Worker Protection (Amendment of Equality Act 2010) Bill

Maria Caulfield Excerpts

Friday 3rd February 2023 Commons Chamber

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

I beg to move amendment 1, page 1, line 1, at end insert—

“(1) The Equality Act 2010 is amended as follows.”

This amendment is consequential on Amendments 3 and 4.

[Mr Deputy Speaker (Sir Roger Gale)]

With this it will be convenient to discuss the following:

Amendment 2, page 1, line 2, leave out “of the Equality Act 2010”.

This amendment is consequential on Amendments 3 and 4.

Amendment 3 , page 1, line 11, at end insert—

“(1C) Subsection (1D) applies if and so far as—

(a) a third party harasses B in the course of B’s employment,

(b) the harassment falls within section 26(1) (unwanted conduct related to a relevant protected characteristic) and not within section 26(2) or (3) (unwanted conduct of a sexual nature etc),

(c) the conduct constituting the harassment involves a conversation in which B is not a participant, or a speech which is not aimed specifically at B,

(d) the conversation or speech involves the expression of an opinion on a political, moral, religious or social matter,

(e) the opinion expressed is not indecent or grossly offensive, and

(f) the expression of the opinion does not have the purpose of violating B’s dignity or of creating an intimidating, hostile, degrading, humiliating or offensive environment for B.

(1D) For the purposes of subsection (1A)(b), A is not to be treated as having failed to take all reasonable steps to prevent the harassment solely because A did not seek to prevent the expression of the opinion.””

This amendment makes provision about when an employer can be held liable for the harassment of their employee by a third party. Its effect is that, where relevant conditions are met, employers will not be expected to prevent the expression of opinions in order to avoid liability.

Amendment 4, page 1, line 11, at end insert—

“(2) In section 109 (liability of employers and principals), after subsection (4) insert—

‘(4A) Subsection (4B) applies if and so far as—

(a) A harasses another employee (C) in the course of C’s employment,

(b) the harassment falls within section 26(1) (unwanted conduct related to a relevant protected characteristic) and not within section 26(2) or (3) (unwanted conduct of a sexual nature etc),

(c) the conduct constituting the harassment involves a conversation in which C is not a participant, or a speech which is not aimed specifically at C,

(d) the conversation or speech involves the expression of an opinion on a political, moral, religious or social matter,

(e) the opinion expressed is not indecent or grossly offensive, and

(f) the expression of the opinion does not have the purpose of violating C’s dignity or of creating an intimidating, hostile, degrading, humiliating or offensive environment for C.

(4B) For the purposes of the defence in subsection (4), B is not to be treated as having failed to take all reasonable steps to prevent the harassment solely because B did not seek to prevent the expression of the opinion.’”

This amendment makes provision about when an employer can be held liable for the harassment of their employee by another employee. Its effect is that, where relevant conditions are met, employers will not be expected to prevent the expression of opinions in order to avoid liability.

[Maria Caulfield]

As the House is aware, the Government have provided their full support for the Bill throughout its passage. We believe that fundamentally everyone should be able to thrive in the workplace, without fear of harassment or violence, and the Bill helps to ensure that. The Government remain committed to this important piece of legislation and we hope it will continue to garner the strong cross-party support we have seen in its previous stages.

However, as with every new piece of legislation put before the House, we must be alive to any potential unintended consequences of changes in the law and seek to address those, where possible. There are concerns that the extension of protections against workplace harassment set out in the Bill, while entirely necessary, could inadvertently worsen the chilling effect on free speech in the workplace.

At present, under the Equality Act 2010, employers can already be considered vicariously liable for the harassment of an employee in the course of their employment, unless the employer can show that they have taken all reasonable steps to prevent the harassment from happening. Clause 1 of the Bill extends employer liability to also cover acts of harassment committed by third parties, such as customers or clients, if the employer fails to take all reasonable steps to prevent that harassment.

In 2018, the employment tribunal case of Sule v. Shoosmiths found the employer liable for harassment, following an incident when two employees were overheard within earshot of another colleague. There are concerns that such cases may cause some employers to feel under a duty to end or modify such conversations, in order to prove that they have taken all reasonable steps to prevent harassment.

Consequently, as a result of the Bill, it was feared that employers may take unreasonable or drastic measures to avoid liability for harassment of their staff, particularly by third parties, to the extent that they will feel obliged to shut down conversations conducted in their workplaces. That could include pubs seeking to prevent certain topics of discussion on their premises or universities cancelling or not inviting speakers to speak on matters that are considered controversial.

Therefore, the Government have tabled an amendment to the Bill to clarify to employers what is expected of them under the Bill, and the wider Equality Act 2010. We want the legislation to be clear, but while employers will be expected to take action against workplace harassment, those actions should fall short of prohibiting the conversation of others, subject to certain limitations that I will set out shortly.

The amendment is designed specifically to signal to employers and employment tribunals that in certain harassment cases, where the conduct concerns conversations where the claimant was not a participant, employers will not be expected to prevent the expression of opinion in order to avoid liability. Examples of cases where the claimant is not a participant could include overheard conversations or speeches not made directly to the claimant.

In those cases, an employment tribunal will not treat an employer as having failed to take all reasonable steps to prevent workplace harassment simply because they did not seek to prevent the expression of the opinion that formed part of the harassment claim. In other words, the amendment sets a ceiling on what can be considered reasonable steps for an employer. It does not seek to define what reasonable steps employers should take, but carves out one particular step that they are not expected to take.

The amendment will apply to cases of employee-on-employee harassment and cases of third-party harassment, with changes being made to both section 109(4) and section 40 of the Equality Act 2010 through amendments 3 and 4. Amendments 1 and 2 are simply consequential on amendments 3 and 4. However, a number of conditions all need to be met in order to trigger the amendment. Members can see those set out clearly in a list in proposed new subsections (1C) and (4A) in amendments 3 and 4 respectively. I hope Members will have the document to hand, as I will address each of the conditions in turn.

