointment is offered. We are hoping that the take up of that will improve.

We have a commitment to recruit 26,000 more healthcare professionals by 2023-24 in addition to the GPs. We are on track to meet that, so that primary care becomes a multidisciplinary experience for patients, and it is not always the GP who they need to see first. However, as my hon. Friend says, we do need more GPs, and a record number of 4,000 doctors have taken up GP training posts this year, which is a real boost to the numbers, but I recognise that they will take several years to be trained and to come through.

Although my hon. Friend speaks well about the pressure on whole-time equivalents, his local clinical commissioning group allows GP registrars to see patients, which boosts patient appointments and capacity in the local area. He will be pleased to note on housing—again, my constituency in the south-east has similar problems, where housing developments are in their thousands rather than their hundreds and spring up overnight with no consultation with the local GP, who then has to take those patients on—that I am meeting the Housing Minister, my right hon. Friend the Member for Pudsey (Stuart Andrew), this month to discuss the very issues my hon. Friend raises about primary care being a key feature during planning and when things such as section 106 and community infrastructure levy money is being allocated. As he rightly says, the health centres need to be built first before the housing.

[Richard Fuller]

I am delighted that the Minister is taking such an active interest in the impact of development on access to services. In my speech, I requested that, ahead of my meeting with the Secretary of State, the Department look back at that history in my constituency as a test case to see what could have been done differently and what might be done now. Will she commit to that being done ahead of my meeting with the Secretary of State?

[Maria Caulfield]

I am not sure when my hon. Friend’s meeting is—I think it is fairly soon.

[Richard Fuller]

July.

[Maria Caulfield]

It is in July. We can certainly look at that, because we need to look at the lessons learned if we are to make progress going forward. The Housing Minister is keen to address this problem, so it is good to look at what has not happened in the past that should have, so we can take that forward. I cannot commit 100% to that being ready for my hon. Friend’s meeting, but we can certainly look at it.

The final point was on the GP partner model and support for GPs in their role and in some of the challenges they face, whether that is taking on premises or taking on liability. There is definitely a trend where partnership numbers are going down, but salaried GP numbers are going up. That is because younger GPs coming forward often do not want to take on the responsibility of being a partner and everything that entails, but partners feel that being bought into the practice gives them a huge amount of additional investment in terms of time and finance, as well as guidance, development and support for patients.

The Secretary of State has instigated the Fuller review—that is not my hon. Friend, obviously, but a GP—around the future models of GP practice, and whether that is partnership or salaried or whether there are different models available. We will take a good look at those recommendations because there may not be a one-size-fits-all solution. Some partners have a definite view of where they want to go; others are struggling and need support and help. I do not think it will be that one size fits all, but the Fuller review will certainly make some strong recommendations.

I hope in the short time we have had that I have been able to acknowledge the main challenges my hon. Friend’s constituents and GPs are facing and have outlined some of the measures we are taking to support primary care and enable patients to see their GPs more quickly and easily, whether that is virtually or face to face.

Question put and agreed to.

Draft Pharmacy (Preparation and Dispensing Errors - Hospital and Other Pharmacy Services) Order 2022 Draft Pharmacy (Responsible Pharmacists, Superintendent Pharmacists etc.) Order 2022

Maria Caulfield Excerpts

Monday 6th June 2022 General Committees

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

I beg to move,

That the Committee has considered the draft Pharmacy (Preparation and Dispensing Errors – Hospital and Other Pharmacy Services) Order 2022.

[The Chair]

With this it will be convenient to consider the draft Pharmacy (Responsible Pharmacists, Superintendent Pharmacists etc.) Order 2022.

[Maria Caulfield]

It is a pleasure to serve under your chairmanship, Mr Sharma.

The draft order, which was laid before Parliament on 28 April, extends across the United Kingdom. Both orders have been in development for a long time under the auspices of the rebalancing medicines legislation and pharmacy regulation programme board, membership of which includes representatives of the pharmacy sector, and professional and regulatory bodies from across the United Kingdom. The draft orders have benefited from full scrutiny by those experts, and they have been welcomed by pharmacy professionals working in hospitals and relevant pharmacy services. They also have the support of the four chief pharmaceutical officers of the United Kingdom.

During the covid pandemic, as I think hon. Members will agree, community pharmacies proved once again that they sit at the centre of our communities. They are a vital first port of call for healthcare advice. The Government want community pharmacy to deliver more patient-focused care. It is therefore right and proper to have a strong governance system to ensure that professionals and staff have clear frameworks within which to deliver the care they give to patients, and are enabled to have the roles, responsibilities and ability to deliver safe patient care.

