Advance Care Planning: Universal Principles
Maria Caulfield Excerpts(2 years, 8 months ago)
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The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)
The Government are announcing today the publication of the “Universal Principles for Advance Care Planning”, a document jointly published by a coalition of partners in response to the Care Quality Commission’s (CQC) report into the use of do not attempt cardiopulmonary resuscitation (DNACPR) decisions taken during the covid-19 pandemic.
We would like to firstly thank all of the partner organisations involved in developing the document, which sets out six high-level principles for advance care planning in England. This work has been produced for the benefit of patients and those important to them, as well as practitioners and organisations involved in supporting advance care planning conversations and making sure their outcomes are honoured. By working together on developing and publishing the principles, partner organisations will ensure a consistent national approach to advance care planning.
We would also like to thank the CQC for its continued work in this area, as well as patients, their families, representatives and staff who continue to share their experiences on such an important and complex issue.
Planning for future care is an empowering act that allows people to feel confident their wishes will be considered if they are ever unable to fully participate in decision making. By having good quality conversations about future treatment in advance, individuals will have a greater sense of control over their ability to live and die well.
The joint publication of the universal principles demonstrates the commitment that all of these organisations have to ensuring good practice is embedded across the health and care system. It demonstrates the importance of all people, their families or representatives, clinicians and professionals sharing an understanding of the role good advance care planning conversations, including DNACPR decisions, play in high-quality personalised care.
This piece of work has been overseen by the DNACPR Ministerial Oversight Group, which was established to look in depth at the issues raised in the CQC’s report and to oversee the delivery and required changes of the recommendations. The universal principles published today represent a culmination of all the hard work this group and its working representatives have put into addressing the issues highlighted in the report.
The Government and NHS England have remained clear that the inappropriate application of DNACPRs is unacceptable in any circumstance. It is important that those organisations that are responsible for taking the universal principles forward at an operational level do so to implement clear and consistent best practice across all settings, ensuring everyone receives the high-quality personal care they deserve.
The “Universal Principles for Advance Care Planning” can be found here:
https://www.england.nhs.uk/publication/universal-principles-for-advance-care-planning/
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Irish Diaspora in Britain
Maria Caulfield Excerpts(2 years, 8 months ago)
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The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)
It is a pleasure to follow the hon. Member for St Helens North (Conor McGinn), who is a friend as well as a colleague.
I thank the hon. Member for Rochdale (Tony Lloyd) for securing this timely debate on St Patrick’s day, and I am delighted to respond. Unfortunately, I will perpetuate the stereotype. because I am second-generation Irish and my parents came from Ireland in the 1950s, my dad as a builder and my mum as a nurse. They came here not by choice but by necessity, because times were hard in Ireland. Many people left for Britain, Australia or America, and many never returned home—it was a difficult time.
Many colleagues mentioned that the welcome for the Irish in Britain was not always warm. My parents faced signs in windows refusing entry to Irish people looking for accommodation. They faced difficult, tough times. My dad, as a builder, did not benefit from the health and safety legislation and employment rights that we have today. We have a lot for which to thank the generation who went before us and who created the community here in Britain.
The community in this country takes many forms, such as the county associations that do tremendous work bringing together people from the same county. As young girls, we were all forced to go to Irish dancing lessons whether or not we were any good, and we travelled the country to take part in feises. The GAA’s Gaelic football teams join communities together, as does the traditional Irish music scene, which we missed tremendously during lockdown when we were not able to listen to traditional music in our local communities.
The hon. Member for Salford and Eccles (Rebecca Long Bailey) mentioned the work of publications such as The Irish Post and The Irish World, which I, too, was forced to read every week. I did not win many medals for Irish dancing, so my picture was rarely in The Irish Post, but we still read it every week.
Every summer holiday we made the annual pilgrimage to Ireland to catch up with grandparents, cousins, aunts and uncles. It rained a lot and we did not get much of a suntan, but we enjoyed our visits and would bring home Tayto crisps, Kimberley biscuits and Barry’s tea—other products are available—to take a bit of Ireland with us to keep those memories burning. Things have changed: Tayto crisps now come in more than one flavour. The new generation of Irish in Britain come here for very different reasons. They come not out of necessity but out of choice, and they are able to make a positive contribution to our country in so many ways, as many hon. Members have highlighted today.
The impact and influence of Irish men and women has been woven into Britain for a very long time. My hon. Friend the Member for Bury North (James Daly) touched on the contribution of his family during the second world war, when Irish citizens served in the British armed forces. Irish citizens also helped literally to rebuild this country after the war. They built roads, railways, homes and factories to get this country back on its feet. People like my dad contributed to that and played a huge part in this country’s future.
The Irish have also made a significant contribution to art and culture, whether it is Oscar Wilde and George Bernard Shaw, as the hon. Member for Rochdale highlighted, or broadcasters such as Sir Terry Wogan on the radio and television. My favourite Bond, on Her Majesty’s secret service, was played by Pierce Brosnan.
The Irish have also contributed through sport. We have the captain of the England cricket team, and he is doing a tremendous job, but British talent has also been exported to Ireland in the shape of Jackie Charlton, who led Ireland to that famous penalty shoot-out in the 1990 World cup. As an Arsenal fan, I am ashamed to say that I did not think David O’Leary would score that penalty—we all breathed a collective sigh of relief when he did.
Martin Docherty-Hughes
The Minister has the opportunity to answer the question I posed in my speech about the culture and diversity of language, whether it be a guid Scots Ulster leid in yer tongue or the Irish language Act, which was promised in the St Andrews agreement. Will she say something about the opportunities to build on that and bring it forward?
Maria Caulfield
I was going to touch on that, but I shall come to it now. The Government’s preference is that the Northern Ireland Executive bring forward the legislation in the Northern Ireland Assembly, but in the absence of any progress on that the UK Government have been taking the necessary steps to introduce the legislation in Parliament. The legislation will faithfully deliver what was agreed in the New Decade, New Approach commitments on identity, language and culture. It will provide for the status of the Irish language and the development of the Ulster Scots and Ulster British tradition, and create the two commissioners and an office of identity and cultural expression, as negotiated with the Executive. Therefore, we want the Northern Ireland Executive to legislate, but the Government are committed to introducing the legislation if progress is not made.
With such a broad and significant influence on the fabric of Britain, it is extremely pleasing that we are able to celebrate with this debate today and to acknowledge that our relationship with the Irish Government has been critical in establishing and protecting the hard-won peace in Northern Ireland. I grew up in this country during some of the troubles and it was not easy for my generation either. Here we were seen as Irish people living in England, but when we went back for our summer holidays, we were English people in Ireland. Having an identity was difficult, because we actually belonged nowhere. With the progress made in the Good Friday agreement and the Anglo-Irish agreement, peace, as the shadow Minister said, brought as much resolution for us as an Irish community here as it did to many parts of Northern Ireland and the Republic of Ireland. When there are celebrations of the peace agreement, we celebrate the hard work of people such as David Trimble, Gerry Adams, Martin McGuinness, Bill Clinton, George Mitchell, Bertie Ahern and Tony Blair, but we never mention my absolute heroine, Mo Mowlam. She did so much to bring those parties together—people who just would not get in a room and talk—throwing her wig on the table and banging heads together. I want to pay tribute to her, because she is the unsung heroine of the peace process and her legacy definitely lives on.
The Irish Government have remained an ally in maintaining peace and stability in Northern Ireland, and have played important roles as interlocutors in the subsequent agreements, such as the St Andrews agreement in 2007 and the recent New Decade, New Approach agreement in 2020. We greatly value that relationship, and the Prime Minister and the Taoiseach met only last weekend in London, ahead of the Ireland-England rugby match. Perhaps it was best that that meeting was before the match, rather than after it. I have a foot in both camps, so my team always wins, but the loyalty of the SNP may be tested on Saturday when Ireland could win the triple crown if it is successful against Scotland—we await that match with interest.
