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.

David Fuller Case: Independent Inquiry

Maria Caulfield Excerpts

Thursday 19th May 2022 Written Statements

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

Following earlier statements by Department of Health and Social Care Ministers, I would like to inform the House that the independent inquiry into the issues raised by the David Fuller case has today published a progress update on its work to date. This can be found at: https://fuller.independent-inquiry.uk/announcements/.

The progress update sets out the transition from a local, independent investigation initiated by the Maidstone and Tunbridge Wells NHS Trust to the current independent inquiry that the Secretary of State for Health and Social Care announced in November of last year. It describes how the work already undertaken as part of the independent investigation is feeding into the inquiry, as well as the important common themes that emerged from families and other interested parties which gave rise to amendments to the inquiry’s terms of reference. The independent inquiry published its final terms of reference on 23 February 2022.

Although the local investigation was constrained from taking evidence while the criminal prosecution of David Fuller was under way, Sir Jonathan Michael does set out some urgent, high-level themes and areas of concern arising from the investigation at the time in his progress update:

Responsibilities between NHS trusts and contractors/subcontractors

Security and access

Policies and procedures versus practice

Oversight of regulated activities

Management of areas and services not covered by regulation.

These themes had been shared with the trust in August 2021 and subsequently with NHS England and NHS Improvement. The trust has been putting its own steps in place regarding its mortuary practices ahead of the substantive, initial report of the inquiry. NHS England and NHS Improvement has continued to work with trusts to provide assurances against current guidance from the Human Tissue Authority (HTA), and on the additional measures that have been taken to improve the effectiveness of security in place for all their mortuaries and post-mortem activities.

The progress update makes clear that the first phase of the independent inquiry is firmly under way and describes the rapid progress that it has so far achieved. Also, from the inquiry’s engagement with witnesses so far, it has experienced a high degree of co-operation and expects this to continue. Both are testament to the hard work of Sir Jonathan and his team.

The progress update also sets out the next steps, including a revised timing for the initial report on matters relating to Maidstone and Tunbridge Wells NHS Trust. Due to the volume of evidence that is emerging, the initial report will now be available later this year. This will be followed by a final report next year, looking at the broader national picture and the wider lessons for the NHS and for other settings. While there is real urgency in understanding how Fuller was able to carry out his shocking and unlawful actions, and why these went unnoticed, the inquiry must be allowed the time it needs to fully consider all of the relevant evidence and assemble its findings. The inquiry continues to liaise with Kent police to ensure that if it identifies possible criminal conduct, this is referred swiftly for further investigation, in line with its terms of reference.

The HTA was asked by the Secretary of State to provide advice on its regulatory framework following the conclusion of the murder trial of David Fuller and the public revelation of his sexual offending against bodies in a hospital mortuary at Maidstone and Tunbridge Wells NHS Trust.

The HTA advice, received in December 2021, along with a short progress update, has been published today. Both can be found at:

https://www.hta.gov.uk/news/december-2021-advice-published

The HTA has focused on three areas since December 2021; preparation for the inquiry, working with stakeholders on licensed mortuary security, and starting the revision of HTA guidance for licensed mortuaries in the post mortem sector, with implementation planned later this year.

Further details are available on gov.uk via the following link.

https://www.gov.uk/government/news/the-fuller-inquiry-update-to-the-secretary-of-state-19-may-2022.

[HCWS41]

Parliamentary Written Questions 53263 and 53380: Correction

Maria Caulfield Excerpts

Thursday 28th April 2022 Written Statements

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

I would like to inform the House that written answers I gave on 18 and 21 October 2021 Official Report 53263 and 53380 to the hon. Member for Bootle (Peter Dowd) were incorrect.

In the response to the written questions, I said that radioligand therapy is not yet licensed for the National Health Service (NHS) and has yet to receive approval from the National Institute for Health and Care Excellence (NICE). That was incorrect. A licensed radioligand treatment, Lutetium (177Lu) oxodotreotide, has been recommended by NICE for treating unresectable or metastatic neuroendocrine tumours (NICE Technology appraisal guidance [TA539] Published: 29 August 2018). The NHS funds Lutetium in line with NICE’S recommendations and is treating the expected number of patients estimated by NICE:

https://www.nice.org.uk/Guidance/ta539/chapter/1-Recommendations

NICE is also now developing guidance on Lu vipivotide tetraxetan for treating PSMA-positive hormone-relapsed metastatic prostate cancer after two or more therapies and currently expects to publish final guidance on 23 November 2022. This technology was granted a positive early access to medicine scientific opinion in April 2022 and is currently available to NHS patients as an unlicensed treatment.

[HCWS800]

International Thalassaemia Day

Maria Caulfield Excerpts

Wednesday 27th April 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 Hosie.

I thank the hon. Member for Enfield, Southgate (Bambos Charalambous) for securing today’s debate so efficiently ahead of International Thalassaemia Day on 8 May—we may well be prorogued by then, so it is a timely debate. Let me take the opportunity to thank him for all his work to champion the community as chair of the all-party parliamentary group for thalassaemia. I understand that the UK Thalassaemia Society is based in his constituency, and I am sure it is thankful for all his help and support.

Like sickle cell—I note the right hon. Member for Wolverhampton South East (Mr McFadden) is here—thalassaemia is a blood disorder that affects ethnic minority communities in the UK. It is right that the hon. Member for Enfield, Southgate raises the inequalities and inconsistencies around services that people with thalassaemia face. We are determined to address some of the long-standing issues in many areas.

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[Stewart Hosie (in the Chair)]

We now resume the suspended debate. I call the Minister.

[Maria Caulfield]

To go back to where we were, the Government are determined to address long-standing health disparities, particularly for those with thalassaemia. The NHS Race and Health Observatory was established just over a year ago with a remit to tackle some of the issues that minority communities face, particularly in health inequalities. Last year, the Government launched the Office for Health Improvement and Disparities, or OHID, which is doing huge amounts of work in these areas.

Health features quite heavily in the levelling-up White Paper. We want to reduce the gap in life expectancy between the areas with the highest and lowest, and by 2035 we want life expectancy to have risen by five years. Tackling the issues raised is key to that, particularly for the groups most at risk. I am mindful that the right hon. Member for Wolverhampton South East raised the “No One’s Listening” report, which features issues that those with thalassaemia face—the lack of understanding of the condition among healthcare staff and the treatment that patients need to receive. Those receiving blood transfusions might look well compared with a typical patient receiving a blood transfusion, but a three-weekly blood transfusion for life is very difficult even if things go smoothly. I want to reassure the right hon. Gentleman that we are trying to improve the experience of those with thalassaemia in a number of areas.