The draft Pharmacy (Preparation and Dispensing Errors – Hospital and Other Pharmacy Services) Order is the next stage in our work to improve patient safety in pharmacy. About 52 million items a year are dispensed in secondary care, which covers hospitals and other settings. Despite the incredible work of our pharmacy teams, errors happen, but we estimate that only about 5% of the errors in secondary care are reported. In our efforts to create a culture of safety and a duty of candour when mistakes are made, the draft order aims to improve the statistic by reducing fear of prosecution and by incentivising reporting and learning from errors. We want the NHS to be a place of learning, and the order is key to improve patient safety, which should always be our goal.

The purpose of the draft order is to extend the defences already available to pharmacy workers in the community pharmacy setting under the Pharmacy (Preparation and Dispensing Errors – Registered Pharmacies) Order 2018. The draft order will ensure that registered pharmacy professionals who work in hospital and other settings such as prisons and care homes will have the same access to defences that community pharmacists have currently. It will provide them with access in defined circumstances to the defences against criminal offences set out in sections 63 and 64 of the Medicines Act 1968, which concern the standards of medicinal products and the sale of any medicinal product that is not of the nature or quality demanded by the purchaser. The order will make these defences available in defined circumstances and, importantly, will incentivise the reporting of errors when pharmacy professionals make a genuine dispensing errors, and will inform learning to prevent such errors happening again.

One important aspect of the conditions of the defence is that a pharmacy service must have a chief pharmacist, or someone with the duties of that statutory role, who is responsible for the pharmacy services, ensuring that necessary governance is in place to provide assurance to patients. The pharmacy regulator will be given new powers to set the standards for the role of chief pharmacist, mirroring the role of superintendent pharmacist, which I will discuss in the context of the second draft order, so that the hospital and secondary care settings match those of community pharmacy. Last year, a survey by the Community Pharmacy Patients Safety Group found that following the changes, 95% of pharmacists said they now report errors to improve practice and 80% said they now learn from their mistakes. The survey also found that fear of prosecution as a reason not to report an error has dropped from 40% in 2016 to 18% last year. That is largely attributed to the change in the law in 2018. We therefore expect a similar drop in the fear of being prosecuted for pharmacy professionals in the secondary care setting covered by the draft order.

The role of the draft Pharmacy (Responsible Pharmacists, Superintendent Pharmacists etc.) Order 2022 is to define and clarify the core purpose of the responsible pharmacist, who is in charge of a pharmacy of a particular retail outlet on a day-to-day basis, and the superintendent pharmacist, who is the person responsible for setting policies across the whole retail pharmacy business. They are two clearly defined, separate roles. The draft order gives powers to the General Pharmaceutical Council and the Pharmaceutical Society of Northern Ireland to define in professional regulation how the purpose of these roles is fulfilled.

The regulators already have powers to set rules and standards around professional regulation, and it makes sense that pharmacy practice matters sit with the regulator rather than with Ministers, which is how things currently stand. That is already the case for the powers of the regulators of other healthcare professionals. We are putting in place a more flexible regulatory framework and the necessary systems to support and maximise the potential of the community pharmacy teams, and the skill mix within them to deliver more clinical services in the community and support the wider NHS capacity ideals.

The measures will apply across the United Kingdom and have been developed collaboratively with all four Health Departments across all four nations. I would like to draw hon. Members’ attention to two provisions specific to Northern Ireland, designed to better align Northern Ireland with Great Britain. At the request of the Department of Health in Northern Ireland and the Pharmaceutical Society of Northern Ireland, it is proposed to give the Department of Health in Northern Ireland the power to appoint a deputy registrar in respect of duties set out in the Pharmacy (Northern Ireland) Order 1976. The second change would be to extend the requirement that already exists for Great Britain that a superintendent pharmacist must inform the relevant pharmacy regulator when they stop holding the role in a pharmacy business in Northern Ireland. For Northern Ireland, that would be the Pharmaceutical Society of Northern Ireland.