First, the amendments will apply only where the harassment is related to a protected characteristic and has taken place in the course of the claimant’s employment. That means it will not apply to cases of sexual harassment or less favourable treatment because one has either submitted or failed to submit to sexual harassment, or harassment related to sex or gender reassignment, as described in section 26 of the Equality Act 2010. Secondly, as I have set out above, the harassment must involve a conversation in which the claimant is not a participant or a speech that is not specifically aimed at them. Thirdly, the conversation or speech must contain the expression of an opinion on a political, moral, religious or social matter. That would exclude, for example, opinions on individual employees. Fourthly, the opinion expressed must not be indecent or grossly offensive.

Finally, the harassment must not be intentional. Under the Act, harassment is defined as unwanted conduct that has the purpose or effect of creating a hostile environment or violating a person’s dignity. The amendment will capture only cases where the harassment was not found to be intentional, as per the definition in section 26(1) of the 2010 Act. These limitations are intended to ensure that employers are not discouraged from taking steps to prevent extreme conduct, such as racial slurs or rape jokes, under the amendment. The Government are clear that such behaviour is not acceptable. The amendment is about protecting legitimate and appropriate workplace discussions, not targeted and grossly offensive remarks, or any form of sexual harassment. I should also be clear that the amendment will not affect the new duty on employers to take all reasonable steps to prevent sexual harassment in the workplace, as introduced in clause 2 of this Bill, which remains a key tenet of the Bill, as originally drafted.

To conclude, let me reiterate the Government’s support for the Bill and its important provisions. The employer duty and third-party harassment protections introduced by clauses 1 and 2 deliver against two Government commitments made in our national strategy for tackling violence against women and girls. They have widespread public and stakeholder support, and will ultimately improve working culture across this country. Amendment 1 does not detract from that. It provides what we believe is a necessary clarification of the expectations that this Bill and the wider Equality Act place on employers in relation to workplace harassment. We hope it will assist employers and employment tribunals in the accurate implementation of the new legislation and, in doing so, safeguard our vital right to free speech. The Government greatly welcomes the fact that the Bill’s sponsor, the hon. Member for Bath (Wera Hobhouse), has signed her name in support of the amendment. We hope that other Members will agree with our making this change and see the Bill on to the statute book as soon as possible.

[Wera Hobhouse (Bath) (LD)]

This Bill cannot be allowed to fall. It will make a huge difference to the lives of many people in the workplace and will help to provide a cultural shift in attitudes towards appropriate behaviours at work. The Government’s amendment will not impinge on the protections from sexual harassment in the Bill, which will be so important to many women across the country—although of course sexual harassment is not faced only by women. I have also been assured that the amendment should not stop employers prohibiting targeted, indecent or grossly offensive conversations in the workplace, meaning employees will still be protected from third-party workplace harassment.

After taking advice from the Fawcett Society and the Equality and Human Rights Commission, I have concluded that I should get behind the Government’s amendments, because the overall aims of the Bill are so important and it is important that it is put into statute. As a Liberal, of course I do not want important political conversation to be shut down in the workplace; people should be free to express an opinion. However, we should be careful to ensure that expressing an opinion does not become a defence for harassment.

I was slightly disappointed that the Government tabled their amendments after Committee had concluded. That led to an enormous rush, and it was quite difficult to consult with everybody, but as I said, I have been assured and have concluded that it is the right way to progress with the Bill, and I support the amendment.

I urge the Government to listen to the concerns of the EHRC, which argues that the amendments could be more targeted and limited, and the National Alliance of Women’s Organisations, which worries that the amendments risk diluting these changes, which seek to make workplaces safer, fairer and more respectful not just for women but for everybody. I hope the Government will commit to ensuring the Bill’s smooth passage into law, working with all stakeholders who have voiced their concerns.

--- Later in debate ---

[Danny Kruger]

I thank the hon. Member for that advice. I will look forward to that guidance, as I have great faith in that commission under its present chair to make sensible guidance.

For the sake of clarity, is it the case that the list of criteria—the eligibility for the law to be triggered—are individual criteria, so that if any of these criteria are not met, then the law does not apply? Or is it that every single one of them must be met for an employer to be exempt from the operations of the Act? I fear that if they are all required to be met, that is a very high bar for employers to get over, and I would rather it was just any of them being met.

I end by expressing my concern about how, increasingly, the spirit of our law is simply declaratory. We decide that something is bad in our society and we pass a law saying that it is bad and that it should not happen, and we expect that to work. What we need to consider in drafting and passing legislation is the actual effect of the law on the people who will be responsible for enforcing it, given the culture and the effect of the culture on the law. The law is a teacher, and we must be aware of the attitudes, the spirits, the fears and the politics, including the increasingly transgressive politics, of people with power our country’s public life and about how they will use the laws that we are passing. In future times, what will be done with laws such as this? I would be grateful to the Minister if she could reassure me on those points.

[Maria Caulfield]

I thank my hon. Friend the Member for Devizes (Danny Kruger) for raising those points. The amendments make the case that any harassment must be directed to the employee; it cannot simply be third-party conversations that are overheard. To his specific point, all the conditions must be met for the amendment to be triggered. I recognise that he says that that is a high bar, but that is the case.

Turning to my hon. Friend’s examples, such as whether banter will be banned, I gently say that if it is directed at the employee, that can be sexual harassment. One person’s banter is another person’s harassment, and we need to be mindful of that. The other example that he gave was of a footballer: if the crowd are singing a song or directing a chant, that can be targeted harassment. We have multiple examples of footballers being targeted either because of their race or their colour. That is not acceptable and football clubs take action on that now.

As the hon. Member for Bath (Wera Hobhouse) said, guidance will be issued. We understand that it will be difficult for employers and we know that they need clarity. That is why we have tabled these amendments today. Third-party conversations that are not directed at an employee will be exempt, as is the case if all the conditions in the amendment are met. Direct harassment of an employee, whether that is banter or a song at a football match, is still harassment. That is why we need the Bill.

Amendment 1 agreed to.

Amendments made: 2, page 1, line 2, leave out “of the Equality Act 2010”.

This amendment is consequential on Amendments 3 and 4.