The Belfast agreement established structures to encourage and foster a strong relationship between the UK Government and the Irish Government. We will see a great example of that next week at the meeting of the British-Irish intergovernmental conference in Dublin, which the Secretary of State for Northern Ireland will co-chair with Minister Simon Coveney. I want to reassure colleagues in all parts of the House that the UK Government are committed to upholding and promoting the principles of the Belfast/Good Friday agreement, which has provided the framework for Northern Ireland to prosper and develop. As someone who has seen in my lifetime the changes and challenges faced by the Irish community, in my parents’ generation, my generation and the generation who are coming through right now, I see a bright future for British-Irish relationships and their going from strength to strength. We have shown how, together, we can get through the challenges of the past, and how today we have shared values and connected communities and the aspiration for future peace and prosperity on the island of Ireland. Once again, I want to wish everyone a very happy St Patrick’s Day.
Draft Commissioner for Patient Safety (Appointment and Operation) (England) Regulations 2022
Maria Caulfield Excerpts(2 years, 8 months ago)
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The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)
I beg to move,
That the Committee has considered the draft Commissioner for Patient Safety (Appointment and Operation) (England) Regulations 2022.
It is a pleasure to serve under your chairmanship, Dr Huq. Patient safety remains a top priority for the Government, and we continue to place enormous emphasis on making our NHS as safe as possible for patients. Although we have made good progress, we know that more work needs to be done. In July last year, the Government published their formal response to the recommendations in the independent medicines and medical devices safety review, setting out an ambitious programme for change. That included our acceptance of the recommendation to appoint a patient safety commissioner with a remit covering medicines and medical devices.
We are making good progress towards fulfilling that important commitment. We included provisions in the Medicines and Medical Devices Act 2021 to establish the commissioner and set out their core duties. We also held a public consultation between June and August last year on the details of the commissioner’s appointment and operation, and in January we started the process to recruit the very first patient safety commissioner. The job advert closed on 1 February and we hope to make an appointment by the spring. This statutory instrument will allow the Government to make legislative provisions about the appointment and the operation of the role.
Our public consultation covered details such as term of office, reappointment arrangements and remuneration, and we are grateful to all those who took the time to engage with our proposals and share their views. I am pleased to report that each proposal was supported by more than half of those who responded, with 59% to 91% of respondents being in agreement. Having considered all the responses carefully, we have laid before the House a draft statutory instrument that will implement the proposals put forward in our consultation. The instrument will enable the patient safety commissioner to function effectively by providing a clear legislative framework within which they can operate. I am aware that some respondents were concerned that the appointment time would be too short a period for the commissioner to establish themselves; however, the draft regulations also allow for the commissioner to be reappointed for an additional three years, in effect giving them up to six years in office.
Sir Greg Knight (East Yorkshire) (Con)
Will the Minister clarify that point? Paragraph 7.5 of the explanatory memorandum states:
“The Commissioner for Patient Safety will be eligible for reappointment”.
Does that mean just one reappointment or multiple reappointments?
Maria Caulfield
At the moment, my understanding is that it is for an additional three years, and there is not room in the draft regulations to expand that further. I am happy to clarify that for my right hon. Friend, if he is happy with that explanation.
The draft regulations set out a range of other details relating to the operation of the patient safety commissioner. In summary, the commissioner will produce a business plan covering their key priority areas, receiving funding from the Government, keep proper accounts each financial year, receive remuneration, publish an annual report to be laid before Parliament, and have staff who may exercise any of the commissioner’s functions so far as they have been authorised to do so by the commissioner.
The draft regulations also require the commissioner to appoint an advisory panel to provide advice and assistance to the commissioner. The Government believe that the patient’s voice must be central to everything that the healthcare system does. The patient safety commissioner will play a vital role in promoting the safety of patients in relation to the safety of medicines and medical devices. We believe that the draft regulations provide a sensible set of arrangements that will enable the commissioner to function and operate effectively once appointed. As ever, I welcome the scrutiny of Parliament and Members’ valuable contributions. I commend the draft regulations to the Committee.
Maria Caulfield
I thank the hon. Member for Enfield North for the Opposition’s support in establishing this crucial role. I reassure her that Baroness Cumberlege is part of the recruitment process, and will be part of the interview panel that takes the process forward. I put my thanks to her on the record; without her work in this area, we would not be here today. I also reassure the hon. Lady that it is patients’ voices having been heard loud and clear that has established the role. It was a key recommendation, and one that we are taking up as quickly as we can.
This is not the only area within patient safety on which we are making progress. In the Health and Care Bill, which is currently going through the other place, we are changing the Healthcare Safety Investigations Branch into a slightly different body that will look not just at NHS care but at the independent sector. It will be more robust in dealing with patient safety, and patients will have a strong voice in that. On what we are doing in maternity, the early notification scheme has already resulted in an improvement in outcomes for mothers and babies, and is being used as a tool not just to identify problems and find solutions but to learn from processes that have gone wrong in the past. I point the hon. Lady to that amazing work.
Specifically on the patient safety commissioner, there is provision in draft regulation 3 for the term of office, which is initially for three years, with a review process. Because it is a new post, it is important to review how the first three years have gone, but the patient safety commissioner can be reappointed for a further three years, making six in total, which is roughly in line with the term of office for many other commissioners. On the annual report, a copy will be sent to the Secretary of State and put before both Houses of Parliament. Many Members may seek to debate the report and pull out some of its findings. It will be right and proper that the report receives parliamentary scrutiny.
The advisory panel is for the patient safety commissioner to set up. The commissioner has a wide remit, ranging from issues such as maternity to medical devices. It is right and proper that they have a panel of experts, including patients, to look at whichever aspect of patient of safety they are looking at. It will really be for the commissioner to appoint that advisory panel, as set out in the statutory instrument. This is a new role, and we have a break period after the third year to ensure that it is doing the things that we need it to, and that patient safety is the No. 1 priority in healthcare.
Question put and agreed to.
Covid-19: NHS Support for Prostate Cancer Patients
Maria Caulfield Excerpts(2 years, 8 months ago)
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Elliot Colburn (Carshalton and Wallington) (Con)
I beg to move,
That this House has considered NHS support for prostate cancer patients after the covid-19 pandemic.
Ms McDonagh, as your constituency neighbour, it is a pleasure to serve under your chairmanship for the first time in Westminster Hall. I extend my thanks to the Backbench Business Committee for granting time for such an important debate. I also thank the many Carshalton and Wallington residents who came forward to share their experiences of prostate cancer, either having had it themselves or having supported a loved one or friend through it.
Many people in this room and many of those watching will know a male relative or have a friend in their life who has had prostate cancer. I hope this important debate will raise awareness of the need to get yourself checked. There will be many striking statistics mentioned in the debate that will concern Members present, but I am keen to begin with a positive. Cancer survival rates in the United Kingdom have never been higher. Survival rates have improved each year since 2010. Prostate cancer survival has tripled in the past 40 years, with 85% of men surviving for five years or longer. However, the covid-19 pandemic threatens to derail this progress through a decrease in diagnostics, especially for men over the age of 50.
There are over 47,000 new prostate cancer cases every single year, with a man dying every 45 minutes from the condition. Early diagnosis is the key to fighting this disease. The pandemic has resulted in fewer men coming to their GP to get tested for prostate cancer, with the “stay at home” messaging particularly deterring older men, who are most at risk from prostate cancer, from coming forward. While the referral rate for prostate cancer has recovered to 80% of pre-pandemic levels, it still lags behind those for other forms of cancer, such as breast cancer, which is operating at 120% of pre-pandemic levels.