I hope that I have outlined the two draft orders to Members, but I want to be transparent and clear that there was a consultation on them both in which there was general support for them, but also some concerns that I want to address. The first was about distrust of the regulator and giving more power to the regulator. I want to reassure colleagues that although powers are given to the regulator to outline the roles of the responsible pharmacist and superintendent pharmacist, if the regulator wants to make changes to those roles, there would be a statutory consultation and the same negative resolution procedure in Parliament. There would be proper scrutiny and proper debate on any changes made. I want to reassure Members that we are not just handing powers to the regulator; there will be proper scrutiny in place for any changes they want to make.

The second concern was about the impact of the measures on the supervision of the dispensing of medicines in retail pharmacy. I want to emphasise that the draft orders do not affect the legislation that governs the supervision, preparation, sale and supply of prescription-only medicines, including the legal requirement for a pharmacy to supervise the dispensing of prescription-only medicine. That concern came out of the consultation, but I want to reassure Members that that is not the case. Thirdly, there was concern about superintendent pharmacists being in charge of more than one business, but it is and still will be the case that every pharmacy must have a superintendent pharmacist who has a statutory duty in respect of safe and effective running of retail pharmacy businesses. That will not change following the orders. If the regulatory bodies wanted to change that in future, a statutory consultation and full scrutiny from Parliament would take place.

On the final concern about responsible pharmacists being in charge of more than one pharmacy at any one time, as a Minister I can already set out an exception to that in regulations, but that power has never been used to date. Today’s proposal does not change that but simply transfers the exception-making powers from Ministers to pharmacy regulators. Again, a statutory consultation and full parliamentary scrutiny would have to take place in order for pharmacy regulators to change those powers.

I hope the Committee will support these reforms so that we can put in place a strengthened and more flexible framework of organisational governance for registered pharmacies. The order will also support improved patient safety by reinforcing the professional duty of candour, encouraging a culture of candid and fulsome contributions from those involved when things go wrong, and creating an environment where people are not afraid to come forward when they have made a mistake, so that they are able to learn from those mistakes and prevent them from happening again in the future.

Should these orders be approved, I look forward to working with the regulators, setting out their programme of work to support these orders under the powers afforded to them and further scrutiny by both Houses.

--- Later in debate ---

[Maria Caulfield]

I thank Opposition Members for their support for both orders. I will touch on a couple of points that the shadow Minister, the hon. Member for Enfield North, raised. I want to reassure her that although the orders will make it easier for pharmacy teams to report mistakes in secondary care settings, there will still be offences retained when there is a deliberate disregard for patient safety, but she is right: if we are to improve patient safety, we need to foster a culture of openness, transparency and learning from mistakes. I am happy to write to her with the defences against prosecution. The regulator will take the work forward and we will have that detail shortly once they start work, after we have passed the orders.

I can reassure the hon. Lady that when we changed the law for community pharmacists in 2018, they felt more confident, as I set out in my speech, in reporting mistakes, and we hope that will be replicated in the secondary care setting following these orders. We have also passed separate legislation on the duty of candour across the NHS so that if a mistake is made in in any NHS organisation by a pharmacist, a doctor or a nurse, patients should be notified as soon as the mistake is discovered, told about the implications of it, and then about the process to resolve it. There is a statutory duty of candour across the NHS, and today’s order builds on that.

In answer to the hon. Member for Coatbridge, Chryston and Bellshill, I am pleased that we have been able to work with all four nations across the United Kingdom, who all support the measures. I hope that passing these orders and giving greater transparency to any mistakes that happen will build on the work that his Ministers in Scotland are doing. I put my hands up—I am a huge fan of the Pharmacy First model. We are working hard to try to replicate some of that in England. The hon. Gentleman is right that the pandemic has highlighted the experience, qualifications and vast wealth of knowledge of our pharmacists. They are held in high regard and I am glad that we are able to support them in the work that they do. Putting politics aside, I absolutely recognise the work on the Pharmacy First model in Scotland.

I am glad we have agreement on both of the orders.

Question put and agreed to.

DRAFT PHARMACY (RESPONSIBLE PHARMACISTS, SUPERINTENDENT PHARMACISTS ETC.) ORDER 2022

Resolved,

That the Committee has considered the draft Pharmacy (Responsible Pharmacists, Superintendent Pharmacists etc.) Order 2022.—(Maria Caulfield.)

North East Ambulance Service

Maria Caulfield Excerpts

Monday 23rd May 2022 Commons Chamber

[Wes Streeting (Ilford North) (Lab)]

(Urgent Question): To ask the Secretary of State for Health and Social Care if he will make a statement on the North East Ambulance Service and if he will launch an investigation.