Amendment 3 , page 1, line 11, at end insert—

“(1C) Subsection (1D) applies if and so far as—

(a) a third party harasses B in the course of B’s employment,

(b) the harassment falls within section 26(1) (unwanted conduct related to a relevant protected characteristic) and not within section 26(2) or (3) (unwanted conduct of a sexual nature etc),

(c) the conduct constituting the harassment involves a conversation in which B is not a participant, or a speech which is not aimed specifically at B,

(d) the conversation or speech involves the expression of an opinion on a political, moral, religious or social matter,

(e) the opinion expressed is not indecent or grossly offensive, and

(f) the expression of the opinion does not have the purpose of violating B’s dignity or of creating an intimidating, hostile, degrading, humiliating or offensive environment for B.

(1D) For the purposes of subsection (1A)(b), A is not to be treated as having failed to take all reasonable steps to prevent the harassment solely because A did not seek to prevent the expression of the opinion.”

This amendment makes provision about when an employer can be held liable for the harassment of their employee by a third party. Its effect is that, where relevant conditions are met, employers will not be expected to prevent the expression of opinions in order to avoid liability.

Amendment 4, page 1, line 11, at end insert—

“(2) In section 109 (liability of employers and principals), after subsection (4) insert—

‘(4A) Subsection (4B) applies if and so far as—

(a) A harasses another employee (C) in the course of C’s employment,

(b) the harassment falls within section 26(1) (unwanted conduct related to a relevant protected characteristic) and not within section 26(2) or (3) (unwanted conduct of a sexual nature etc),

(c) the conduct constituting the harassment involves a conversation in which C is not a participant, or a speech which is not aimed specifically at C,

(d) the conversation or speech involves the expression of an opinion on a political, moral, religious or social matter,

(e) the opinion expressed is not indecent or grossly offensive, and

(f) the expression of the opinion does not have the purpose of violating C’s dignity or of creating an intimidating, hostile, degrading, humiliating or offensive environment for C.

(4B) For the purposes of the defence in subsection (4), B is not to be treated as having failed to take all reasonable steps to prevent the harassment solely because B did not seek to prevent the expression of the opinion.’”—(Wera Hobhouse.)

This amendment makes provision about when an employer can be held liable for the harassment of their employee by another employee. Its effect is that, where relevant conditions are met, employers will not be expected to prevent the expression of opinions in order to avoid liability.

Third Reading

--- Later in debate ---

[Maria Caulfield]

I congratulate the hon. Member for Bath (Wera Hobhouse) on bringing the Bill to its Third Reading and on the way in which she has championed the fight against workplace harassment. I very much take on board her point about the short notice of the amendments, but I am grateful for her support for them. As I am sure she has heard in the debate, there were concerns about freedom of speech.

I thank all hon. Members who have taken part in the debate—it has been a privilege to debate the proposals with such strong support in the House. I thank my hon. Friend the Member for Guildford (Angela Richardson) for her support. I hope that the legislation will protect her daughter’s generation in the workplace. My hon. Friend the Member for North West Norfolk (James Wild) was right: the vast majority of employers do the right thing, but it is important to protect those in the workplace when the right thing does not happen.

My hon. Friend the Member for South West Hertfordshire (Mr Mohindra) was right to say that there can be unintended consequences, and he gave good examples of them. I am pleased that the amendments have reassured him and that he feels able to support them. That is also the case for my hon. Friend the Member for Bracknell (James Sunderland), who had concerns about freedom of speech. I am pleased that our amendments have also given him reassurance.

Above all, the Bill is about fairness, safety and protecting the workplace. The Government are committed to ensuring that everyone feels safe and is able to thrive in work. In 2019, we held a consultation on sexual harassment in the workplace, and we hope that this legislation will meet many of the concerns that were raised during that period. The Bill demonstrates its own importance, as we have heard this afternoon. The two principal measures are to introduce explicit protections from workplace harassment by third parties such as customers or clients and to place a duty on employers to take all reasonable steps to prevent their employees from experiencing harassment. These new protections against third-party harassment will make an employer legally liable if they fail to take all reasonable steps to prevent third parties from harassing their staff. In concrete terms, this means that employers will now assess the harassment risk that third parties pose in their workplace and will take steps to protect their staff. Bartenders will be better protected from unwanted sexual conduct by drunk customers, and NHS staff will be better protected from racial abuse by patients.

The question of whether an action is reasonable is very familiar, and we have heard a lot about it today. I stress that the Bill does not require employers to succeed in stopping all harassment at work—that is, sadly, impossible and would be unrealistic. The Bill requires employees to take all reasonable steps to protect their employees in circumstances in the workplace where harassment can take place. On Report, Members supported the Government’s amendment to clarify for employers what is expected of them under the Bill and the wider Equality Act.

To conclude, the measures in the Bill will strengthen the protection for employees against workplace harassment. The Government are pleased to continue to support this private Member’s Bill, and I pay tribute to the hon. Member for Bath for making such progress with it.

Attention Deficit Hyperactivity Disorder: Diagnosis

Maria Caulfield Excerpts

Wednesday 1st February 2023 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 Nokes. I thank my right hon. Friend the Member for Tatton (Esther McVey) for securing this important debate. I believe there are two more debates on this issue next week in this Chamber, so she is leading the way in securing this debate, as a starter for that further consideration.

This is a really important issue. We know that people with ADHD have positive traits, strengths and abilities, such as creativity, resilience and the ability to hyper-focus. My right hon. Friend referred to her constituent Tanya Bardsley, who has shown that people with ADHD can be extremely successful, but there are also challenges, as she clearly set out, in living with ADHD and in getting a diagnosis, which is often necessary for people to get the support they need. I am not going to pretend that there is not a problem with accessing assessments at the moment. Many of my constituents also come to see me about that, and many have to go private to get a diagnosis. I fully acknowledge that that is not acceptable.