Stark figures from the charity Prostate Cancer UK reveal that there have been 50,000 fewer referrals for suspected prostate cancer patients than the usual trends would predict. The impact of that is incredibly worrying. Some 14,000 fewer men in the UK started treatment for prostate cancer between April 2020 and December 2021 compared with the equivalent months prior to the pandemic. That means that 14,000 men are living without the knowledge that they have the condition, and it means that 14,000 men have not yet started that all-important treatment plan.
Prostate Cancer UK has warned that, because of that, 3,500 men risk being diagnosed with late-stage prostate cancer. I cannot stress enough the importance of people getting themselves checked if they have symptoms or if they fall into the high-risk categories. Those include men over the age of 50, black African and black Caribbean men, and men with a father or brother who have had prostate cancer.
Sadly, the statistics and anecdotes that many of us will have heard point to the fact that men are far less willing to get themselves checked. Whether that is out of embarrassment or fear, getting diagnosed early can make an enormous difference to survival rates; five-year survival rates for men who are diagnosed with prostate cancer between stages 1 and 3 are over 95%. There are fantastic NHS campaigns, such as the “Help Us Help You” campaign, which has urged people with potential cancer symptoms to come forward for life-saving checks. The second stage of that campaign addresses the fear that often comes with booking the first appointment. Despite the fantastic work that is already being carried out, I hope that the Minister will be able to enlighten us about what more the Government are doing to destigmatise men coming forward to check their symptoms.
While being checked for prostate cancer is important for all men, it is especially important for men of black African or black Caribbean origin. I was taken aback to learn that, while one in eight of all men will get the disease, one in four black men will be diagnosed with prostate cancer in their lifetime; black men are also far more likely to be diagnosed with a more aggressive type. People from black and ethnic minority groups are also 4% less likely to receive radical treatment than people from white ethnic groups.
Through covid-19, we have seen what we can achieve when we work together. Last year, I was proud to host a roundtable in Carshalton and Wallington in collaboration with the NHS, the third sector and community groups to encourage ethnic minority communities to come forward and get the jab. The roundtable was well attended and demonstrated what we could achieve in prostate cancer diagnostics if the Government worked closely with the third sector and community groups to spread awareness.
However, improving awareness requires a corresponding increase in imaging capacity. Imaging services such as multiparametric MRI are critical to achieving earlier diagnoses, which, as I stated earlier, is key to survival. MpMRI scans can confirm or rule out prostate cancer in an accurate and timely manner, reducing the stressful wait for patients and their families. From speaking with cancer charities, I know that the significant variation in access to mpMRI provision is concerning. If we are to bring prostate cancer diagnoses back to pre-pandemic levels—and, indeed, increase them—we must address that postcode lottery. MpMRI provision must, as a minimum, be expanded in line with growth rates prior to the pandemic if we are to get diagnoses back to pre-pandemic levels. The 10-year cancer plan provides a golden opportunity to address this issue.
I have already mentioned the negative impact the pandemic has had on the prostate cancer community, but I am keen to highlight some positives that could be considered in a post-pandemic setting. Prostate Cancer UK has noted that the policy change during the pandemic to grant special access to certain covid-friendly novel hormone therapies for patients was very warmly welcomed by the community. This policy change has been wanted for some time, and it not only kept patients safe at home during the pandemic but improved their care experience, as they spent less time in hospital. Along with the increased interaction between patients and clinicians using technology, the change has made for higher levels of patient satisfaction and experience.
I look forward to seeing greater access to diagnosis and treatment and increased use of technology in my constituency at the London cancer hub, an exceptionally exciting project in the London Borough of Sutton. As a former employee, the Minister will know the Royal Marsden Hospital very well. I will not go over ground that she already knows, as cancer nurse who, I believe, is still practising.
The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)
indicated assent.
Elliot Colburn
The Minister is nodding. The Royal Marsden and the Institute of Cancer Research already form one of the leading cancer research and treatment centres in the world. The development plans for the London cancer hub will double the capacity for cancer research on the site, making the United Kingdom second only to the United States. It will be a game changer and will take our cancer research to the next level. It is a prime opportunity to ensure that the reduction in prostate cancer diagnoses remains a temporary blip in the overall effort to achieve early diagnosis for everyone with the condition.
This effort must include the cancer workforce. The Government have already invested money to address the cancer backlog, but the workforce issue must also be addressed. Patients with prostate cancer and their families go through one of the most difficult things in life to navigate. They are desperate for more clinical nurse specialists, who provide holistic, patient-centred care, with the empathy needed in these very dark times. Having access to clinical nurse specialists means that prostate cancer patients are far more likely to be positive about their care and treatment and to receive more individualised treatment plans.
One suggestion to be considered for the post-pandemic NHS is non-medical practitioner-led prostate cancer clinics. Such clinics would not only enhance the clinical pathways in prostate cancer, but relieve time burdens on oncologists and help to reduce costs that can be cycled back into the system. With one in four consultant clinical oncologists reporting risk of burnout, and with covid-19 exacerbating those issues over the past two years, investing in non-medical practitioners or increasing the number of clinical nurse specialists—or both—could be solutions to workforce concerns. I urge the Government to work with NHS England, Health Education England and the devolved Administrations to ensure that professional working groups in the prostate cancer workforce are addressing the workforce backlogs, including with clear training routes for healthcare professionals wishing to upskill.
I appreciate that there is strong interest in the debate, so I am keen to conclude my remarks. If the Minister takes anything away, I hope it is the need to find those 14,000 men missing from the prostate cancer treatment pathway, and to ensure that workforce issues are looked at by the Government. The pandemic has provided the NHS with a unique opportunity to rethink how we provide care not just to prostate cancer patients but to all cancer patients, with greater use of technology and the benefits of covid-friendly treatments that patients have had access to throughout the pandemic.
Finally, the one message that I hope those watching the debate—especially those in high-risk categories—will take away from it is: “Please get yourself checked”. The support available for patients and their families is fantastic, and it is out there. I say to people watching: “You are never alone”. I urge them to book that vital first appointment. I look forward to hearing the contributions from other hon. Members on this incredibly important issue.
The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)
It is a pleasure to serve under your chairmanship, Ms McDonagh. May I start by declaring an interest? I still work, as my hon. Friend the Member for Carshalton and Wallington (Elliot Colburn) said, as a cancer nurse. I was slightly disappointed by the tone of the shadow Minister, the hon. Member for Enfield North (Feryal Clark). I did not want to be political but, for the record, I got into politics because, as a cancer nurse, I was so frustrated with the previous Labour Government’s target-driven approach, which looked good on paper, but in reality did not make a huge difference to patients.
I welcome this debate that was secured by my hon. Friend the Member for Carshalton and Wallington. Prostate cancer absolutely deserves a debate that focuses on the key issues that he described so well. I want to reassure colleagues that cancer treatments and diagnosis have remained a top priority throughout the pandemic—one of the few areas of healthcare where much of it stayed open—with over 330,000 urgent referrals and more than 170,000 treatments for urological cancers between March 2020 and December last year.
I want to thank the amazing work of NHS staff up and down the country who maintained cancer treatment levels at 94%, which is an astonishing record when they had to deal with covid in the workforce and patients undergoing prostate treatment also coming through covid, too. Although treatment levels remained very high during the pandemic, there is no doubt that referrals suffered. We asked men and women to stay away from the NHS to protect it during that time and we saw a huge drop-off in referrals. It is estimated that up to 32,000 fewer people than expected have started cancer treatment because of that, but we are seeing a change with record levels of referrals coming through the system right now. Last month’s figure was around 11,000 cancer referrals a day.