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

Can I start by saying how horrified I was to read the concerns raised about the North East Ambulance Service in reports over the weekend? My thoughts are first and foremost with the families affected by the tragic events described. I cannot imagine the distress they are going through. It is hard enough to lose a loved one suddenly, but to have fears that mistakes were made that could have made a difference, and more than that, that the facts of what happened were not revealed in every case, goes further. They have my unreserved sympathy and support.

In healthcare, a willingness to learn from mistakes can be the difference between life and death, and it is because of this that, as a Government, we place such a high value on a culture of openness and a commitment to learning across the NHS. That is why the allegations raised by The Sunday Times this weekend are so concerning. As was made abundantly clear by the Secretary of State’s predecessor almost a decade ago, non-disclosure agreements have no place in the NHS and reputation management is never more important than patient safety.

The Government are wholly supportive of the right of staff working in the NHS to raise their concerns. Speaking up is vital for ensuring that patient safety, and quality of services, improve, and it should be a routine part of the business of the NHS. That is why, over the last decade, substantial measures have been introduced to the NHS to reduce patient harm and improve the response to harmed patients, including legal protections for whistleblowers, the statutory duty of candour, the establishment of the Health Services Safety Investigations Body and the introduction of medical examiners. It is also why, in response to a recommendation of the Sir Robert Francis “Freedom to speak up” review in 2015, the Government established an independent national guardian to help to drive positive cultural change across the NHS so that speaking up becomes business as usual. However, when it comes to patient safety, we cannot afford to be complacent. It remains a top priority for the Government and we continue to place enormous emphasis on making our NHS as safe as possible.

I note the concerns raised in this weekend’s reports. They have been subject to a thorough review at trust level, including through an external investigation, and the trust’s coronial reporting is subject to ongoing independent external audit and quarterly review by an executive director. I also note that the Care Quality Commission has been closely involved. However, given the seriousness of the claims reported over the weekend, we will of course be investigating more thoroughly and will not hesitate to take any action necessary and appropriate to protect patients.

The Government are also committed to supporting the ambulance service to manage the pressures it is facing. We have made significant investments in the ambulance workforce, with the number of NHS ambulance and support staff increasing by 38% since 2010. Health Education England has mandated a target to train 3,000 paramedic graduates nationally per annum from 2021, further increasing the domestic paramedic workforce to meet future demands on the service, while 999 call handlers have been boosted to over 2,400, so we are very serious about improving resources for the service.

I fully appreciate the concerns of right hon. and hon. Members across this House, and we will be pleased to meet any who have constituents affected by the reports this weekend so we can look at the issue more fully.

[Mr Speaker]

Can I just say that it is three minutes—and that means three minutes, not three minutes and 40 seconds —and I am sure whoever writes these speeches can actually time them through? I say to those on both Front Benches that we have to think about Back Benchers, who need to get their hospitals mentioned and their ambulance trusts as well.

I call the shadow Secretary of State, who I am sure will stick to the allocated time.

[Wes Streeting]

I pay tribute to the courage of the whistleblowers, as well as The Sunday Times journalists David Collins, Hannah Al-Othman and Shaun Lintern, without whom none of this would have come to light. But with respect to the Minister, it should not have taken an urgent question to bring her to the House today. On what she said about the Department further investigating, what form will this investigation take, who will be involved and what assurance can she give the families that there will be both answers and accountability, which is what they deserve?

Peter Coates died after an ambulance did not reach him in time. An ambulance two minutes away could not be dispatched because the station door was faulty, and staff did not know about the manual override. The ambulance that was dispatched decided to stop at a service station, even though it had sufficient fuel. Information about these errors was then withheld by the service, statements were changed and staff were asked to withhold the mistakes from the coroner. Peter Coates’ family learned the full truth only when contacted by reporters last week. His is just one of what is thought to be 90 cases involving gross negligence, cover-ups and tens of thousands of pounds of taxpayers’ money offered in exchange for staff silence.

The Minister mentioned the CQC. Why did it fail to spot this, rating the service “good” in 2018? Why did it fail to spot the situation even after being tipped off in 2020? Why is taxpayers’ money still being offered to buy the silence of staff when non-disclosure agreements were supposedly banned in 2014? What role did under-resourcing and understaffing play in this scandal?

Record ambulance waits exist in every part of the country, with heart attack and stroke victims waiting longer than an hour for an ambulance. As for the North East Ambulance Service, it is advising the public to phone a friend or call a cab rather than wait, while presiding over gross negligence, cover-ups and taxpayer-funded gagging orders on staff. That is the record on its watch. It is a national disgrace. What are the Government doing about it?