NICE, which provides the evidence-based guidance, says that commissioners and providers should have due regard for the evidence base when designing and commissioning services. However, my right hon. Friend highlighted a number of key issues that hamper how patients and their families access services. NICE does not actually recommend a maximum waiting time for a diagnosis, so there is no benchmark or gold standard to measure services against. That means that services sometimes struggle to meet what we would consider an acceptable waiting time for assessment. NICE sets out considerations about who should make a diagnosis and the criteria for diagnosis, but the long waits are due to the fact that there is no benchmark for the maximum waiting time.

The second issue that my right hon. Friend highlighted is a national dataset for ADHD assessment waiting times. There is no national collection of data and I note that she said that charities have gone to each ICB for data. In a way, it is encouraging that that data is there, but we need to pull it together nationally so that we have oversight and, as she put it, a waiting list dashboard that we can see. That would be useful not only to see what is happening in terms of best practice but to identify any gaps in certain parts of the country that may have longer waiting times than others.

I am certainly happy to pledge to my right hon. Friend that I will look at that. We are doing so much work in this area at the moment. For decades, mental health services, including neurodiversity services, have been the Cinderella service in health, with physical health much more predominant. We are making the change now to achieve parity of esteem between the two services, but there is a lot of work to do to catch up, and having the data to be able to measure waiting times and standards is a key part of that.

As my right hon. Friend set out, diagnosing ADHD is challenging, because there is no definitive test for it. There are a number of indicators that could suggest an assessment is needed, but someone needs to be seen for that to happen. ADHD often exists in conjunction with other conditions, whose symptoms can overlap and mask those of ADHD. The NICE guidelines aim to improve the diagnosis of ADHD, as well as the quality of care and support that people with ADHD receive.

The NICE guidelines also recognise that ADHD is under-diagnosed in women and girls, and that the indicators are very different. In my work in mental health, we see the consequences of that in young women and girls being admitted to mental health in-patient facilities and having a higher rate of suicide. My right hon. Friend is absolutely correct in what she says.

There are a number of ways in which we are trying to improve access to assessment and diagnosis. Many children and young people seek diagnosis through child and adolescent mental health services, but there are pressures on those services too. We are providing funding to increase access; in the last financial year, £79 million was allocated, which allowed 22,500 more children and young people to access mental health services. As my right hon. Friend eloquently said, it is vital that a person gets a diagnosis as early as possible in their life, so that they get support as soon as possible.

We know that children with ADHD and other neurodiverse conditions such as autism can thrive in and out of school if they get the support they need. We have a trial under way in Bradford looking at an early diagnosis tool to help teachers, parents and others to identify the needs of those with neurodiverse conditions. If successful, that could be expanded across the country. I will update Members as soon as we have the results of the pilot, because we are keen to see improvements in attendance, behaviour and educational outcomes in schools, as well as in the quality of life experienced by children and their parents. The tool is not intended to replace clinical diagnosis, but it should enable support to be made available earlier to children and their parents while they wait for an assessment and a diagnosis.

We also have the special educational needs and disabilities Green Paper, which sets out proposals to improve the outcomes of children and young people with SEND, including those with ADHD, and we will publish a full response to the Green Paper in an improvement plan imminently. Hopefully, my right hon. Friend will feel that that addresses some of the issues that she has raised today.

One of the best forms of practical support that I have seen is the mental health support teams that are now being placed in schools. There are currently 287, which support 4,700 schools, or around 26% of pupils. That figure will increase to 35% of pupils in April. The teams support teachers to identify children who may have ADHD, other neurodiverse conditions or mental health issues, and get them signposted and into the system much quicker. The service is making a real difference on the ground, and we are keen to expand it as quickly as possible. As my right hon. Friend said, children and young people with ADHD suffer higher rates of anxiety—nearly 50% higher than the general population—which is why we need to get that support in as quickly and easily as possible.

I acknowledge that we are not where we want to be with support for ADHD, whether on diagnosis, support or access to assessments. When we respond to the Green Paper, we will hopefully show that we are serious about changing that and making support more easily available. The Bradford pilot will hopefully improve access to services, but the key is getting the data. I commit today to look at the data on waiting times and at a dashboard, because we cannot plan services if we do not know how many people are waiting for an assessment and an ADHD diagnosis. I completely acknowledge that point.

I am happy to meet my right hon. Friend’s constituent Tanya Bardsley. She sounds like an amazing woman—experts by experience are very valuable indeed. I know that there is more to do to improve access to ADHD assessments, but I hope that I have reassured my right hon. Friend that we take the issue seriously.

Question put and agreed to.

NHS Hysteroscopy Treatment

Maria Caulfield Excerpts

Tuesday 31st January 2023 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Sir Mark. I congratulate the hon. Member for West Ham (Ms Brown) on securing this important debate. As Minister, I also responded to her debate on the subject last year and I recognise her campaigning on the issue.

First and foremost, I recognise the pain suffered by women during the hysteroscopy procedure. Many women have contacted me to share their stories and distress. The testimony of the shadow Minister, the hon. Member for Enfield North (Feryal Clark), was powerful in explaining the distress the procedure can cause.

We have seen some progress around the tariff issue, which I will touch on later in my remarks. Last year, the tariff system financially rewarded out-patient settings that undertook hysteroscopies, but that has changed. However, I take the point made by the hon. Member for West Ham about getting it right first time. I may be doing the same with a new initiative, so I will certainly commit to looking at that.

We heard about patients such as Julie, and about how, right from the very start, an appointment letter is sent out that does not provide information about what to expect or the choices that are available. We heard about the procedure itself, including what pain relief is given, and the need to give women informed consent—they can have a general anaesthetic or ask for the procedure to stop. Another 30 seconds is not the answer to “stop”, and that would be my first concern.

My hon. Friend the Member for Thurrock (Jackie Doyle-Price) made a valid point about why the procedures are being done in the first place, and the testimony of Martha lends itself to that. Bleeding after HRT is very common for the first three to six months, and it is usually only after six months, or if there has been bleeding after long periods of non-bleeding, that perhaps an investigation could be considered. My hon. Friend pointed out that sometimes we carry out the procedure where there is not necessarily a clinical case for it. Both the procedure itself and the reason for it need to be justified in those cases.