Although people stayed away during the pandemic, they are coming back in their droves now, and the ambition is to try to get as many of those diagnosed as quickly as possible and into treatment. We are trying to get prostate cancer in particular diagnosed as quickly as possible by implementing best practice timed pathways for prostate cancer, including the use of mpMRI, which my hon. Friend the Member for Carshalton and Wallington mentioned. It captures images of the prostate in a much better way than the standard MRI does, so that is a focus and we have seen a major uptake in that. Back in 2016, only 335 people were going through that system, but by 2020 that had gone up to 11,000 people. We are seeing a real shift in the use of that technology, which better diagnoses men with prostate cancer.
Partnering with Prostate Cancer UK, we are delivering a cancer risk-awareness campaign, which started in February and will continue to run until the end of this month. As a number of colleagues have said, we must raise awareness about the symptoms of prostate cancer and encourage men to come forward.
Although I do not wish to generalise, I take the points made by my hon. Friend the Member for Don Valley (Nick Fletcher) and by the hon. Member for Strangford (Jim Shannon) about the differences in how men and women face health issues. When women have an issue, they will come forward, although they often feel as if they are not being heard and that there is a delay in accessing healthcare. Men are slightly different in that often they will not come forward in the first place, so the campaigns let them know about the symptoms, encourage them come forward and reassure them that diagnosis and treatment will happen relatively quickly.
The outcome is good for many men with prostate cancer, but we encourage people to come forward quickly because the prognosis is improved the earlier they can get involved in treatment, and the treatment is often less invasive. There are good reasons to encourage men to come forward.
The purpose of our campaign is to educate people about their risk of prostate cancer. As we have heard, some people are more at risk than others. As a cancer that does not present with many symptoms, particularly at an early stage, it is vital to encourage those at risk to discuss that with their GP and have a prostate-specific antigen test. To address the point made by my hon. Friend the Member for Don Valley, gentlemen over the age of 50 can request a PSA from their GP.
There is no national screening programme at the moment because the PSA test on its own is not foolproof. It is a simple blood test that measures the PSA level in the blood which, if raised, can be indication that prostate cancer could be present. However, many men with prostate cancer do not have a raised PSA, and many men who have a raised PSA that does not change over time do not have prostate cancer. We do not have a national screening programme because it is not a foolproof test in the way that a mammogram is for breast cancer.
A huge amount of research is going on about that right now. The team at University College London is working on PSA and integrating it with another test, to combine them to see if accuracy can be improved. If there were a more accurate screening test, there would be a strong case to bring that forward, but at the moment the accuracy of the test is holding us back.
Prostate Cancer UK has reported that over 310,000 people have completed their risk checker, so obviously a lot of good work is happening that is getting the voice out there. This debate today also helps raise awareness. As many hon. Members have said, we are encouraging men to come forward if they have concerns.
We also have the “Help Us Help You” NHS campaign, which is looking at a number of cancers, including prostate cancer. It has raised awareness of non-specific symptoms, which are often experienced by the patients who we have the hardest time diagnosing. This month, we are launching a campaign specifically about prostate cancer and the barriers to seeking treatment. The phases of the campaign that have run to date have contributed to the high levels of urgent cancer referrals the NHS has seen—around 11,000 referrals per day—as I mentioned earlier. The campaigns are working and people are coming forward, but there is a huge amount more that we can do.
In addition to these national initiatives, we also fund more local awareness raising through cancer alliances, where we specifically target communities who may be more at risk or less likely to come forward if they have symptoms. As part of that plan, every system will need to take ongoing action to support general practice capacity, so that if people come forward they are able to be seen as soon as possible.
We are also working on long-term prostate cancer improvements. Clearly, the covid pandemic had an impact on referrals, but there were long-term issues before the pandemic, as outlined by the shadow Minister, that we are now trying to address. Research is one of those issues. There is a wide range of treatments for prostate cancer. My hon. Friend the Member for Don Valley talked about the watch and wait policy, and it has been quite successful. There are many older men with prostate cancer that may have a less aggressive form, and this is where techniques such as watch and wait and seeing whether PSA is showing in their blood are very helpful. Many of those men will die of things other than prostate cancer. Watch and wait is a useful and robust treatment.
Treatments for prostate cancer are not without their side effects, despite our best efforts. We are working hard to improve treatments, both in terms of their success rate and the impact they have on a man’s quality of life. The use of stereotactic radiotherapy, for example, to target prostate cancer and reduce side effects is making a huge difference to outcomes for men. Better surgical techniques, and state-of-the-art surgery, are also improving outcomes and the side effects from surgery. Hormone treatments are also available; research is pushing the barriers there. However, hormone treatments are not without their side effects. I reassure men that there is a wide range of treatments, depending on the type of prostate cancer that they have, that will not only treat their cancer but reduce the side effects.
In the spending review we announced an extra £5.9 billion of capital to support our recovery programme, particularly in diagnostics. That includes £2.3 billion to increase the volume of diagnostic activity in our community diagnostic centres. What we are trying to create in local communities is a situation where if someone presents with non-specific symptoms to their GP, we can use the community diagnostic centres to refer people so that they can have the tests—whether it is an ultrasound, an MRI, or blood tests—and can get a more rapid diagnosis than has historically been the case. We are rolling out 44 community diagnostic centres to increase our capacity, which could deliver up to 2.8 million scans in the first full year of operation. By 2024-25, the aim is to deliver at least another 56 of those centres. That will allow the NHS to carry out 4.5 million additional scans. The diagnostic centres will make a big difference, diagnosing people as quickly as possible and at as early a stage of their cancer as possible.
There are some pilot works going on that look at self-referral; that is particularly the case with breast and skin cancers. I do not want to speak for cancer alliances, but there could be an argument for prostate cancer to be included too, if people have specific symptoms. Watch this space with regards to self-referral and its ability to get people into the system as quickly as possible.
We also talked about workforce. As someone who has worked as a nurse specialist, I take it on board that a urology nurse specialist will often cover all urology cancers. There is a difference between treating someone for testicular cancer; they often tend to be younger men who need very different treatment. Prostate cancer is a very different type of cancer, but it is often lumped in under urology. I recognise that nurses there have a greater volume of patients to see than nurses treating other types of cancer. There is huge progress being made on that. There is investment going into workforce planning, and we are supporting the training and development of nurses, in particular, to become specialists and practitioners in both screening and diagnostics. It is not just about increasing numbers in our workforce; it is about giving them the skills and training to expand the roles and services that they can go into. That is at the forefront of our mind.
My hon. Friend the Member for Don Valley talked about a men’s health strategy. I will say to him that just by having a women’s health strategy does not mean we are ignoring men at all. We are producing our health disparities White Paper very soon. Some of the issues that he talks about around life expectancy and differences in suicide rates will feature quite heavily in that. However, if he does not feel that that goes far enough, I am very happy to have a further conversation. There are differences, in some areas, for men and, on prostate cancer particularly, we can do more to support them with their diagnoses and treatment.
For many men, prostate cancer will be a chronic illness. We will be able to treat and cure many, but some will need to learn to live with their disease—people can live with quite advanced prostate cancer for many years—and it is about providing them with support. Living with prostate cancer often causes psychological challenges, where people are just getting on and dealing with it but are not getting the support that they need with many of the issues that they face. We fully recognise that that is something that we need to focus on.