[Maria Caulfield]

We take the patient safety element of this extremely seriously. To answer the hon. Gentleman’s questions on who we will be meeting, I am happy to meet all the families affected to hear their concerns and the actions that they want taken. We met with the CQC this morning on this specific example, but we will be meeting with the ambulance trust. I also want to meet the coroner, and we want to hear from the whistleblowers. I am very happy to meet any member of staff who wants to raise concerns so that we can get to the bottom of exactly what has happened.

This Government introduced the duty of candour. Mistakes will always happen, no matter how much money is put into the health service or how many staff it has, but when a mistake does happen the hospital trust or ambulance trust should be open and up front about it, start a proper investigation, and learn the lessons so that it never happens again.

[Mr Speaker]

I call the Chair of the Health and Social Care Committee.

[Jeremy Hunt (South West Surrey) (Con)]

I thank the Minister, who is a practising nurse, for her profound commitment to patient safety. What happened to Peter Coates, Quinn Evie Beadle and others was a terrible tragedy for them and their families. No doubt the paramedics made mistakes, but everyone makes mistakes in the course of their work. What is unforgivable is the cover-up by the North East Ambulance Service, and the fact that we made the families go through such hell to get to the truth.

At the heart of this is that we still make it far too difficult for everyone involved in such cases to distinguish between ordinary human error and gross negligence, with the result that the organisations responsible for people’s care default to a defensive, covering-up position. Will the Minister take this up with the Ministry of Justice to ensure much clearer delineation between the ordinary human errors that we all make and gross negligence, which is never forgivable?

[Maria Caulfield]

I thank my right hon. Friend for making those points. Several safety measures were started when he was Secretary of State for Health, including the duty of candour. There is supposed to be a culture in place where, if mistakes happen, the health service is open and honest about that. The Healthcare Safety Investigation Branch was introduced. There is independent investigation. Anyone can report concerns to that body and an investigation will take place. There is the early notification system in maternity, where if mistakes or incidents happen the process is first and foremost to say that to relatives and family and to start a lessons-learned process. The patient safety commissioner is to be appointed shortly. We are doing everything we can not just to improve patient safety, but to improve openness and learning within the system to change the culture within the NHS.

[Ian Lavery (Wansbeck) (Lab)]

The North East Ambulance Service has been dysfunctional for years—before covid, during covid, since covid. Elderly women and men are still lying on the pavement with broken bones waiting to receive attention. Pregnant women and people suffering from acute problems such as heart attacks and strokes are still being asked to call a cab to get to hospital. It is not good enough. When this investigation starts, will MPs in the region be allowed to participate? We all have numerous tragic cases that we would like to discuss.

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[Maria Caulfield]

As I said in my opening remarks, I am happy to meet the affected MPs. It is important that we hear from everyone, whether that is the family and friends of those affected, staff who have concerns or MPs who hear from their constituents first hand, but may I just say that the staff in the North East Ambulance Service are working hard? In the past year, they responded in less than 15 minutes to more than 28,000 serious and life-threatening incidents. Mistakes can happen, and it is important to learn from them, but we should place on record our thanks for all the hard work they do on a daily basis.

[Dehenna Davison (Bishop Auckland) (Con)]

At a surgery earlier this month, Mr Mitchell, a retired paramedic, told me about how his wife suffered a cardiac arrest. He called an ambulance and was told that there would be a wait for that ambulance. After 20 agonising minutes, and knowing the importance of timely care, he drove his wife down to a local defibrillator and administered care himself. Ninety minutes after his call, five ambulances arrived on the scene. His wife, sadly, lost her life. That is just one case brought to my attention that outlines the absolutely shocking record of the North East Ambulance Service. Will my hon. Friend give me, Mr Mitchell and all our affected constituents her assurance that the Department will investigate NEAS’s failures fully and rapidly to ensure that no more lives are needlessly lost?

[Maria Caulfield]

I have heard of the sad incident affecting Mr Mitchell. Incidents such as that are exactly what we need to learn from. It is not acceptable for five ambulances to arrive on the scene after 90 minutes. We need a learning culture and system where staff can flag such concerns and learn from them, with systems put in place so that these incidents do not happen again, but my concern is that I am not confident that that is happening at the moment. I am happy to meet my hon. Friend and other local MPs to discuss what more needs to be done.