As the shadow Minister said, hysteroscopy is an essential investigative tool. We do not want to put women off coming forward for diagnosis of their conditions or for investigations into distressing problems—whether it be heavy periods, miscarriages or difficulty getting pregnant—but it is true that women’s experiences of pain, and sharing those experiences with friends and family, can put women off or prevent someone from coming back for treatment or further investigation. Many women experience little or no pain, but the percentage that do experience pain is of significant concern.

The hon. Member for York Central (Rachael Maskell) highlighted the experience of Jan and the sheer scale of her pain. That was very powerful, and I reiterate to Jan’s husband, Steve, that her voice has been heard very powerfully in the debate. I am keen that we make progress on the issue, because we, like the hon. Member for West Ham, who comes on an annual basis, have been talking about it for far too long. I am keen to meet with the Campaign Against Painful Hysteroscopy group, and hope to do so fairly soon, to discuss how we can take the issues forward. A general anaesthetic can be used in some circumstances, but there are also a range of other anaesthetics—it does not have to be general anaesthetic—to make the procedure less painful.

For most women, the first issue is choice, having information about what to expect up front and being able to make a decision based on that. That needs to be done in advance of the procedure and not, as my hon. Friend the Member for Thurrock described, when your legs are in the stirrups. That is why the guidance is so important. The Royal College of Obstetricians and Gynaecologists provides evidence-based guidance. It is old, and it is being updated. My understanding is that RCOG is producing a good-practice paper on pain relief and informed decision making for out-patient hysteroscopy that will be published imminently— I understand in days rather than weeks or months. I committed in the debate last year to wait for that, and I hope that it will be through fairly soon. If we can get those good-practice guidelines, it is essential that they are rolled out in practice.

[Ms Lyn Brown]

I do not really know how to phrase this, but part of the problem is that, as we have heard, gynaecologists are basically being utterly insensitive to the needs of the women they are treating. My anxiety is that we will be told, yet again, that it is all okay, and that they have changed this or tweaked that. But the stories that we have heard today are from this year, so there has not been change. I am not sure whether we will be able to manage change unless the Minister is quite firm about the actions that she wants to see.

[Maria Caulfield]

I very much take the hon. Lady’s point. The change to RCOG guidance is not the only way we will change this. The hon. Member for Strangford (Jim Shannon) highlighted his wife’s experience, which also shows why this is so important. The royal college is important because it can bring clinical change on the ground, but it is not enough just to assume that its updated guidance will be enough to change what happens in practice. Its current guidance already sets out that a leaflet should be provided with information about what a hysteroscopy is, what happens, and what the possible risks and alternatives are, but that does not always happen. Women can choose whether to have their hysteroscopy in an outpatient setting or have a general anaesthetic and come in as a day case. They do not always get that leaflet now, so just changing the guidance does not necessarily mean that we change the practice, and that is the key.

It is important that women are in control when it comes to hysteroscopies, which we are talking about today, and many other issues that we have debated. That is the fundamental principle behind the women’s health strategy, which we introduced because women are very often not listened to in all aspects of their healthcare.

The hon. Member for Enfield North touched on the top priorities for the first year of the women’s health strategy. The reason that hysteroscopy did not make that list is that we want to wait for the guidance before we act, but it will be a high priority, and work is starting this year.

One of the key priorities is to provide better information to women and girls about their health. We are setting up a space on the NHS website for women’s health so that women who are going for a procedure have go-to information. If they are thinking, “I don’t know what a hysteroscopy is. I don’t know what sort of tests I need. I am going for an ultrasound, but what else might they suggest to me while I am there?” they can go to that site and get reliable information that will help them make that decision. If they are not sent a leaflet and the procedure is not discussed in the clinic, they will be able to know in advance what to expect. We want that to happen this year so that women have more power when making decisions about their healthcare needs.

Waiting times for gynae procedures have not come up much today, but we know that the covid pandemic has had an impact on them. Gynae procedures are part of the elective recovery plan, which is why we are investing in community diagnostic centres to get those waiting lists down as quickly as possible. It is hoped that by having specialist centres such as community diagnostic centres, which are specialists in doing diagnostic tests, we may be able to improve women’s experience.

One of the things that will make the greatest difference is the appointment of Professor Dame Lesley Regan as the first women’s health ambassador—my hon. Friend the Member for Thurrock mentioned her. She is a female gynaecologist, and she completely gets the issues facing women. We also now have the patient safety commissioner, Dr Henrietta Hughes, who was appointed last year. She is a female GP. Dame Lesley has been passionate about this issue for many years and has been working with women’s groups on it. I have asked her and Dr Hughes to discuss hysteroscopies. They are planning a roundtable on the issue to get stakeholders round the table to discuss how we can make things happen in practice. If guidance is issued, how do we make sure that is what is happening on the ground? The roundtable will be chaired by Dame Lesley, and the patient safety commissioner will be attending. I will update Members on their recommendations, which I will take extremely seriously, and I will want to implement them as quickly as possible.

[Rachael Maskell]

I am grateful for the Minister’s response. Will she include women from ethnic minority groups? Their experience of the health system is very different, so it is really important that their voices are heard in this discussion.

[Maria Caulfield]

Absolutely. Dame Lesley has been very keen in some of her first work to ensure that we go out to women, rather than expecting women to come to us with their experiences. Often, if we wait for them to come to us, it is the usual voices that get heard. The people who have the greatest difficulties accessing healthcare are often the ones who get missed, so I can absolutely reassure the hon. Lady about that.

That is why we are setting up women’s health hubs, which are a particular priority of the women’s health ambassador. They are go-to one-stop shops that have experienced women’s healthcare professionals. If someone is going for a smear test, contraceptive advice or perhaps a hysteroscopy, there are experienced practitioners there who can support women’s health needs and perhaps give a better experience than many women have now. We hope to improve women’s experience in those areas.