I reassure colleagues that prostate cancer is very much top of our agenda in the cancer sphere. We are improving the facility to try to diagnose it much more easily. Treatments for prostate cancer are changing and improving all the time. We must focus on supporting men with prostate cancer through their cancer journey. We must encourage men to come forward and reassure them that they will be diagnosed quickly and receive the treatment that they need for their prostate cancer.
Breastfeeding: Government Support
Maria Caulfield Excerpts(2 years, 8 months ago)
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The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)
It is a pleasure to serve under your chairmanship, Mr Efford.
I associate myself with comments on the importance of thinking about the mums and babies in Ukraine at this time, given how difficult it must be for all of them.
I congratulate the hon. Member for Glasgow Central (Alison Thewliss) on calling for and securing this debate, particularly today, which is International Women’s Day. We often talk about many issues affecting mums, but very rarely do we talk about breastfeeding, so it is really important to have this debate. Ensuring that every baby gets the best start in life is really important. As we have heard, positive experiences during this period will have a significant impact on a child’s health and wellbeing, and will inform the course of the rest of their life. Although the hon. Member for Aberdeen North (Kirsty Blackman) did not get the chance to speak for long, I sense her passion on this subject and she made her points very well.
Breastfeeding provides significant health benefits for both mother and baby. It has been shown to reduce the prevalence of common diseases in babies, such as respiratory infections and gastroenteritis and the risk of maternal breast cancer, as well as offering protection against childhood and maternal obesity. Breastfeeding also promotes emotional attachment and parental wellbeing. However, as the hon. Member for Glasgow Central said, we need to be mindful of the women for whom it does not work. We must ensure that they get the support and reassurance they need. As the hon. Member for Bristol South (Karin Smyth) said, it can be a very difficult experience for some.
I want to reassure colleagues that the Government are taking this matter extremely seriously. We want to promote breastfeeding as much as possible. The latest available data from the infant feeding survey, which we discussed, shows that only 1% of mothers in England are still exclusively breastfeeding at six months. More than 80% of mothers who stopped breastfeeding in the first two weeks reported that they would have liked to have carried on for longer and that perhaps, with support, they could have done. Common reasons for stopping include a lack of access to support services, as we have heard today, both in the community and at work, while misinformation, inconsistent advice, negative experiences and sometimes even cultural barriers can also deter women.
There are significant disparities in breastfeeding rates across England and the UK. We heard today about some excellent experiences in Scotland and Northern Ireland. The prevalence of breastfeeding is particularly low among young mothers, those who left education before the age of 18, and those from lower socioeconomic backgrounds. That contributes to a cycle of deprivation and further widens disparities. I agree with the hon. Member for Glasgow Central: it is so important that we teach young girls about breastfeeding in schools, so they learn early on about its importance and what to expect when their time comes.
In light of that, I want to reassure colleagues that the Government are taking action to support breastfeeding and to make that support accessible to everyone who needs it. First, we have the healthy child programme, a national evidence-based programme of interventions to support parenting and healthy choices. It outlines all services that children and families need to receive if they are to achieve optimum health and wellbeing, including breastfeeding and infant support.
Secondly, we have the maternity transformation programme, which seeks to achieve the visions set out by Better Births. National guidelines have been published for midwifery and health visiting services to support breastfeeding. I want to take this opportunity to thank all midwives, health visitors, support workers and those offering peer support. I met March with Midwives just before this debate and I recognise the pressures those workers are under. Sometimes things such as breastfeeding support are reduced or taken away when there is pressure on the service overall. I recognise that, and I am very happy to work with the service to try to improve that.
Thirdly, we have the 2019 NHS long-term plan, which recognises the importance of improving breastfeeding support and sets out a commitment to ensuring that all maternity services have an accredited, evidence-based infant feeding programme by 2024. However, we need the staff and the resources to make that happen. I have heard that loud and clear. We also encourage parents to access support through the Better Health Start for Life campaign, which provides advice and information on breastfeeding.
However, for me the most exciting development is the Government’s vision for the best start for life programme. It is only in England, but I am very happy to work with colleagues in the devolved nations to share best practice. The programme will roll out support to the areas of the country that absolutely need the most help. I thank my right hon. Friend the Member for South Northamptonshire (Dame Andrea Leadsom) for her inspirational work in this field.
The early years healthy development review has taken the Government’s commitment to improving breastfeeding rates and improving the support to be included as part of the universal offer for all parents and carers, which will include practical support with breastfeeding, early diagnosis of issues such as tongue-tie and help with formula feeding, which is more appropriate in some cases. The review heard repeatedly from parents about the positive impact breastfeeding can have on their confidence and self-esteem, as well as the value of breastfeeding support groups and peer networks.
In the spending review, the Chancellor announced a £300 million investment to transform family hubs and improve Start for Life services with £50 million for breastfeeding support services. Funding will be made available initially to 75 upper-tier local authorities where we feel the most disparities exist. We will be announcing very soon where those 75 authorities will be and where we can support breastfeeding in those communities. Those local authorities will be able to invest in increasing the range of breastfeeding advice, specialist and peer support, and out-of-hours support that is available in person, on the phone and digitally, creating breastfeeding-friendly environments that will help mothers meet their breastfeeding goals.
Fleur Anderson
I know that time is pressing; I thank the Minister for giving way. Has the Minister done any assessment of how many clinics there were pre-covid? That number of 75 local authorities is great, but what about everywhere else? Has there been an assessment of initial services, what has been cut and what has been reinstated?
Maria Caulfield
I do not have that information, but I was interested to hear about the experience in Putney. I will take that away because I spoke to midwives who were redirected during covid, but I am not aware of which services have and have not restarted. I am keen to look at that, so I will follow that up. I am happy to conclude, Mr Efford, if that would be helpful.
Clive Efford (in the Chair)
The message we are receiving is that the Chamber has been suspended. I was going to suspend the sitting at 4.57 pm, but if the Minister has finished, we can suspend now and come back after.
Maria Caulfield
I will just conclude by thanking everyone. There remains a huge amount to be done. I very much take on board the points that have been raised in the debate, and I will follow up with colleagues because we need to put breastfeeding higher up the agenda.
Clive Efford (in the Chair)
I am suspending the sitting for 15 minutes, but we will start as soon as people are back in their places.
Departmental Minute: Liability
Maria Caulfield Excerpts(2 years, 8 months ago)
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The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)
It is normal practice, when a Government Department proposes to undertake a contingent liability in excess of £300,000 for which there is no specific statutory authority, for the Minister concerned to present a departmental minute to Parliament giving particulars of the liability created and explaining the circumstances; and to refrain from incurring the liability until 14 parliamentary sitting days after the issue of the minute, except in cases of special urgency.
I have today laid a departmental minute proposing the provision by the NHS Trust Development Authority (TDA), now part of NHS Improvement, of an indemnity that is necessary in respect of an NHS Improvement non-statutory independent review of maternity services at Shrewsbury and Telford Hospital NHS Trust. This review follows a number of serious clinical incidents, beginning with a newborn baby who sadly died in 2009; an incident which was not managed, investigated or acknowledged appropriately by the trust at the time. In subsequent years from 2009 until 2014 a number of further investigations and reviews (internal and external) were also undertaken to confirm whether appropriate investigations were conducted and the assurance processes relating to investigations in the maternity service were adequate. Following the original launch of the review, more families came forward with concerns about their care and this led to an extension to the scope of the original independent review.
The review published its first interim report on 10 December 2020. The report outlined the local actions for learning for the trust and immediate and essential actions for the trust and wider system that are required to be implemented now to improve safety in maternity services for the trust and across England. In response, NHS England and NHS Improvement committed to investing £95 million for workforce numbers, training and development programmes to support culture and leadership, and strengthening board assurance and surveillance to identify issues earlier.