In 2019, NHS England concluded the review of haemoglobinopathy services, which resulted in the development of the new model that we now have, based on haemoglobinopathy co-ordinating centres and the national panel. That brings specialist services together to improve the experience of those using the services, and addresses health inequalities and improves outcomes for those with haemoglobinopathies, which includes thalassaemia patients.

To touch on thalassaemia in particular, four specific centres, alongside 10 sickle cell centres, have been commissioned to provide clinical expertise. We hope that even if patients cannot access those, the experience and good practice will ripple out across the country and improve the service and experience for patients and improve standards of care.

One of the main treatments for thalassaemia is, as the hon. Member for Enfield, Southgate touched on, regular blood transfusions. We need people to donate blood, and I want to use this afternoon’s debate as an opportunity to encourage people to come forward not only to give blood but to think about stem-cell donation as well, which can be used as a treatment. Anyone interested can go on the Anthony Nolan website, which can register people and give them information about what is involved.

We also need to touch on the issue of training for healthcare staff. I am encouraged that the training curriculum for haematology set by the Joint Royal Colleges of Physicians Training Board has now included sickle cell and thalassaemia as core competencies, so we can make sure that healthcare professionals are informed. Even though these are rare diseases, they affect a significant proportion of people, particularly in certain communities.

In addition, Health Education England now provides two relevant e-learning healthcare programmes on the NHS screening programme, including sickle cell and thalassaemia and the maternity support work programme. That is important because of the breakthroughs we are making in screening everyone for both sickle cell and thalassaemia. All women should now be screened during pregnancy for thalassaemia, along with partners’ screening, and an affected pregnancy could be identified at the 12-week gestation period. That helps not just to prepare parents for their child, but to make sure that services are in place as soon as the child is born.

Nearly all sickle cell affected children born in England and the majority of thalassaemia babies will be identified by the NHS sickle cell and thalassemia screening programme, which will make a difference to the outcome for people. It will help us to co-ordinate and develop services to make sure that there is a better experience for patients going forward.

The hon. Gentleman raised the issue of treatment. I am keen to look at that because although blood transfusions are a treatment for some, ideally gene therapy is potentially curative for the affected population. I know there are ongoing issues with NICE approval for a number of drugs, and I am happy to meet him to discuss that further after this debate. I am really keen that, where we can make significant drug developments, which are available in other countries and not necessarily here, we make progress and discuss with NICE the issues that might be preventing approval or slowing down progress at the moment.

I want to also touch on some of the research being done, because that is the key to improving treatment outcomes for patients to make sure that their life chances and their experience in the health service are improved. There are a number of research studies going on. I am hopeful that we can improve their outcomes and make sure that access to research is available for patients, too.

The disease is rare; as the hon. Member for Enfield, Southgate pointed out, there is only a small group of patients. We are making sure we take part in international studies and speak to bodies such as NICE to say that, although there will only ever be a small number of patients, that should not deter approval for drugs because of the difference they may make overall.

I very much take the points made by the hon. Gentleman. Following on from the recent debate on sickle cell patients, which raised very similar issues, I suggest that I meet both him and the right hon. Member for Wolverhampton South East to see whether we can pin down some of those issues, particularly as the health disparities White Paper is coming forward shortly. It presents a good opportunity for the communities affected by both diseases to try to iron out some of those problems.

I thank the hon. Member for Enfield, Southgate for tabling today’s debate, as well as all the Members who are interested in this issue. We had a big turnout in the sickle cell debate a few weeks ago, where very similar points were made. I reassure colleagues that progress is being made, whether that is in screening, which will be a game-changer for patients; the gene therapy treatments that will come through online; or the general experience of patients being treated with dignity, respect and knowledge of their condition. I place on the record my thanks to all those working hard behind the scenes in specialist units to improve care for thalassaemia patients, and I look forward to working with the hon. Gentleman to see if we can make a difference for those patients.

Question put and agreed to.

Childhood Cancer Outcomes

Maria Caulfield Excerpts

Tuesday 26th April 2022 Commons Chamber

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

I start by congratulating my hon. Friend the Member for Gosport (Dame Caroline Dinenage) on securing this debate. We talk often about cancer in this place, whether at oral questions, in Westminster Hall or in Backbench Business debates, but rarely do we talk about childhood cancers. As we have heard today, it is crucial that we talk about them, and that we listen and learn from the experience of Sophie and the campaigns she started, which her family are continuing.

There have been many contributions, and I will list as many as I can. We heard from the right hon. Member for Alyn and Deeside (Mark Tami), who shared his son’s experience. My hon. Friend the Member for Scunthorpe (Holly Mumby-Croft) shared the experience of her constituent Laura, whose daughter Ebony was affected. The hon. Member for Airdrie and Shotts (Ms Qaisar) told Rayhan’s story. The hon. Member for Delyn (Rob Roberts) shared Jordan’s story. My hon. Friend the Member for North Cornwall (Scott Mann) contacted me ahead of the debate to talk about his constituent Talan. The hon. Member for North Antrim (Ian Paisley) mentioned Jake. The hon. Member for Coventry North West (Taiwo Owatemi) told us the story of Ben, who sadly died. My hon. Friend the Member for South Cambridgeshire (Anthony Browne) talked about Georgia. The hon. Member for East Renfrewshire (Kirsten Oswald) mentioned River and their experience.

My right hon. Friend the Member for Romsey and Southampton North (Caroline Nokes) told us George’s story. We heard about Ruby from the hon. Member for Dulwich and West Norwood (Helen Hayes) and about Alice, who is doing well, thankfully, from my hon. Friend the Member for Sevenoaks (Laura Trott). We heard about Elsa from the hon. Member for Leeds East (Richard Burgon) and Liam from my hon. Friend the Member for Tonbridge and Malling (Tom Tugendhat). My right hon. Friend the Member for Pudsey (Stuart Andrew) contacted me ahead of the debate to tell me about his constituent Catherine Beaumont and her nephew Oliver, who sadly died last year.

We heard from my hon. Friend the Member for Berwickshire, Roxburgh and Selkirk (John Lamont) about Julie. My hon. Friend the Member for Meon Valley (Mrs Drummond) told us about her own personal experience but also that of her constituent Alison’s son Jake. Finally, my hon. Friend the Member for North Norfolk (Duncan Baker) talked about Benny and my hon. Friend the Member for Hartlepool (Jill Mortimer) talked about Isabellah.