I say to the hon. Member for West Ham that I absolutely recognise the significance of this issue. It is unacceptable that a test that is so important for women’s health is currently such a painful experience. We changed the tariff in the hope that it would encourage the use of general anaesthetics if that is what women want, because we felt that the previous tariff system worked against that. However, I am really keen that we deliver changes on the ground once we get the royal college guidelines and the roundtable with Professor Dame Lesley Regan and the Patient Safety Commissioner, who are there to advocate for women and patients. I hope that will be within the next few months, and I am happy to meet the hon. Member for West Ham, as I will be meeting the patient campaign groups too.

We can change this behaviour. A woman who is having a hysteroscopy should know in advance what is involved and what her choices are. She should feel confident that if she turns up for her appointment and finds it uncomfortable, which she was not expecting, the procedure can be halted and a separate appointment can be made swiftly to make sure that the procedure is as comfortable as possible. I hope that gives some reassurances that I absolutely take the seriousness of this issue on board, and that we want to make a change and a difference for women.

PIP Breast Implants

Maria Caulfield Excerpts

Monday 30th January 2023 Commons Chamber

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

I congratulate the hon. Member for Putney (Fleur Anderson) on securing this important debate. Let me begin by expressing my sympathy for the women who have suffered as a result of exposure to substandard PIP implants.

As soon as it was found that PIP had fraudulently changed the filler material used in its implants, they were withdrawn from use in the United Kingdom, back in 2010. It is true—as with all medical devices—that there are some risks associated with any breast implant, but the Medicines and Healthcare products Regulatory Agency, the UK regulator for medicines and medical devices, monitors all incidences reported to it, ensuring that they are investigated fully and any necessary action is taken. At the time, the MHRA worked with the NHS and other health partners to ensure that this specific issue was thoroughly investigated. It has undertaken extensive engagement work with PIP campaign groups such as PIP Action Campaign, and is committed to ongoing engagement with affected patients.

PIP implants were found to involve a higher risk of rupture than other implants, with a rupture rate roughly twice that of other types of implant. Ruptures often lead to unpleasant symptoms such as pain, hardness of the breast and swollen lymph glands, as well as many other side-effects to which the hon. Lady referred, although there is no evidence that ruptured implants—PIP implants or other types of implant—can cause serious long-term health risks.

[Sarah Champion]

I thank the Minister for engaging with this topic. I am aware that she knows about the field. Can she please explain why, more than a decade ago, both France and Sweden withdrew this device and facilitated the change in the process?

[Maria Caulfield]

I will come on to that. As I said earlier, we stopped the use of these implants immediately in 2010. As for the 47,000 women who were given PIP implants, mainly in private clinics, they are now able to come forward and have those implants removed on the NHS if their doctors agree. Many women have done that, either to avoid the risk of rupture or to prevent it from happening if they fear that it might.

The hon. Lady asked for an inquiry. As she mentioned, independent reviews have been conducted, expertly led by Lord Howe in 2012 and by Sir Bruce Keogh in 2012 and 2013. The Department has led a programme of work to ensure that the recommendations from all those reviews have been implemented, including a set of actions to prevent this from happening again. We have ensured that cosmetic surgery is effectively regulated, and that only doctors who are registered with the General Medical Council can perform surgical procedures. We have introduced a number of measures requiring all surgeons offering cosmetic procedures to follow the guidelines. The Care Quality Commission now has a duty to rate and assess the performance of providers of surgical cosmetic procedures to ensure that they meet fully the standards of safety and quality expected of them, and enforcement action is taken when they do not.

As the hon. Lady also mentioned, the Breast and Cosmetic Implant Registry was established in 2016. It collects detailed information on every implant, so that affected women can be traced and contacted in the event of a product recall or safety concern. The difficulty involved in doing that retrospectively is that many of the procedures took place in private clinics where there was no access to that information, either because it was not recorded at the time or because it was recorded but difficult to access. However, the registry covers both the NHS and the private sector, so that would not happen today, and it covers England, Scotland and Northern Ireland.

The lessons learned from the work on PIP and the recommendations made by Baroness Cumberlege in her report on medical devices have been used to drive wider-ranging improvements. NHS England now has speciality-level clinical steering boards for the top 10 medical devices implanted, which represent around 80% of the implants now used. The boards drive forward improvements for implants used in a range of medical devices, and are developing the medical device registry to ensure that the relevant patients can be traced and contacted if problems exist.

The MHRA intends to further drive forward this issue by improving the traceability of medical devices through the unique device identifier and implant cards. Again, those were not available when the incidents happened. The Medicines and Medical Devices Act 2021 introduced powers to allow the MHRA to improve transparency on medical device safety issues. As the hon. Lady indicated, we now have the plastic, reconstructive and aesthetic surgery expert advisory group, which looks for future issues around implants or other medical devices used in aesthetic surgery in a way that was not available back in 2010.

The breast cancer element is important for women to know. I take the hon. Lady's point about making that information more readily available. I also take her point about the black box labels that the FDA is using in the US, to see if we need to improve the information available for women. Any breast implant has the potential to cause a very rare form of non-Hodgkin’s lymphoma called breast implant-associated anaplastic large cell lymphoma. It is not breast cancer but a rare form of non-Hodgkin lymphoma that grows in response to the body’s reaction to a breast implant. It is not specifically related to PIP; there is a small risk from any breast implant. The MHRA has issued guidance for people with breast implants, but I take the hon. Lady’s point that women need to be informed of that small risk when deciding to go for a cosmetic procedure. We will follow up on that after this debate.

[Fleur Anderson]

I thank the Minister for her reassurance about what will happen now. I am thinking back to those women who have been affected; I take the point that it is hard to trace them. Could the Minister look at asking GPs if they know whether women have had implants, so that they can be contacted and informed about the links with the cancer, through those means if no other?

[Maria Caulfield]

Absolutely. It is important to ensure that women who have had PIP breast implants in the past are reassured and have the opportunity to come forward. As part of the women’s health strategy this year, we are developing a space on the NHS website—a go-to, informed place—specifically for women’s health. I am happy to raise this issue with officials to make sure that the information is there. PIP implants have a higher risk of rupture, but not necessarily a higher risk of the lymphoma that we have talked about. There is a small risk with any breast implant. We need to make that clear to women.