The review’s second and final report is now planned to be published soon.
NHS Improvement are able to obtain indemnity cover from NHS Resolution through the liabilities to third parties scheme (LTPS). The scheme applies to any liability which a member of the scheme owes to any third party in respect of loss, damage or injury arising out of an act or omission in the course of the carrying out of any relevant function of that member which is a qualifying liability.
The indemnity will cover any sums (including any legal or other associated costs) that members of the review team are liable to pay in relation to legal action brought against them by a third party in respect of liabilities arising from any act done, or omission made, honestly and in good faith, when carrying out activities for the purposes of the review. The indemnity will apply to any work carried out from the commencement of the review to its completion in 2022, in accordance with the review terms of reference. The indemnity will cover the contingent liability of any legal action following the publication of the review report and for two years after that date.
The liability of the scheme for any proceedings brought against the member by virtue of Section 13 of the Data Protection Act 1998 for all compensation payable to any claimant or any number of claimants in respect of or arising out of any one event or series of events consequent on or attributable to one source or original cause shall not exceed £50,000. Further, the maximum sum payable for such cases in any one membership year shall not exceed £500,000. However, in view of the potentially substantial Information Commissioner Office (ICO) fines for data breach, it would be prudent for the £50,000 cover available under the NHS Resolution LTPS scheme to be “topped up” with a specific NHSI indemnity to £1 million. If the liability is called, provision for any payment will be sought through the normal supply procedure.
The Treasury has approved the proposal in principle. If, during the period of 14 parliamentary sitting days beginning on the date on which this minute was laid before Parliament, a Member signifies an objection by giving notice of a parliamentary question or by otherwise raising the matter in Parliament, final approval to proceed with incurring the liability will be withheld pending an examination of the objection.
[HCWS665]
Health and Social Care
Maria Caulfield Excerpts(2 years, 8 months ago)
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Maria Caulfield
I place on record my thanks to dental teams up and down the country. Urgent appointments went back to pre-pandemic levels in December 2020, but with only 85% of activity allowed the backlogs will only grow.
[Official Report, 10 February 2022, Vol. 708, c. 485WH.]
Letter of correspondence from the Under-Secretary of State for Health and Social Care, the hon. Member for Lewes (Maria Caulfield).
An error has been identified in my response to the Westminster Hall debate on Access to NHS Dentistry.
The correct response should have been:
Maria Caulfield
I place on record my thanks to dental teams up and down the country. Urgent appointments went back to pre-pandemic levels in December 2020, but with the quarter four threshold set at 85% of activity, the backlogs will only grow.
Vaccine Damage Payments Act 1979
Maria Caulfield Excerpts(2 years, 8 months ago)
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The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)
I thank my hon. Friend the Member for Christchurch (Sir Christopher Chope) for bringing this debate to the Floor of the House; it is an important debate that raises important questions.
Vaccinations are an effective health intervention which can save lives and promote good health. We have one of the best immunisation programmes in the world and are at the forefront of rolling out new initiatives, and I am very proud that the vaccine programme has been a key factor in getting us through the covid pandemic. However, as my hon. Friend pointed out, there are extremely rare and very sad circumstances where individuals have experienced severe disablement with a possible link to the vaccine.
The VDPS that we are debating today is one of the many ways in which the Government support individuals and their families where that has happened. It recognises that vaccines themselves remain the best way to protect us, particularly against covid, and that people have done the right thing in coming forward and having the vaccine. I want to assure people today that the vaccine is safe, and we are still encouraging people to have their vaccination, but I do recognise that some people have had experiences from the vaccine that we need to address, and that my hon. Friend is asking very important questions.
Alicia Kearns (Rutland and Melton) (Con)
I know my hon. Friend the Minister is about to talk about the types of support available, so I want to make my pitch at this point: I have a wonderful 38-year-old female constituent, a mother of three, who after her first shot of AstraZeneca has had horrendous, life-limiting conditions. The NHS seems to have closed its doors to her: for 10 months she has been asking for help, but no one will give it. She has had to go to Germany to get the specialist blood analysis she needs. So can the Minister kindly say what medical ongoing support and pathways the NHS has created within its support specifically to ensure that people like my constituent get the help they so desperately need to live healthier, happier lives?
Maria Caulfield
If my hon. Friend contacts me after the debate I will be happy to find out what specific help is available for her constituent in the local area. But we do have a robust safety mechanism in place, dealing with not just covid vaccines but all medicines, and the VDPS was established in 1979 as a one-off, tax-free payment, with the aim of easing the financial burden on individuals when, on very rare occasions, vaccination has caused severe disablement.
For the specific groups of vaccines that are covid-related, the Prime Minister announced on 21 September 2021 that responsibility for the operation of the VDPS would transfer from the Department for Work and Pensions to us in the Department of Health and Social Care on 1 November 2021. We are picking up that mantle and are working at pace to address the many issues my hon. Friend the Member for Christchurch has raised.
Jim Shannon
Will the compensation scheme to which the Minister referred apply across the whole of the United Kingdom of Great Britain and Northern Ireland—will people in Northern Ireland, Scotland and Wales qualify if they have ailments such as those to which the hon. Member for Rutland and Melton (Alicia Kearns) referred?
Maria Caulfield
My understanding is that it does, but I will clarify that for the hon. Gentleman as I do not want to inadvertently mislead the House if I have got it wrong.
The NHS Business Services Authority has taken over the process and is looking to improve the claimant journey on the scheme through increasing personalised engagement and reducing response times, which was one of the points made today. A difficulty we have with the covid-19 vaccines is that they are new; we are still learning about them and the scientific evidence on potential causal links between the vaccine and instances of disablement is still developing. That is part of the reason for the delay in claims being addressed.
Sir Christopher Chope
My hon. Friend will not have time to answer all my questions, so will she meet me to discuss the issues I have raised that she is unable to deal with now? Also, on this issue of evidence, does she require more evidence than a coroner’s verdict to enable the relatives of somebody who died following the vaccine to get compensation?
Maria Caulfield
The ruling on a causal link between a medicine and an adverse event, and whether that has led to death or injury, is made by the Medicines and Healthcare products Regulatory Authority. A process has to be followed—the process is independent of Government —and that has started on this range of vaccines. It remains vital that decisions are made on the evidence presented. Currently, the MHRA is going through the notes of affected patients to gather that evidence and look for causal links.
If these vaccines were perhaps five, six or seven years old, we would be in a very different place. However, as of 18 February this year, there have been 920 claims to the vaccine damage payment scheme related to covid-19. The work currently going on is establishing whether there is a causal link between the vaccine and the adverse events that people have been suffering. The yellow card scheme, which we have for all medicines, helps us to gather information, and I encourage people, whether they have had severe or minor symptoms—whatever they are—to report them, because that is how we gather evidence on medicines.
For all the claimants who have applied to the VDPS in relation to covid-19, while we are gathering evidence from their medical records, the approach will be to look at the assessment criteria and ensure that we are in the strongest possible position before we put the evidence to the medical examiner. That in turn will help ensure that claims are assessed as quickly as possible. We think that will take about six months. I will certainly meet my hon. Friend and ensure that we hold people’s feet to the fire so that there is not a longer delay than is needed. The NHSBSA is working as quickly as possible to progress claims. I understand that it has been in touch with claimants to update them on progress and will continue to update them as it has news.
We estimate that the process will take on average six months. It requires gaining access to people’s medical notes and their previous medical history, because, while someone may have had a reaction on the day, we cannot say for sure until we have looked at all the evidence that that is a causal link between the vaccine and the adverse event, even though there may be a strong suggestion that it is. It is therefore important to follow that process correctly.