[Dean Russell (Watford) (Con)]

I think the common thread in all those stories was families who lost a loved one and still wanted to make a difference for families in future, the same as my constituent Laura MacQueen, who sadly had to endure the loss of her daughter Jess at the age of nine to a rare form of cancer. It was heartbreaking hearing her story, but what she is doing now is continuing to call for more investment and research into childhood cancers. I hope the Minister will hear that loud and clear.

[Maria Caulfield]

I think the names that we have read out this afternoon show that, while cancer in children only accounts for 1% of cancer cases, if you are in that 1%, it does not feel very rare at all. I thank all hon. and right hon. Members for sharing the stories of their constituents.

That means, as has been pointed out, that GPs will only see one or two cases of childhood cancer over the course of their career. These can be difficult cancers to spot because some of the symptoms reflect other illnesses and other conditions. NICE guidelines are trying to support GPs. The NG12 guidelines underpin cancer referrals. They set out detailed guidelines for GPs on the symptoms of cancer in children and recommend very urgent referrals that mean an appointment within 48 hours for children presenting with a wide range of potential cancer symptoms, from unexplained lumps to bruising or bleeding. The guidance also recognises the knowledge and insight that parents have, as it sets out that GPs should consider referrals for children where their parents are thinking that their child is not well or there is just something not quite right with them. That referral should happen when parents are concerned, even if the symptoms are most likely to have a benign cause.

[Mike Wood (Dudley South) (Con)]

Will the Minister give way?

[Maria Caulfield]

I will not, if my hon. Friend does not mind, because we do not have a huge amount of time.

NICE regularly reviews and updates these guidelines on suspected cancers. It urges GPs to think of cancers sooner and lower the referral threshold for tests, and ultimately catch cancer sooner, which does not always save lives but can make a difference if a cancer is diagnosed earlier.

To help GPs to identify signs and symptoms of these childhood cancers, online education programmes such as Gateway C are available, but also face-to-face education sessions have now resumed, including seminars offered by providers such as Cancer Research UK, and primary networks are establishing cancer clinical lead groups to share latest research and good practice.

The rarity of cancers in children, as the hon. Member for North Antrim pointed out, means that it is harder to diagnose outside a specialist setting, and many of the symptoms can mimic other illnesses. For example, diagnosing brain cancer in children is particularly challenging because it often presents in a similar way to epilepsy, and sarcoma symptoms can often start with limb pain, which is often a common complaint in children. It is therefore crucial that children up and down the country have access to specialist services in cancer care, which are not necessarily provided in most hospitals, where traditionally cancer services are arranged by cancer type. Children’s cancer services need to be contained in a small number of specialist units, which we refer to as principal treatment centres, or PTCs. Each child with a suspected cancer should be referred directly to a PTC, which will make the diagnosis and direct provision of treatment. In England, we have 14 of these centres. They manage care through the multi-disciplinary teams and drive diagnosis, treatment and, crucially, as we have heard from many Members, research participation.

As well as diagnosing the condition, the centres are expert in offering psychosocial support, helping children to continue their education and helping, as Sophie campaigned for, to provide specialist play facilities seven days a week. Sophie’s complaint was that those were only provided for five days a week. It is important that we hear from children and young people who receive a cancer diagnosis. I personally thank charities such as Young Lives vs Cancer and the Teenage Cancer Trust, which last year put together guidance for young people in England, Scotland, Wales and Northern Ireland discussing having a visitor and a hand to hold when having cancer treatment. That is useful guidance, and it has been distributed by the NHS to all our cancer alliances in England.

I will touch on the issues that Sophie in particular was campaigning on. Food was a big bugbear of hers. I think she described it as “disgusting” in some of the reports I read. We know that food is important for all patients, but particularly for children, because nutritious food is a way of aiding patients’ recovery. It is difficult in hospital. I know from my experience as a nurse that we always serve food at 7, 12 and 6, and if someone is hungry in between, it is often very difficult to get any food at all. We are working extremely hard to improve hospital food following the publication of the independent review in October 2020. The review made a suite of recommendations across several areas, including nutrition and hydration. The three-year plan, “Great Food, Good Health”, led by NHS England, is under way to implement the recommendations from that review. I hope that Sophie and her family will be pleased we are making some progress with that, because I fully recognise the complaints she made from her experience.

I will touch on research, because it came up so often in hon. and right hon. Members’ contributions. It is important that we improve not only treatment, but its side effects. We have heard from many Members that childhood cancers can have a very successful outcome in terms of survival, but often the impact of those treatments can have a lifelong effect for those with cancer and their families.

I reassure Members that research is taking place. Since 2019, the NHS has been offering whole genome sequencing to all children with cancer to enable more comprehensive and precise diagnosis and access to more personalised treatments that will reduce the number of young people experiencing long-term symptoms from their treatment. There has been a lot of progress on the treatment of childhood cancers, with the majority of children now surviving, but for certain childhood conditions, such as rhabdomyosarcoma, that is not yet the case. Research is crucial to how we deal with it in the long term.

The NIHR, which funds research across the board in the NHS, is funding childhood cancer research across its whole remit, from early translational research right through to clinical research and social care research. I am concerned by the case raised by my hon. Friend the Member for Scunthorpe of researchers in her constituency finding it difficult to access those funds and go through the application process. I am happy to meet her and the researchers to see whether we can unlock some of those jams.

There is support for research into rhabdomyosarcoma at the Royal Marsden biomedical research centre—I declare an interest, as I still work as a nurse at the Royal Marsden—the Royal Marsden clinical research facility and the Great Ormond Street biomedical research centre. We are making some great inroads in funding research into not only cancer treatments, but the effects of treatments.

There is so much more I would like to say to answer Members’ questions, but due to time I simply reassure my hon. Friend the Member for Gosport that the 10-year cancer strategy that the Secretary of State has just announced will tackle many of the issues she has raised. The call for evidence recently closed, but it is a great opportunity to put forward the case for childhood cancers, and I am happy to meet her after the debate to see whether we can push her case forward.