The company that produced the implants was the third biggest supplier of breast implants in the world. It went into liquidation in 2010. The founder was convicted of aggravated fraud and sentenced to four years in prison. The company had to take responsibility for its actions. I take on board the point that women who have had those implants can have them removed, but they need to know that that is available to them. I am happy to work with the hon. Lady to see whether we can improve that advice and information for women.

I reassure the House that the Government and I have patient safety and women’s health as a top priority. We will continue to keep current initiatives under review. We have put safeguards in place. I do not want to tempt fate, but we are not likely to see the same incident again, where we cannot trace women who have had the implants. We need to support those women who have been affected, and I am happy to work with the hon. Lady to make sure that that happens.

Question put and agreed to.

Covid-19: 2023 Vaccination Programme

Maria Caulfield Excerpts

Wednesday 25th January 2023 Written Statements

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

Since the first covid-19 vaccine was authorised for use in the UK in December 2020, the aim of the covid-19 vaccination programme has been, and continues to be, the reduction of severe disease—hospitalisation and mortality—across the population, while protecting the NHS.

The independent Joint Committee on Vaccination And Immunisation (JCVI) has provided interim advice on the 2023 covid-19 vaccination programme for planning purposes.

The JCVI’s interim advice is that:

In autumn 2023, persons at higher risk of severe covid-19 would be offered a booster vaccine dose in preparation for winter 2023-24;

in addition, for a smaller group of persons (such as persons of older age and those who are immunosuppressed) an extra booster vaccine dose may be offered in spring 2023;

emergency surge vaccine responses may be required should a novel variant of concern emerge with clinically significant biological differences compared to the omicron variant.

The JCVI has also provided advice on the ongoing offer of initial covid-19 vaccination—primary course—and 2021 booster dose offers—third dose. As the transition continues away from a pandemic emergency response towards pandemic recovery, the JCVI considers that the risk of severe covid-19 continues to be disproportionately greater in those from older age groups, residents in care homes for older adults and for persons with certain underlying health conditions.

The JCVI’s advice is that:

The 2021 booster offer (third dose) for persons aged 16 to 49 years who are not in a clinical risk group should end in alignment with the close of the autumn 2022 vaccination campaign;

otherwise healthy persons aged 5 to 49 years, who develop a new health condition in 2023 that places them in a clinical risk group would be offered primary vaccination and/or a booster vaccine during the next seasonal vaccination campaign, as appropriate. Vaccination outside these campaign periods would be subject to individual clinical judgement;

primary course (initial doses) of covid-19 vaccination should move, over the course of 2023, towards a more targeted offer during vaccination campaigns to protect those persons at higher risk of severe covid-19; this would include:

residents in a care home for older adults and staff working in care homes for older adults

frontline health and social care workers

all adults aged 50 years and over

persons aged 5 to 49 years in a clinical risk group

persons aged 12 to 49 years who are household contacts of people with immunosuppression

persons aged 16 to 49 years who are carers

research should be considered to inform the optimal timing of booster vaccinations to protect against severe covid-19 (hospitalisations and death) for groups who are at different levels of clinical risk.

His Majesty’s Government have accepted the JCVI’s advice. In England, the 2021 booster offer—third dose—for persons aged 16 to 49 years who are not in a clinical risk group will end in alignment with the close of the autumn 2022 campaign in England on 12 February 2023. The JCVI’s advice to target the initial vaccination—primary course— offer to those at higher risk from covid-19 has been accepted by HMG subject to further consideration of timings.

I am informed that all four parts of the UK intend to accept the JCVI’s advice on the same basis.

I will update the House when further advice is received from the JCVI on the covid-19 vaccination programmes recommended for 2023, including confirmation of whether a spring booster programme is advised.

[HCWS518]

Mental Health: Capital Investment and Rapid Review

Maria Caulfield Excerpts

Monday 23rd January 2023 Written Statements

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

I am pleased to share an update on the Government’s £150 million of capital investment in NHS mental health urgent and emergency care infrastructure, first announced as part of the 2021 spending review. This investment—being delivered through NHS England—will support people experiencing, or at risk of experiencing, mental health crisis to receive care and support in more appropriate settings outside of A&E and inpatient facilities, in turn improving the experience and alleviating pressures on local urgent care pathways and in the wider system.

Seven million pounds of the investment is specifically being used to centrally procure up to 100 specially designed mental health ambulances over the next two years. These vehicles will be staffed by both physical and mental health professionals, equipped to respond to and assess people on-scene or take people to the most appropriate place for care, reducing the amount of people who are taken to A&E by ambulance services. The vehicles, designed by patients and clinical experts, will provide a much calmer environment than the traditional fully kitted, bright yellow ambulances. They have been designed with simple NHS ambulance service logos and will have a less clinical interior with dimmable lighting, equipment to play music and space for parents, carers or companions to accompany during assessments and transfers.

The remaining £143 million of capital funding is being invested in providing and improving a range of spaces to more appropriately support people experiencing, or at risk of experiencing, mental health crisis. This includes the redesign and refurbishment of existing mental health suites and facilities including in emergency departments, the provision of spaces outside of A&E and the expansion of crisis lines. The programme also includes schemes designed to avoid people reaching crisis, such as improvement of sanctuary spaces and community mental health facilities.

This is alongside investment of almost £1 billion extra in community mental health care for adults with severe mental illness by 2023-24. This will give 370,000 adults and older adults with severe mental illnesses, including eating disorders, greater choice and control over their care and support them to live well in their communities.

Today, I am also announcing the commencement of a rapid review into patient safety in mental health inpatient settings in England. This review is an essential first step in improving safety in mental health inpatient settings. It will focus on what data and evidence is currently available to healthcare services, including information provided by patients and families, and how we can use this data and evidence more effectively to identify patient safety risks and failures in care. I am immensely pleased to announce that the review will be chaired by Dr Geraldine Strathdee. Dr Strathdee brings a wealth of experience from working for over 20 years in senior roles in mental health policy, regulation and clinical management, at national and regional levels.