My hon. Friend touched on payments. The payment was set originally at £10,000 in 1979, and it is currently £120,000. We have not made any payments in relation to the covid vaccine, but we are working at pace through all applications to the scheme and, once a causal link is established in those cases, we can look at those claims more swiftly.
Sir Christopher Chope
I am grateful to the Minister for agreeing to a meeting to discuss the further issues that she cannot cover tonight. On the £120,000 payment, that has not increased since 2007, so in effect it should now be worth £177,000. Why will the Government not give in on that point? That would be a great victory tonight.
Maria Caulfield
I am not going to commit tonight to increasing the payment—I think that is above my pay grade. Perhaps we can discuss that further when we meet.
I reassure people watching the debate and right hon. and hon. Members that the safety of the covid vaccine and its benefits outweigh any adverse events that may be caused by it. With any medicine—even a simple paracetamol—if people look at the yellow forms and the side effects mentioned on the leaflet in the packet, they will see that there are always side effects. We want to reassure people that the vaccine is still a safe and effective way of protecting them and their loved ones from the virus. However, where there have been concerns, we need to identify causal links and, if they are established, as my hon. Friend the Member for Rutland and Melton (Alicia Kearns) pointed out, we must be better at supporting people. I am very keen to do that.
Although these vaccines have been with us for nearly two years, they are still new in the lifespan of medicines and we are still learning about both their efficacy and their side effect profile. Each vaccine is assessed by a team of scientists and clinicians on a case-by-case basis. We are acting at pace, although it can feel like a long time for people affected by side effects. I will meet my hon. Friend the Member for Christchurch to discuss the matter further. I am keen to get support and payment in place for those affected, if we can, as quickly as possible.
Question put and agreed to.
Oral Answers to Questions
Maria Caulfield Excerpts(2 years, 8 months ago)
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Karl Turner (Kingston upon Hull East) (Lab)
The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)
We are determined to address the many health disparities that exist across England, particularly in areas such as maternity. Last week I was pleased to announce the maternity disparities taskforce. It aims to tackle the difference in outcomes for pregnant women based on their race and background, which we want to end.
Karl Turner
The problem is that the Government talk a good scrap, but their record on health inequalities is utterly deplorable. Before the pandemic, 4.5 million people were waiting for treatment on NHS lists, and 5,000 people in Hull were waiting for treatment at Hull Royal Infirmary and Castle Hill. Why is someone who lives in east Hull more than twice as likely to be waiting for more than 12 months on an NHS waiting list?
Maria Caulfield
While I recognise that the waiting times in Hull are some of the highest in the country, I am sure the hon. Gentleman will welcome the investment that the Government are putting into his constituency to change that. The Royal Infirmary and Castle Hill Hospitals have £60 million of funding, and his own hospital recognises that it will provide some of the most modern facilities in the country. That includes £2.8 million for new respiratory wards, £1.6 million for new specialist theatre facilities, and £1.1 million for oxygen resilience wards, ensuring that his local hospital is able to tackle some of those health disparities.
Nick Fletcher (Don Valley) (Con)
In addition to regional disparities, will the Minister look into disparities between men and women’s health? Men die four years earlier than women on average, 75% of suicides are by men, and during the time taken for oral questions, one man will die from prostate cancer. Through my work as chair of the all-party group on issues affecting men and boys, we have taken evidence that points to the need for a men’s health strategy. The Government have done much over the years to reduce the gender pay gap. Will the Minister help me to reduce the gender age gap?
Maria Caulfield
I absolutely take the point that my hon. Friend makes around the disparity in life expectancy between those in the most and the least deprived areas, which is greater for men. We will be publishing the health disparities White Paper, and we will focus on any disparities, including those that affect men.
Andrew Gwynne (Denton and Reddish) (Lab)
The Minister’s answer to my hon. Friend the Member for Kingston upon Hull East (Karl Turner) was quite frankly unbelievable. The fact is that waiting lists are projected to continue increasing year on year. NHS data shows huge regional inequalities in waiting times. Across the river, at Guy’s and St Thomas’ NHS Foundation Trust, over 70% of patients are being seen within 18 weeks, but in University Hospitals Birmingham NHS Foundation Trust just 38% of patients are being seen in that time. That is not levelling up, so exactly when do the Government plan on getting a grip on those health inequalities?
Maria Caulfield
I am disappointed that the hon. Gentleman is not happy with the investment going into Hull that will try to tackle some of those disparities, because we recognise that there are waiting lists.
Maria Caulfield
I do not know whether the hon. Gentleman realises that there has been a pandemic for two years. The Government have committed funding for elective recovery. We are investing in those areas that are in greatest need in the country, including Hull. I am sure that the residents of Hull welcome the investment that the Government are making in their hospital.
Bill Esterson (Sefton Central) (Lab)
The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)
Following the recent spending review, the next round of projects, including those from Mersey Care NHS Foundation Trust, are being considered, and local health systems should receive confirmation of their funding envelope for 2022-23 shortly.
Bill Esterson
In November 2018, the then Health Minister, the hon. Member for Winchester (Steve Brine), told me that building a new health centre in Maghull was a priority for NHS England, but the estates and technology transformation fund has closed and the funding for Maghull has not been approved by the Government. Can the Minister confirm that the Government still agree that a new health centre, as opposed to what she mentioned before, which is a mental health facility, is needed in Maghull? Can she also tell me what the funding arrangements are in the absence of the estates and technology transformation fund?
Maria Caulfield
I take the hon. Gentleman’s point, and of course he will lobby for more investment in his constituency. As I said, the funding envelope will be announced shortly, and it will be for his local area to decide how it spends that.
Sarah Champion (Rotherham) (Lab)
Mrs Sheryll Murray (South East Cornwall) (Con)
The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)
There are three ways in which we are increasing dental provision. First, we are increasing dental activity levels to 85%, as infection controls now allow us to. The second way is through the £50 million access fund, which will increase appointments by 350,000, and we encourage local commissioners to apply for that funding. Finally, we are reforming the contract, which, for too long, has resulted in a perverse disincentive for dentists.
Mrs Murray
I thank my hon. Friend for that answer, but my constituents are telling me that there are no places available with NHS dentists in my constituency. Will the Government now make that a priority following the covid pandemic?
Maria Caulfield
I thank my hon. Friend for all her hard work on campaigning for more dental appointments for her constituents. I believe that she met the Secretary of State last night to push him further on this. Her local area has an allocation of £4.7 million from the £50 million fund, and I encourage her to speak to her local commissioners to make use of that allocation. We are also looking at improving dental training so that we can get more dentists into her area.
Rachael Maskell (York Central) (Lab/Co-op)
Since dentistry was debated just a few weeks ago, another 10,000 of my constituents have received letters to tell them that they will have to go private. They are already waiting for five years to get an appointment. When will they actually get to see a dentist, or are they expected to have poor teeth?
Maria Caulfield
I am not sure where those constituents’ letters have come from, but if a contract has been handed back and that is the reason for the letter, the local commissioners should be looking for new providers, so I am very happy to meet the hon. Lady and her commissioners to see what is going on to make that happen.
Jason McCartney (Colne Valley) (Con)
Damien Moore (Southport) (Con)
The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)
I am very interested in hearing proposals on patient self-referral. I am happy to meet my hon. Friend. From a cancer perspective, we are also potentially looking at self-referrals for skin diagnosis for possible skin cancer and for breast lumps, because we want to reduce waiting times and increase GP capacity.
Alex Davies-Jones (Pontypridd) (Lab)
Maria Caulfield
I am happy to meet the hon. Lady. She raises a very important point that affects people who are desperate to try for children.