Oral Answers to Questions

Maria Caulfield Excerpts

Tuesday 19th April 2022 Commons Chamber

[Tom Hunt (Ipswich) (Con)]

3. What steps his Department is taking to tackle the backlog in NHS dentistry appointments.

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

The dental activity threshold has recently been raised to 95% of usual activity. That is another quarter-on-quarter increase to get us towards 100% of pre-pandemic activity. I fully recognise, though, that access to NHS dentistry before the pandemic was patchy and that the crux of the problem is the current NHS dental contract, so work is under way to reform that contract. As negotiations have started, I am limited in what further I can say, but I will update the House as soon as possible.

[Tom Hunt]

A number of my constituents are finding it impossible to access NHS dental care. They include Alison, one of my constituents who worked as a midwife in Ipswich Hospital for 40 years. Some of them have contacted 40 different practices and have not got anywhere. My understanding is that there has been a 30% drop in the number of dentists taking on NHS work in Suffolk. Will the Minister explain what local work is going on between the Department and the local NHS bodies to try to ensure that this issue is addressed?

[Maria Caulfield]

My hon. Friend is quite right in his question and is campaigning hard to increase dental activity in his constituency. One of the key pieces of work is being done through Health Education England, which set out a range of recommendations in its “Advancing Dental Care” review. That will do a number of things, such as increase the skill mix and scope of practitioners across dental teams, and we may well require legislation to bring some of that work forward. Health Education England is also introducing more flexible routes into dental training and doing some workforce modelling to identify the parts of the country with the biggest gaps in provision, so that we can establish centres of dental development in those areas. I will look at Ipswich in particular.

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

My constituent contacted me to tell me that when she broke her canine and went to contact her NHS dentist, she found she had been kicked off the list and was facing a bill of £4,000, which she simply does not have, to have the work done privately. Will the Minister speak to some of the dental practices about the possibility of relaxing their rules on kicking people off their dental lists, especially as covid has meant that patients might have had legitimate reasons for missing appointments?

[Maria Caulfield]

I am sorry to hear about the hon. Lady’s constituent’s experience. There is not actually a list system for dentists as there is for GPs, so patients can see any dentist when they have a dental issue. With that said, we have asked dental practices to update their availability for NHS patients on the website. This morning, I looked at the website to see what availability there was throughout the country and saw that many dentists still have not updated their availability, so I will ask officials—particularly in her constituency—to update the lists so that patients can access NHS dentistry more easily.

[Sir Peter Bottomley (Worthing West) (Con)]

I join the Minister in thanking dentists and their associates for getting so much of the service back. Does she agree that in places such as the Arun parts of my constituency, where people cannot find a dentist and have not been able to for two or three years, there must be a way for people to get on a dentist’s list and get treated, and for dentists to be properly rewarded? Dentists and patients would be grateful for a change in the contract.

[Maria Caulfield]

The Father of the House is quite right that the crux of the problem is that there is a shortage throughout the country not of dentists but of dentists taking on NHS work. The contract is the nub of the problem, which is why work is under way to reform it. We will shortly announce some short-term changes and some longer-term reforms, which will hopefully help my hon. Friend’s constituents.

[Jim Shannon (Strangford) (DUP)]

Bearing in mind that dentists are now determined to turn their practices wholly private as they cannot make ends meet with NHS prices, will the Minister pledge to review NHS payments to stop the haemorrhaging of NHS dentistry provision?

[Maria Caulfield]

The hon. Gentleman is correct that the units of dental activity payments are a perverse disincentive. Sometimes, when someone needs more extensive work, their dentist is paid the same as they would be for, say, one or two simple fillings. That is the nub of the problem and we are currently in negotiations on the matter.

[Mrs Maria Miller (Basingstoke) (Con)]

My hon. Friend the Minister is right to talk about the contracts with dentists, but should she not also look at how dentistry is structured and the regional nature of the contracting? It sits outside our clinical commissioning groups, which reduces co-ordination and accountability in respect of something that is central to our health. Should this not change?

[Maria Caulfield]

My right hon. Friend is right. Health Education England is addressing the overall system of where dentists are training and where the gaps in provision are filled in its “Advancing Dental Care” review. It is also working with commissioners at a local level to develop more opportunities in those places that we term dental deserts, where there is currently a lack of provision.

[Feryal Clark (Enfield North) (Lab)]

NHS dentistry is in crisis. Patients are stuck with either a never-ending wait for an NHS appointment or footing the bill for going private, which is simply not an option for most families suffering rising bills and taxes. With a third of the population experiencing untreated tooth decay, when will this Government, who have had 12 years to do so, finally come up with some practical solutions that put patients’ needs first, rather than the half-baked, unworkable ideas we have heard to date?

[Maria Caulfield]

I am sorry to the hear that tone from the hon. Lady. We are working under Labour’s 2006 dental contract, and she may have missed that dentists were unable to offer any routine care during the pandemic over the last two years, which we have slowly worked up to 95% of usual activity. She may want to play politics with this issue, but perhaps she should speak to her Labour colleagues who run the NHS in Wales, where 6% of dental posts were lost last year. She should get her own side in order before lecturing this side of the House.

[Steve Brine (Winchester) (Con)]

With the exception of the previous question, I do not think that anybody on either side of the House who has raised this issue is playing politics, because a pattern is emerging of a backlog and problems in accessing NHS dentistry. An increasing number of constituents are contacting me having gone to their NHS dentist with an acute dental problem only to be told either that NHS patients are no longer being seen or that they have fallen off the list, as the hon. Member for Kingston upon Hull West and Hessle (Emma Hardy) mentioned. How can Ministers help in the short term? I know the long-term answer is around the contract—I used to give that answer when I was in her seat—but will the Minister please meet me over a cup of tea so that we can try, as a starter for 10, get to the bottom of this?

[Maria Caulfield]

I thank my hon. Friend for his question. We have had many cross-party meetings with colleagues about dentistry, with many raising constituency issues that we have followed up. He could speak to his local commissioners, because there can sometimes be local problems with the commissioning of dental services. However, now that we are moving towards 95% of usual activity—a significant change compared with last year— I hope that his constituents will be able to access services more easily.

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

4. What recent assessment he has made of the adequacy of access to NHS ear irrigation and microsuction treatments.

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

Ear wax services are the responsibility of local commissioners, who are responsible for meeting local healthcare needs. Depending on a local area’s arrangements, services should be undertaken either at local primary care practices or through referrals to appropriate local NHS services.