[Julie Elliott (Sunderland Central) (Lab)]

I am not reassured by the Minister’s response. She talks about substantial measures, but substantial measures have not worked. She talks about the CQC, but it has been involved, it did not find the errors and it has not apologised for the mistakes. I would like the Minister to add the trade unions—the GMB and Unison in particular, who represent the majority of NEAS staff—to the list of people she will talk to. NEAS has been making mistakes for decades and nothing seems to be done about it. She needs to get a grip of it for the people of the north-east.

[Maria Caulfield]

I am absolutely happy to meet anyone who wants to discuss concerns, but there are routes. We introduced the whistleblowing policy so that, at any stage, those staff and their unions can raise concerns and instigate investigations with the Healthcare Safety Investigation Branch, with those investigations looking at a service as a whole. I am happy to take any concerns forward and meet any group who wants to discuss them with me.

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

My constituents have been horrified to see and read about what has been going on in their local ambulance services. They have a right to know what has been happening, and bereaved families in my constituency and those of my neighbours really have a right to know. It is also crucial to know that so that we can get to the bottom of it and prevent it from ever happening again. Will the Minister ensure that her Department acts rapidly on this? Will she also reiterate that NDAs have no place in our NHS, because they go to the heart of preventing the positive change and learning from mistakes that we need to see?

[Maria Caulfield]

I can reassure my hon. Friend that I have already had an initial meeting with the CQC and the trust this morning and that I will instigate further meetings after today. On NDAs, a previous Health Secretary made a move to outlaw them, and I will speak to the Secretary of State about whether we need to go further, because I am concerned that we cannot have a culture of learning and disclosure while NDAs may be in place.

[Andy McDonald (Middlesbrough) (Lab)]

This cover-up totally stinks. It will stink to the family of a gentleman who tragically died while waiting for an ambulance which, unbeknown to the family, had been dispatched to Middlesbrough from Bishop Auckland, around 25 miles and 40 minutes away. If the family had been allowed to know how long the ambulance would take to get there, they would indeed have tried to save his life by driving him to the hospital less than 3 miles away. The people of Middlesbrough and the north-east are entitled to the security of knowing that an ambulance will get to them promptly in the event of an emergency. Will the Minister guarantee that?

[Maria Caulfield]

I would like to hear more from the hon. Gentleman about his constituent’s case. I have concerns about what was reported in The Sunday Times. I am concerned that the process followed in investigating those concerns has not got to the bottom of some of the fundamental problems, so if he would like to meet me afterwards I would be very happy to take it further.

[Dr Julian Lewis (New Forest East) (Con)]

When senior managers and administrators are found to be directly involved in gross negligence and deliberate cover-ups, will they lose their jobs or will they be allowed to continue?

[Maria Caulfield]

A statutory duty of candour is in place. As I said, if a mistake happens—mistakes can always happen, even with the best prevention methods in the world—there is a statutory duty to reveal it to the family and the patient involved, and to have a full investigation and learn lessons from it. I am concerned that that may not have happened in this case.

[Liz Twist (Blaydon) (Lab)]

The reports in The Sunday Times yesterday on what has happened with the North East Ambulance Service and the cover-ups were truly shocking. My thoughts, and I am sure those of everyone, are with the families who have found out information that had previously been covered up. The Minister talks about the steps the Government have taken to ensure that whistleblowers can come forward, but clearly something has not worked. Equally, the CQC also missed it. What more steps will the Government take to pursue the investigation to ensure that this simply cannot happen again?

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[Maria Caulfield]

The hon. Lady is quite right that the reports in the newspaper this weekend were absolutely shocking. The cases highlighted were not about ambulances not attending, but about mistakes that happened at the scene. What is more concerning is that those facts were not necessarily shared with the coroner and that families were not told either. That is more concerning to me than the actual events, because when there is a suspicion that the facts are not known, it prompts fears about what else is not known. I therefore take that extremely seriously and will be following up later today, and with the Secretary of State, to see what steps we need to take to reassure families further.

[Mr Mark Francois (Rayleigh and Wickford) (Con)]

Some of us who have been here for a while can recall that we desperately tried to warn the last Labour Government that big was not always beautiful and that regionalising the ambulance services would not work well because they were too large and too remote. Nevertheless, they pressed on. But we are where we are. The East of England Ambulance Service has some very deep-seated problems, despite the best efforts of the paramedics, although thankfully not quite as horrendous as this case. Will the Minister, when she has a moment, announce a review into the operation of all regional ambulance trusts to improve their performance across the whole country? If that cannot be done, can they be broken up into smaller, more effective units? The current system is not working.