Laura Trott (Sevenoaks) (Con)
Mr Toby Perkins (Chesterfield) (Lab)
Maria Caulfield
I can only reiterate that we have a laser focus on this issue, and that is why we will be bringing forward the health disparities White Paper. I also point the hon. Gentleman to the NHS’s approach of the Core20PLUS5, where it is targeting the most deprived 20% of the population in five clinical priority areas: maternity, severe mental illness, chronic respiratory disease, early cancer diagnosis and hypertension. We will deliver on resolving disparities issues.
Jeremy Hunt (South West Surrey) (Con)
Today is the first day of Brain Tumour Awareness Month. The Secretary of State kindly wrote to me in January when my mother died from a brain tumour, and Baroness Tessa Jowell, who was much loved on all sides of the House, also died from a brain tumour. Given that it is the biggest cause of cancer death for the under-40s, and we still do not really know what causes them, does he agree that this should be a priority for research, so that we understand as much about brain tumours as about other cancers?
Kirsten Oswald (East Renfrewshire) (SNP)
Maria Caulfield
The hon. Lady raises an important point. She is right that women are under-represented in clinical research and are waiting far too long for diagnoses of conditions such as endometriosis. The women’s health strategy will be published very shortly and I think that she will be pleased with some of its recommendations to drive improvements forward.
Greg Smith (Buckingham) (Con)
I am grateful to the Minister for Health for giving his time over recent months to hear the case for an exciting and innovative new health centre for the village of Long Crendon in my constituency, as proposed by the parish council and action group. Will he update the House on where we are with finding funding to help the construction of the project?
Jane Hunt (Loughborough) (Con)
A dental practice in Shepshed has informed me that its NHS contract has changed little since 2006. Can the contracts and value of units of dental activity for treatment be increased to focus on prevention, rather than treatment alone?
Maria Caulfield
I absolutely agree; my hon. Friend hits the nail on the head of why we are seeing such problems in dentistry. We have started negotiations on the dental contract and are working with the British Dental Association. The UDA has to be reformed as part of that: it is a perverse disincentive that turns dentists away from providing NHS services. I will keep her updated on our progress.
Jim Shannon (Strangford) (DUP)
I thank all the Ministers for their responses. What steps have been taken to work with the Education Secretary to provide a higher number of places for medical students containing a golden handshake that allows for no student loan repayment or fees on condition that they stay in the NHS for a set time?
Maternity Services Improvement: Update
Maria Caulfield Excerpts(2 years, 9 months ago)
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The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)
Following the Baby Loss Awareness Week debate on 23 September 2021, I wish to update the House on progress with work to improve safe and equitable outcomes for women and families using maternity services.
The Government’s maternity ambition is to halve the 2010 rates of stillbirth, neonatal and maternal deaths and brain injuries in babies occurring during or soon after birth by 2025. The ambition also includes reducing the rate of pre-term births from 8% to 6%. Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK (MBRRACE-UK) have published several reports which provide some insight on progress towards meeting our ambition.
The last two years have been challenging but I am pleased to report on the good progress made with reducing stillbirths and neonatal deaths. According to Office for National Statistics data, the stillbirth rate has fallen 25% from 5.1 stillbirths per 1,000 in 2010 to 3.8 stillbirths per 1,000 births in 2020—unchanged since 2019—and the neonatal mortality rate for babies born from 24 weeks gestation has fallen 36% from 2.0 deaths per 1,000 live births in 2010 to 1.3 deaths per 1,000 live births in 2020.
In their perinatal mortality report published on 14 October 2021, MBRRACE-UK analysis has shown that the variation in stillbirth rates between NHS trusts has significantly reduced with 97% of trusts in England having stabilised and adjusted stillbirth rates within 5% of other trusts of similar size and case mix. The report suggested that this demonstrates “equitable healthcare provision across providers”.
Maternity services are also getting better at improving and learning from cases of perinatal deaths. The MBRRACE-UK third annual report on use of the perinatal mortality review tool (PMRT), published on 13 October 2021, that the proportion of deaths reviewed has increased with an estimated 83% of cases of babies who died in the perinatal period having been reviewed during March 2020 to February 2021. The report also found an increase of multidisciplinary teams carrying out reviews and an increase in parent engagement during the reviews.
The MBRRACE-UK maternal mortality report, “Saving Lives, Improving Mothers’ Care 2021: Lessons learned to inform maternity care from the UK and Ireland Confidential Enquiries in Maternal Death and Morbidity 2017-2019”, published on 11 November 2021, found that the maternal mortality rate in the UK was 8.8 per 100,000 in 2017-19, compared to 10.6 per 100,000, which shows a 17.4% decrease from the 2009-2011 baseline.
More progress is needed to meet our ambition to reduce the rate of brain injuries in babies occurring during or soon after births. On 5 November 2021, I announced that £3 million has been awarded to the Royal College of Obstetricians and Gynaecologists (RCOG) in collaboration with the Royal College of Midwives (RCM) and the Healthcare Improvement Studies Institute at the University of Cambridge (THIS Institute) to deliver the second phase of a brain injury reduction programme.
Phase one of this programme, also being led by the RCOG, RCM and THIS Institute, is focusing on developing national consensus on how best to monitor a baby during labour and to escalate any concerns about deterioration. Phase two will focus on developing the clinical tools and training approaches needed for future implementation to standardise the identification and escalation of a deteriorating baby.
Despite the reductions in stillbirth, neonatal mortality and maternal mortality rates seen since 2010, the MBRRACE-UK surveillance reports show us that women and babies of black or Asian ethnicity or those living in the most deprived areas are more likely to die from causes linked to pregnancy and birth compared to women and babies of white ethnicity or those living in the least deprived areas.
I am committed to tackling disparities in health outcomes and experience of care. On 6 September 2021, equity and equality guidance was published which includes an analysis of evidence, interventions to improve equity and equality, resources, indicators and metrics. The guidance asks local maternity systems to submit an equity and equality analysis—covering health outcomes, community assets and staff experience—and co-produce equity and equality action plans.
In conjunction with the guidance, four pledges for women, babies and staff were also published. The four pledges include:
Pledge 1: The NHS will take action to improve equity for mothers and babies and race equality for NHS staff.
Pledge 2: Local Maternity Systems will set out plans to improve equity and equality.
Pledge 3: Local Maternity Systems will receive support to improve equity and equality.
Pledge 4: the NHS will measure progress towards the equity aims.
I am also pleased to announce that I am establishing a maternity disparities taskforce to tackle disparities and reduce maternal and neonatal deaths by improving access to effective preconception and maternity care for women from ethnic minorities and those living in the most deprived areas. This taskforce will also aim to address the wider social determinants that are linked to poorer outcomes such as poverty, housing and smoking, drinking and obesity in pregnancy.
We know that improving women’s health in the run-up to pregnancy and improving the support they receive are vital to improving health outcomes for mothers and their babies. The taskforce will bring together experts from across the health system, Government Departments and the voluntary sector to address disparities in maternal and neonatal outcomes. The taskforce will work to consider and support evidence-based individual, community, and targeted population interventions to tackle disparities and will develop key priorities that will be included as commitments in the women’s health strategy.
I hope to hold the first meeting of the taskforce in early March, and plan to hold the meetings every two months afterwards to maintain progress with delivery of actions and interventions to tackle disparities in maternal and neonatal outcomes.
Finally, as a nurse who worked during the pandemic, I know how incredibly challenging the last two years have been. Therefore, I would like to say a personal thank you to all maternity staff for their hard work and dedication throughout the covid-19 pandemic to provide safe and personalised care for all mothers and their babies.
I hope to update the House again regarding the progress towards the Government maternity ambition and progress of the maternity disparities taskforce in due course.
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