[Steve McCabe]

Well, I obviously want to thank the Minister for that answer, but I was recently contacted by a constituent who complained that she was told by her GP surgery that such services were no longer available on the NHS and that she should consider obtaining them privately. This is happening despite recent studies that link the effect of impacted cerumen with cognitive decline and dementia. Will the Minister consider writing to clinical commissioning groups to remind them of their obligations and patient entitlements?

[Maria Caulfield]

I thank the hon. Gentleman for his question. There has been no national removal of ear wax services, which can still be commissioned locally. NICE guidance is clear on the types of services that should be commissioned. Traditional methods of manual ear syringing are no longer offered for safety reasons, but electronic irrigation and microsuction should be being offered. If his local CCG is not commissioning such services, I am happy to meet him and them to discuss why not.

[Andrew Selous (South West Bedfordshire) (Con)]

GPs provided the service for decades. We all understand why the NICE guidance means that they no longer offer syringing, but there is a gap in that many clinical commissioning groups are not offering alternative services. We are talking about people with dementia or receiving end-of-life care who literally cannot hear and are going deaf. The Minister must be direct with CCGs on this issue.

[Maria Caulfield]

My hon. Friend is right that there must be consistency across the country in how those procedures are commissioned. After today’s questions I will take this up with officials to see why that is not happening consistently across the country.

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

5. What steps his Department is taking to tackle regional health inequalities.

--- Later in debate ---

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

Cancer treatment and diagnosis remained a top priority throughout the pandemic, with 4.4 million urgent referrals during the period and over 1 million people receiving cancer treatment. Thanks to the brilliant work of our NHS staff, first treatments for cancer have been maintained at above 94% of usual levels over the course of the pandemic. However, we know that fewer people came forward, so we are now seeing record numbers of people coming through the system, with November last year having the highest number of 11,000 cancer referrals per working day.

[Mr Perkins]

I asked specifically about Derbyshire, but I did not get an answer. Derbyshire clinical commissioning group has failed to reach any of the cancer referral targets for the most recent 12 months. Although this is a national failure, the shortages are particularly acute in Derbyshire. These failures have tragic consequences. My constituent Paul Bryan is just 58. He has been attending his surgery for two years; he kept getting dismissed and was not tested, and now the prostate cancer that was undiagnosed for all that time has spread to his ribs, spine and bones, and his diagnosis is terminal. His family are urging the Government to show more urgency to improve outcomes, so that other families do not have to experience such needless heartbreak. Will the Minister explain to the Bryans why the Government rejected the workforce planning amendment to the Health and Care Bill that could have helped our NHS get the cancer specialists it needs and prevented heartbreak like the Bryans in other families?

[Maria Caulfield]

I am sorry to hear about the case of the Bryan family, but I reassure the hon. Gentleman that, in Derby and Derbyshire, 92% of treatments start within 30 days, despite record numbers of patients coming forward. To tackle the issue of getting people diagnosed earlier, which is key to getting more successful treatment, we are rolling out rapid diagnostic centres across the country so that people can access screening and testing much more quickly and easily. We have 159 of those live right now, with more to follow.

[David Simmonds (Ruislip, Northwood and Pinner) (Con)]

9. What steps he is taking to increase the delivery of personalised healthcare.

--- Later in debate ---

[Mr Speaker]

Come on; we have got to get others in.

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

I thank the hon. Lady for her question, and we have met to discuss this previously. I am happy to discuss with Health Education England whether one of its centres for dentist development could be suitable for her constituency.

[Mr Peter Bone (Wellingborough) (Con)]

T6. In 2019 Kettering General Hospital, which serves my constituency, was promised £46 million for a major upgrade. Three years later the hospital still has not got the money. Secretary of State, will you go out and buy a very big pair of scissors, cut through the red tape and get it sorted?

--- Later in debate ---

[Ruth Edwards (Rushcliffe) (Con)]

One of the best ways to maximise NHS capacity is to increase people’s access to GP appointments and treatments such as mental health services and physiotherapy in their own communities. Will the Minister join me in backing our bid for a new health centre in East Leake and in calling on Nottinghamshire’s clinical commissioning group to prioritise funds for this vital service?

[Maria Caulfield]

I thank my hon. Friend for her question. I had an excellent visit to the surgery in East Leake, and I look forward to the submission of the business case so that we can look at it further. She is right that investing in primary care does a huge amount to support the health of the local community.

[Helen Hayes (Dulwich and West Norwood) (Lab)]

T10. A survey by the charity stem4 has found that 95% of GPs believe that children and adolescent mental health services are in crisis, with children and young people waiting up to two years for treatment after referral. Will the Secretary of State stop treating children as an afterthought and act to provide open access mental health hubs for young people in every community, to put an end to these agonising waits?

--- Later in debate ---

[Simon Jupp (East Devon) (Con)]

At Prime Minister’s questions, I raised a local campaign for a specialist menopause clinic in Devon. I am pleased the Minister agreed to meet me. Will my hon. Friend encourage local NHS leaders to fund specialist menopause centres?

[Maria Caulfield]

The Government recognise that menopause services need to improve, which is why menopause is a priority area in our women’s health strategy. We recognise such services are often best provided in primary care, but that some women need specialist services. We are looking at that in our women’s health strategy and the menopause taskforce.

[Kate Osborne (Jarrow) (Lab)]

In December last year, the Department of Health and Social Care promised three urgent actions to tackle the gender health gap: the appointment of a women’s health ambassador; legislation to ban hymenoplasty; and the publication of the women’s health strategy for England in spring 2022. Can I ask the Minister when those vital actions are actually going to happen?

[Maria Caulfield]

I can let the hon. Lady know that interviews have taken place for a women’s health ambassador. We are expecting an announcement on the appointment any day now. We will be publishing the women’s health strategy in the coming weeks.

[Sir David Evennett (Bexleyheath and Crayford) (Con)]

I welcome all that my right hon. Friend is doing to address health inequalities. However, could I ask him to look carefully at public health funding for my borough of Bexley, as we are seriously underfunded compared with similar boroughs in London?

Special Schools Eye Care Service

Maria Caulfield Excerpts

Wednesday 30th March 2022 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Ms Bardell. I thank the hon. Member for Mitcham and Morden (Siobhain McDonagh) for securing this important and timely debate. As she said, I have visited Perseid in her constituency and seen its incredible work at first hand, as well as the work that SeeAbility does on assessing young people’s eyesight and supporting them with glasses and their bespoke needs, which are not always able to be supported on the high street—it can be difficult for parents and children to attend appointments elsewhere.