[Maria Caulfield]

I hear my right hon. Friend’s concerns. I am happy to look at his concerns for his own particular ambulance service and discuss them further.

[Alex Cunningham (Stockton North) (Lab)]

The Government have again failed the north-east. The failures of the North East Ambulance Service could fill a book and there is no doubt that there cannot be a north-east MP who has not had complaints about poor response times and lack of care. It is also evident that NEAS is now highly reliant on crews from other organisations, something I was told years ago would be phased out of the service as it grew its own paramedics. The latest revelations show the service is far from fit for purpose and we can no longer sit back. Will the Minister order not just an inquiry but a root and branch review of NEAS and get it sorted?

[Maria Caulfield]

In my role as patient safety Minister, I am happy to look at any patient safety concerns. The Minister for Health, my hon. Friend the Member for Charnwood (Edward Argar), who is responsible for ambulances, has heard the hon. Member’s request.

[Robert Halfon (Harlow) (Con)]

Further to the question from my right hon. Friend the Member for Rayleigh and Wickford (Mr Francois), the Minister will be aware that there have been significant problems in the East of England Ambulance Service over a number of years. He is absolutely right that the ambulance service regions are too big, so will the Minister consider making the ambulance service in the eastern region much smaller and creating an Essex ambulance service, so that it is better able to provide the services that people in Essex and my constituency need?

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[Maria Caulfield]

As I said to the hon. Member for Stockton North (Alex Cunningham), I am happy, as the Minister for patient safety, to meet to discuss any safety concerns and issues following the review of the cases that we have heard about today. As for wider ambulance reforms, the Minister for Health is here and he has heard that request.

[Grahame Morris (Easington) (Lab)]

Notwithstanding the appalling and heartbreaking cases that were highlighted in The Sunday Times and, indeed, The Northern Echo, including that of my constituent, Quinn Beadle, the Minister implied in her response that processes had been put in place to ensure that these things do not happen again. Does she want to take this opportunity to apologise to my constituents, Mr and Mrs Brocklehurst, for an incident that happened this year? Mrs Brocklehurst fell in her driveway, sustaining severe injuries, including five broken ribs, a collapsed lung, two crushed discs in her spine and other damage. It took the North East Ambulance Service three hours and 15 minutes to arrive. She experienced systemic failures throughout her experience, from a call handler advising her to place a bag of frozen peas on her broken back, to a trainee and two other paramedics wanting to lift her, before administering six syringes of morphine and placing her on a board without a neck brace. At the hospital, Mrs Brocklehurst was queued by the trust, in agony, for six hours before being treated. It is a disgrace, Minister.

[Maria Caulfield]

I am very sorry to hear that and I apologise to Mrs Brocklehurst. That is not an acceptable event to have happened, and I can only imagine the pain that she was going through. I am very happy to meet him and his constituent to discuss that further because, obviously, that wait should not have happened.

[Duncan Baker (North Norfolk) (Con)]

I have tirelessly raised the issue of North Norfolk ambulance response times over and over again in this place, and there is absolutely no sign of them improving. Wells-next-the-Sea has the record of the worst response times in the entire country, which, given the elderly demographic and high number of tourists there, is not good enough. I am trying to be practical: why can the Government not fund a national programme and recruitment drive of community first responders to really help and assist our paramedics, who are completely beleaguered? Will the Minister please take that away as a serious consideration, because we cannot keep going on as we are?

[Maria Caulfield]

First responders do have an important role but they are not a substitute for paramedics. We have 3,000 paramedic graduates trained nationally per annum and we have increased our ambulance and support staff by 38%, so we are making that investment in the ambulance service.

[Helen Morgan (North Shropshire) (LD)]

I have been struck by the similarities between this case and the failings in maternity care at the Shrewsbury and Telford Hospital NHS Trust that were in part due to a toxic management culture—as outlined by Donna Ockenden earlier this year—in which staff were afraid to raise concerns. Given the similarities, will the Minister commit to ensuring that we have a system where staff can whistleblow to an independent organisation and where they feel safe to admit that they have made a mistake?

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[Maria Caulfield]

The hon. Lady shares my concerns about what underpins all these issues. From Mid Staffs to the Ockenden review, the fundamental issues in events that have happened under a number of Governments have been about covering up facts and about staff not feeling confident or safe in speaking out. There is a HSIB mechanism whereby staff can refer a matter directly for investigation, and we have introduced the national guardian to support staff in speaking out, but it is clear that more needs to be done.

[Mohammad Yasin (Bedford) (Lab)]

A whistleblower working for the East of England Ambulance Service NHS Trust said this month that the service is on the verge of collapse. Patient safety, ambulance waiting times, inadequate pay, burnout and understaffing issues were highlighted as areas of concern after the publication of the trust’s staff survey report last month. The Minister has spoken a lot today about mistakes. Does she agree that failing to back stronger provisions on workforce planning in the Health and Care Act 2022 will prove to have been a massive mistake?

[Maria Caulfield]

I can reassure the hon. Gentleman that NHS England is doing work on workforce planning, which is crucial to ensuring that we have not just the right number of staff, but the right skills mix. I can also reassure him that performance in the ambulance service nationally has improved from March to April.

The ambulance service has been working under severe stress during the pandemic and in dealing with the ensuing backlog. We need to be mindful that although these are tragic events, the vast majority of ambulance staff are working extremely hard and caring for patients.

[Graham Stringer (Blackley and Broughton) (Lab)]

This is an appalling scandal and tragedy. Unfortunately, it follows a whole series of events that everybody in this Chamber could name, from Morecambe Bay to Mid Staffs to Bristol. The Minister claims that the NHS is open and that it has a learning culture when genuine mistakes are made. That is good rhetoric, but I am afraid that it is not the reality. What will she do to make it a reality? Last week, The Economist estimated that 1% of all deaths in this country are down to mistakes in the NHS.

[Maria Caulfield]

As I have said to other hon. Members, mistakes are always going to happen; that is human nature. The difference is that we are trying to introduce a culture of openness and learning in the NHS so that staff feel confident in coming forward, and so that when a mistake does happen, lessons are learned to prevent it from happening again.

Let us look at the record of this Government. It is this Government who are introducing a commissioner to oversee patient safety across the NHS. It is this Government who have introduced a statutory duty of candour so that when mistakes happen, patients and their families are notified and the process of learning starts. It is this Government who have introduced an early notification system specific to maternity—

[Wes Streeting]

It is not working.

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[Maria Caulfield]

It is working. Neonatal deaths and stillbirths have reduced by 25%, so the systems are working. When they do not, we need to investigate and find out why.

[Chris Bryant (Rhondda) (Lab)]

It feels as if there is no sense of urgency. I introduced the Assaults on Emergency Workers (Offences) Act 2018 to protect emergency workers; I hope that it is working, but assaults on ambulance staff and paramedics are still increasing. No wonder so many of them are leaving. We need a radical overhaul to ensure that we recruit more staff into the NHS, including more paramedics, and that fewer of them leave because of burnout.

What I really do not understand is why the Minister is not announcing an investigation today. Apart from anything else, surely it is an offence to provide false information to a coroner. Should that not be investigated by the police?

[Maria Caulfield]

I reassure the hon. Gentleman that the police have investigated and that they did not find evidence of that. As I have said at the Dispatch Box, I will look into specific cases to be confident that no stone has been left unturned with respect to the allegations in The Sunday Times. There are measures in the Police, Crime, Sentencing and Courts Act 2022 that increase sentences for assaults on emergency workers, which we take extremely seriously.

[Daisy Cooper (St Albans) (LD)]

As far back as December last year, I wrote to the Secretary of State urging him to commission a CQC investigation of the crisis in our ambulance service, using his powers under the Health and Social Care Act 2008, because the CQC does not have powers to conduct thematic reviews itself. Since I wrote to him, we have seen scandal after scandal. In the north-east, people were told to phone a friend; in the west midlands, a patient waited more than 22 hours; in the south-west, stroke and heart attack victims are having to wait more than an hour; and in my own constituency, a cancer patient nearing the end of life had to wait almost 12 hours in agony for an ambulance to arrive. Surely it is time for the Government to stop sitting on their hands and to commission the CQC to launch a wide-ranging investigation of the crisis facing all our ambulance services.

[Maria Caulfield]

Let me reassure the hon. Lady. The CQC has been heavily involved in this case. I met representatives this morning to hear from them, and will be following that up. Moreover, an extra £55 million has been invested in the ambulance service nationally. We are aware of the pressures that the service is facing, and will do all that we can to support it.