People with learning disabilities experience a higher prevalence of visual impairment than the general population. The hon. Lady said they are 28 times more likely to have a serious sight problem. More than 40% require the use of glasses. Very often, children with learning disabilities have specific issues on the fit of glasses. When children are able to get glasses that fit, teachers tell us of the difference in their behaviour, mood, anxiety and ability to learn. That difference makes it even more vital that this group have access to eye testing and services.

I reassure the hon. Lady that we are keen to ensure that eye testing is available for children with learning disabilities. NHS England and NHS Improvement are responsible for the contracting of the testing service to meet local need. All children under the age of 16, or 19 in full-time education, are entitled to free NHS sight tests on the high street, but I recognise that attending a high-street sight test is easier said than done for some children with learning disabilities. High-street services are available for some children with learning disabilities, and these services can meet many children’s needs. However, such children often do not like crowded, busy places and going into a high-street optician whom they do not know and where the environment is different from what they are used to can be quite difficult.

SeeAbility and other charities do a lot of work to support high-street opticians to make them aware of specific needs, including familiarisation visits, extended and split appointments, as well as adapting how the sight test, which can be very difficult for some children, is undertaken. Some children might need three or four visits just to put on a pair of glasses and have the eye test.

The hon. Lady mentioned the anxiety of her young constituent Ellie, and her mum, about going for a test. For many children who do not have a learning disability, going for an eye test is not an issue, but a learning disability or autism can mean additional challenges and I fully understand that.

A hospitalised service is also available. It can provide routine eye-care services and ongoing care but, again, there can be challenges with hospital visits. Departments are busy, often in out-patient settings, with multiple patients and healthcare professionals, and for children with learning disabilities, that is a difficult environment as well.

We therefore have the special schools proof-of-concept pilot. The hon. Lady is right that the long-term plan has made the commitment to ensure that children and young people with a learning disability, autism or both in residential schools have access to eye checks. It is important that that group of young people, too, have the facility to have their eyes tested and to have ongoing support and supervision with glasses or whatever treatment is recommended. That recognises that children and young people in special residential schools are likely to be placed a distance from home, so the option of a high-street optician or local hospitals is almost impossible. Having residential provision is a key part of the service that we want to make progress with.

To progress that long-term plan commitment, the proof-of-concept programme started pilots in residential and day schools in many parts of the country—London, the north-west, the north-east and Yorkshire. More than 93 special schools are participating in the programme, with more than 3,000 children having received an eye test, of whom more than 1,300 required and received glasses.

Sight testing in special residential schools means that children receive their eye care in a familiar place. I am sure that that the hon. Lady appreciates that the residential setting also needs the services that the day school in her constituency has received. We are able to share a child’s visual ability and needs between parents, children and teachers, and share how that is likely to develop and impact their learning. When children need glasses, they are provided free of charge, including a spare pair, so that children are not left without glasses should they break or lose them.

Fundamentally, it is right that we evaluate the proof-of-concept model, and the hon. Lady is right that that phase is coming to an end. In July, NHS England will review the proof-of-concept model, gathering information and feedback on the experience, looking at the effectiveness of the model in residential and day schools, and listening to the stakeholders, including providers such as SeeAbility, and the teachers and staff involved. The information will be looked at and further decisions about future roll-out considered.

The hon. Lady touched on the work of SeeAbility. I saw at first hand its extensive knowledge, and how that is used in practice with children who have difficult needs in addition to any eye problems, and its full understanding of how that fits together. Given the rapport that the people at SeeAbility have with the children, they can do checks on their eyes. Without that rapport and experience, checks would be difficult. I fully appreciate and thank SeeAbility for all its work in special schools, in particular in London.

[Siobhain McDonagh]

SeeAbility is very worried that, by raising this issue, it will be seen as just trying to keep its work. It wishes the Minister to be absolutely clear that its concern is for this invaluable service to remain in the special day schools that it already exists in, and for other children and young people to get the opportunity to have that life-changing service as well.

[Maria Caulfield]

I absolutely take on board the hon. Lady’s point. There is no impression at all that SeeAbility is touting for work. In fact, I would say the opposite: it demonstrated to me the value of its work and the value that similar organisations could provide if the services were rolled out to residential schools and other day schools.

I reassure the hon. Lady that NHS England will be evaluating the proof-of-concept programme when it comes to an end in July. I very much acknowledge her point that she wants to know how long that evaluation will take and what the process after will be. I am happy to tell her that I will speak to NHS England about that. It is not something that I, the Minister, will be deciding, and nor will I be looking at the evaluation. However, having seen it for myself and having heard the hon. Lady’s words today, I am conscious that there is some uncertainty about the future of the service. I think there is certainty for residential schools, but once July comes and NHS England starts the evaluation, I am happy to keep a close eye on that and to work with the hon. Lady so she has some certainty about what will be happening.

We have local commissioners as well as national commissioners. The Health and Care Bill will provide integrated care boards that will be able to commission local services. I am not sure if the hon. Lady has spoken to any of her local commissioners about what they envisage for eye testing in day schools, but I am happy to meet her to talk through the particular options in her constituency, to see if local commissioners are looking at this and to iron out some of her points about the proof-of-concept pilot coming to an end in July, the evaluation process going forward and potential options after that.

[Siobhain McDonagh]

The Minister will be aware that the problem with these services is that they are small and difficult to set up on a local basis. Given the pressure that the NHS is under to do big things and to commission work that large numbers of people need, this sort of specialist service gets left behind, except where an individual is personally committed to it. That does not happen everywhere, not because people are bad but simply because they have so much on. It is important that NHS England takes on this service as a whole and is committed to it as a whole. Will the Minister help me, and any other Members who are interested, to secure the opportunity to speak to NHS England?

[Maria Caulfield]

I take on board the hon. Lady’s point that NHS England is responsible for the roll-out of this programme and for the evaluation of the proof of concept. I am happy to organise a meeting with her and NHS officials to discuss this, so she has some certainty that she can take back to the parents and teachers at Perseid, who value this service very much. I am happy to do that because I am keen that the hon. Lady’s questions are answered and that she has some confidence.

I reassure the hon. Lady that the service I have seen is second to none, and I have seen the difference it makes. We are committed in the long-term plan to providing that service in residential schools, but I take her point that not all children have access to residential schools and they are not available in all parts of the country. Where day schools are available, the proof of concept model seems to have made a difference.

[Siobhain McDonagh]

The Minister is being generous with her time, but I am sure she understands why I am so passionate about this service. It is not just great quality for the children, but it helps the teachers there is an easier way of learning. A parent of a child with severe special needs has a huge number of appointments to attend, as well as the demands of other children and their work. Just getting their child into a high-street or hospital eye clinic is yet another problem that takes time, is difficult to do and causes a bit of mayhem when they get there. This scheme works for everybody: the children, the schools and the hard-pressed parents.

[Maria Caulfield]

I commend the hon. Lady for her campaign. She makes her points very well. Given that the proof of concept will be re-evaluated in July, a good way forward will be for us to meet with NHS England before then, to iron out some of her questions. I hope the hon. Lady is happy with that suggestion and, with that, I bring my remarks to a close.

Question put and agreed to.

Men’s Health Strategy

Maria Caulfield Excerpts

Tuesday 22nd March 2022 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Stringer. I thank my hon. Friend the Member for Don Valley (Nick Fletcher) for securing this important debate, which provides us with an opportunity to discuss the health issues that affect men across the country. Although I am passionate about tackling the health inequalities that women face, there is no doubt that men also face specific issues.

I thank my hon. Friend for his work as chair of the APPG on issues affecting men and boys. It does a huge amount of work in this area and its report, “The Case for a Men’s Health Strategy”, is compelling reading. I thank him and all the members of the APPG for their work on that. He has discussed with the Secretary of State for Health and Social Care the potential merits of a men’s health strategy, and further meetings are planned as part of an ongoing discussion.

I do not want to generalise and put people in different categories, but there is a difference in the way in which women and men access the healthcare system. More than 100,000 women replied to our call for evidence. They told us that they often access healthcare but feel that they are not listened to and that it is a challenge to get the services they want. Men, on the other hand, often do not access healthcare services at all, and that is a significant barrier. They do not come forward for a variety of reasons, and my hon. Friend touched on some of them, including ease of access to services and sometimes the attitudes of employers or colleagues on seeking help. There are different barriers that certainly make a difference. It is true that the average male life expectancy in the United Kingdom is below that of women, although women spend a greater proportion of their lives in ill health and disability.

We also know that male and female life expectancy differs depending on where they live. We are absolutely passionate about ending that. It should not matter where someone lives or where they come from. Everyone should have the same health outcomes. A man in Blackpool can expect to live over 10 years less than a man in Westminster. We will publish our health disparities White Paper later this year to seek to address the gaps in life expectancy for men and women. I am particularly keen that the issues my hon. Friend has raised today are looked at as part of the health disparities White Paper, because he has provided some stark statistics that absolutely need to be tackled if we are to improve outcomes for men in particular.

The Department is already taking action to address conditions that affect men in particular, including suicide, heart disease and cancer, and other risk factors such as smoking. Although I do not want to generalise, we know that some men are less likely than women to seek help or to talk about suicidal feelings, and they can be reluctant to engage with health and other support services. Men are around three times more likely to die from suicide than women, and suicide prevention requires co-ordinated action and a national focus on men’s low uptake of services to help with suicide prevention more broadly.

Over the coming year we will review the suicide prevention strategy for England and focus on high-risk groups, including middle-aged men. I encourage the APPG to take part and scrutinise that to make sure that it addresses the very important issues that my hon. Friend has raised. We are making funding available. Almost £5.5 million is available this financial year through a suicide prevention grant to support the voluntary sector in particular.

I was interested to hear about the work in Yorkshire. My hon. Friend is right that part of the failure of NHS services to reach out to men is that we often expect men to come to those services. Organisations such as Men’s Sheds, where services can be brought to men, are often more effective, so I very much take his point and it is something that we need to look at.

Heart disease is one of the leading causes of death in men. The long-term plan is committed to several key ambitions to improve outcomes for individuals with cardiovascular disease, including enhanced diagnostic support in the community. I hope that our community diagnostic centres will bring healthcare into communities so that men are able to go for tests, screening and appointments slightly more easily than at present. Our ambition is to prevent 150,000 heart attacks, strokes and dementia by 2029, and we hope that our initiatives will improve outcomes for men.

Although smoking rates have fallen consistently across the population, the rates for men remain consistently higher than those for women. Men, however, generally report more success when they attempt to stop smoking, but it is still the case that smoking rates are higher for men than for women. We are undertaking an independent review of our tobacco control policies, led by Javed Khan. The review will make a set of policy recommendations that will give us the best chance to reduce smoking and achieve the Government’s smoke-free 2030 ambition. Again, I encourage the APPG to look at that work and to feed into it.

Finally, I will touch on cancer, because we know that lung cancer outcomes in particular are poorer for men than for women. We are trying to target our diagnostic services towards high-risk groups. One of our most successful areas has been our targeted lung health checks, which took place in 23 locations last year, with a further 20 being rolled out this year. We are using low-dose CT scans and are targeting, in particular, individuals who have smoked for a long time, those in high-risk groups and those in high-risk areas of the country. We are seeing remarkable success rates, with lung cancer being identified at stages 1 and 2 when it would otherwise have taken months for those individuals to show symptoms. Those checks will seek to improve the lung cancer outcomes for men.

[Nick Fletcher]

I believe that a lot of smoking, obesity and alcohol problems stem from men being lonely. Many years ago, there was an advert that said that “You’re never alone” with a certain brand of cigarette I think that many men use those things as comforts and to pass the time. When men are feeling low, they might drink or go to the fridge. The men’s health strategy should look at that, and take an overarching view of all the issues, bringing them together. Clubs such as Andy’s Man Club are a fantastic place for men to talk and to feel valued and part of society, so that they do not feel lonely. When men do not feel lonely, perhaps they do not need to reach for those items that otherwise help them get through the day. I take on board what the Minister said about getting GP and health services to those clubs—that would be a fantastic thing to do. We should then automatically see a reduction in the issues that we are testing for now, such as cancer. However, I do also welcome the centres that the Minister has spoken about.

[Maria Caulfield]

My hon. Friend is absolutely right. Although we are focusing on trying to diagnose lung and prostate cancer as early as possible, encouraging men to come forward and making them aware of the signs and symptoms, he is right that prevention—reducing smoking, alcohol and obesity—will help keep men healthier for longer. He is right that if men are lonely or do not feel like they have other avenues to meet people and get involved in society, they will reach out to smoking or drinking. Often, gambling is a way to meet people down the betting shop; a racecourse near me is very popular indeed. Men do have a different way of dealing with their emotional problems. They will not often talk about them, but meeting other people is a way of coping with some of the issues they face.

I have touched on several separate issues, which is exactly what my hon. Friend said we should not be doing. However, there is a golden thread running through all of them. The health inequalities for some groups of me, whether in life expectancy, life outcomes or accessing healthcare, are different from the issues and challenges that women face. We should not be dismissive of that, because those challenges are equally important.

I want to reassure my hon. Friend that the health issues facing men are being taken seriously. He has met the Secretary of State already and will be having further meetings. I think that today’s debate, in addition to our previous debate on prostate cancer, is the start of the conversation about how we improve outcomes for men. There are specific issues that they face, but there are also common threads that run through those issues. If we do not tackle those, we will not improve the overall health and life expectancy of men. I look forward to working with my hon. Friend further and to taking up some of the challenges that he has raised.

Question put and agreed to.

Genome UK

Maria Caulfield Excerpts

Friday 18th March 2022 Written Statements

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

My noble Friend the Parliamentary Under-Secretary of State, Lord Kamall, has today made the following written ministerial statement:

In September 2020, we launched Genome UK—the UK’s genomic healthcare strategy, which set out a vision to create the most advanced genomic healthcare system in the world to deliver better healthcare at a lower cost. The first implementation plan for this strategy was published in May 2021, to align with the spending review cycle.

For the UK to remain at the forefront of international competition in genomic research and healthcare, and attract investment, it is essential that we continue to deliver on the commitments set out in Genome UK.

I am therefore delighted to inform the House of the launch of a UK-wide shared commitments document which sets out how we will work together with the devolved Governments to implement the strategy over the next three years.

The commitments included in this document have been agreed by members of the National Genomics Board, a group of senior life sciences sector stakeholders, which I chair with Sir John Bell. We have worked with the devolved Governments and delivery partners over the past six months to identify commitments that we can work together to deliver by 2025.

I am pleased to announce the following UK-wide commitments:

A continued emphasis on keeping the public across the UK at the heart of genomic healthcare research programmes by providing opportunities for representatives to be involved in discussions and decision-making both in healthcare genomics and genomics research.

Ongoing review and appraisal of emerging genomic science, new clinical indications and new technologies on a UK-wide basis to enable all four healthcare systems to stay at the forefront of genomic healthcare.

Delivering on the promise of personalised medicine including in cancer diagnosis and treatment through improved access to clinical trials and targeted therapies.

Building on our successful partnership on SARS-CoV-2 sequencing to develop public health pathogen genomics services across the UK.

Establishing a clear, evidence-based position across the UK on whether and how genomic sequencing may be implemented in the newborn period, for the benefit of newborns and their parents in all parts of the UK to enable earlier detection of disease.

Continuing to explore opportunities that could support a UK functional genomics initiative to deepen our understanding of disease and assist the identification and validation of novel drug targets.

Working collectively to increase access to genomics-enabled clinical trials, linking up across the UK, to ensure research feeds back into clinical services to improve and transform patient care. For example, using “Find, Recruit and Follow up” to better identify and recruit individuals who might benefit from clinical research studies.

Supporting initiatives to link large genomic datasets across the UK to improve access for researchers. Potential examples including the Trusted Research Environments hosted by Genomics England, UK Biobank and Our Future Health.

Working together to establish a joint workforce group across the United Kingdom to share best practice and strategic priorities, ensuring consistency of capability and expertise across the UK.

Given that Genome UK runs over 10 years, some of its 45 commitments are either long term or will be delivered through cumulative action over the coming years, which is why the implementation process is phased. Genomics is a fast-moving field, and the phased approach allows us to review our commitments to reflect emerging science and the latest research findings. Our intention is to continue to align future iterations of this plan with Government funding cycles.

We will continue to work with the devolved Governments and our partners in the NHS, industry and research, including via the National Genomics Board, to ensure that we deliver on our goal to create the most advanced genomic healthcare system in the world. I also want to emphasise that engagement and dialogue with the healthcare workforce, patients and the diverse UK population, will be at the heart of the journey to reach the vision set out in the strategy.

[HCWS698]

Health Update

Maria Caulfield Excerpts

Thursday 17th March 2022 Written Statements

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

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

I have today laid a departmental minute proposing to provide an indemnity that is required urgently in respect of a Department of Health and Social Care established non-statutory, independent inquiry into the circumstances surrounding the offences committed by David Fuller (DF) at the Maidstone and Tunbridge Wells NHS Trust, and their national implications.

The inquiry will be split into two phases:

an initial report, on matters relating to Maidstone and Tunbridge Wells NHS Trust, reporting by the middle of 2022, and

a final report, looking at the broader national picture and the wider lessons for the NHS and for other settings, reporting by the middle of 2023.

It will review DF’s unlawful actions, how he was able to carry these out, why his actions went apparently unnoticed, and will make recommendations with the aim of preventing anything similar from happening again. We expect the inquiry to publish a progress update as soon as possible after Easter recess.

In November 2021, the Secretary of State for Health and Social Care announced the inquiry (Official Report, 8 November 2021, volume 703, column 23) to be chaired by Sir Jonathan Michael. The Department of Health and Social Care will indemnify the inquiry insofar as the chair or any other member of the inquiry who has acted honestly and in good faith will not have to meet out of his or her personal resources any personal civil liability, including costs, which is incurred in the execution or the purported execution of his or her inquiry functions, save where the inquiry member has acted recklessly. This indemnity will cover the entire duration of the inquiry’s work, from November 2021 until when the inquiry submits its final report, expected in 2023, and for an unlimited period after that date. However, we believe there is a low risk of the indemnity being called upon beyond five years of the inquiry having reported. There will be no cap placed upon the indemnity, so the maximum exposure is strictly unlimited. However, any losses are not expected to exceed a value of £3 million based upon the best estimate currently available at this stage of the inquiry’s work. If the liability is called, provision for any payment will be sought through the normal supply procedure.

The Treasury has approved the proposal in principle which mirrors the standard indemnity for board members described in “Managing Public Money”. If, during the period of 14 parliamentary sitting days beginning on the date on which this minute was laid before Parliament, a Member signifies an objection by giving notice of a parliamentary question or by otherwise raising the matter in Parliament, final approval to proceed with incurring the liability will be withheld pending an examination of the objection. The indemnity is expected to come into force on 26 April 2022, subject to the approval of Parliament on this basis.

Copies of the departmental minute have been laid in both Houses.

[HCWS692]