Dr Strathdee will remain the chair of the Essex Mental Health Independent Inquiry, which is looking at inpatient mental health deaths in Essex between 2000 and 2020 and which will continue its work during the period of the rapid review. The rapid review will be separate from, but complementary to, the Essex inquiry, and we are excited that she brings her significant expertise from all her work on mental health so far. Dr Strathdee also has a long-standing passion for using data to improve services.

NHS England has also established a three-year Quality Improvement programme which seeks to tackle the root causes of unsafe, poor-quality inpatient care in mental health, learning disability and autism settings. My officials will continue to work closely with their colleagues in NHS England to make sure the review is aligned with and complementary to the Quality Improvement programme.

[HCWS512]

Health and Social Care

Maria Caulfield Excerpts

Tuesday 20th December 2022 Ministerial Corrections

[Stella Creasy (Walthamstow) (Lab/Co-op)]

I think the Minister’s definition of a “shortage” is different from that of parents. One parent in my constituency got in touch with me last week. She was a local mum of a 13-month-old boy who has been diagnosed with strep A. After a frantic search for antibiotics—during which the doctors changed the prescription—she managed, in her desperation, to get a third of the necessary prescription. Since then she has been trying pharmacies repeatedly to get the remainder. Today, she runs out, and she still does not have the drugs that she needs. What is the Minister’s message for that mum trying to keep that little boy safe?

[Maria Caulfield]

We recognise that there are supply issues with pharmacies. That is why pharmacists have had the flexibility since before last week to adjust doses and preparations. Since Friday they have also been able to issue alternative antibiotics. I would say to the hon. Lady’s constituent to go back to her pharmacist, who will be able to give her an alternative supply.

[Official Report, 19 December 2022, Vol. 725, c. 28.]

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

An error has been identified in the response given to the hon. Member for Walthamstow (Stella Creasy) in the urgent question on the supply of strep A treatments.

The correct response should have been:

[Maria Caulfield]

We recognise that there are supply issues with pharmacies. That is why pharmacists have had the flexibility since early last week to give different formulations. Since Friday they have also been able to issue alternative antibiotics. I would say to the hon. Lady’s constituent to go back to her pharmacist, who will be able to give her an alternative supply.

Strep A Treatments: Supply

Maria Caulfield Excerpts

Monday 19th December 2022 Commons Chamber

[Daisy Cooper (St Albans) (LD)]

(Urgent Question): To ask the Secretary of State for Health and Social Care if he will make a statement on the supply of strep A treatments.

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

I thank the hon. Lady for her question. I know families are concerned about the recent outbreak of strep A in children. Although the vast majority of strep A cases are mild and can easily be treated with antibiotics, a small number of children have gone on to develop serious infections.

The UK Health Security Agency has already declared a national enhanced incident to co-ordinate our public response. Increased demand has led to some temporary supply issues, but I reassure Members on both sides of the House that we have stock of antibiotics and have taken a number of steps to deal with some of the supply issues.

First, we have worked at pace to help to ensure that there are supplies of vital medicines to meet the increased demand. Earlier this month, we convened roundtables with manufacturers of the preferred treatment, penicillin V, and with major UK wholesalers. We continue to work with manufacturers and wholesalers to boost supply to meet demand. The key issue is getting stock to pharmacies across the country. We have brought forward stock to make sure it gets to where it is needed, and we are expediting deliveries. Deliveries to wholesalers and pharmacies continues to be made, with more expected in the coming days and weeks.

Secondly, we have issued eight serious shortage protocols to allow pharmacists to supply not only alternative forms of penicillin, but alternative antibiotics. This will make things easier for pharmacists, general practitioners and, of course, patients. We have also added a number of antibiotics to our list of medicines that cannot be exported or hoarded.

Finally, we have updated advice across the board. Further guidance was given to GPs and pharmacists on Friday as part of the new SSPs. My Department has provided advice to colleagues in primary and secondary care on the management of the current supply issues. We have also held a cross-party briefing for MPs, and a “Dear Colleague” letter will go out later today.

I know this is a worrying time for families across the country, but I reassure them and people across the healthcare sector that we are managing the higher-than-normal number of strep A cases this winter and we have a range of medicines available.

[Daisy Cooper]

Across the country, parents are worried sick about the sharp rise in strep A infections. Tragically, strep A has caused the death of at least 19 children since September.

Last Thursday, just a few days after insisting there were no shortages, the Government finally admitted that there were indeed serious shortages of three penicillin medicines and issued serious shortage protocols to give pharmacists emergency powers to deal with supply issues. Why on earth did they take so long?

The Government will have seen the data on the number of prescriptions for strep A antibiotics, which started to rise more than a month ago. Health professionals, including Leyla Hannbeck, the chief executive of the Association of Independent Multiple Pharmacies, have been raising the alarm publicly for more than two weeks, and I called for a strep A summit to resolve the supply issues. Because the Government did not come clean sooner about the shortage of antibiotics, parents who are worried about their children have been left to travel to multiple pharmacies, GPs have had to find time to rewrite prescriptions and A&E departments have been overwhelmed by anxious parents and children who cannot access medical help when they need it.

Why have the Government taken so long to act? Did they not look at prescription data, or did they just ignore it? Why did the Secretary of State insist on television that there were no shortages, when GPs, pharmacists, directors of public health and parents all said that there were?

After shortages of lateral flow tests, hormone replacement therapy and so on—you name it—why are we in this position again? The Government seem incapable of forward planning, and we are stuck in a shortage groundhog day. Can the Minister update us on the Competition and Markets Authority investigation into the sharp rise in the prices of antibiotics?

Finally, we are in the lead-up to Christmas. Pharmacists have told me that some key contacts in the manufacturing companies are already on leave for the Christmas holiday. Families are making difficult decisions about the safety of their children and extended family. What action will the Government take now to ensure that families across the country can access the antibiotics they might need over the entire Christmas period?

[Maria Caulfield]

I reassure the hon. Lady that we have not waited to act. We have already issued serious shortage protocols, which are routine mechanisms when there is pressure on supplies. We have the stock of antibiotics in the country—as I outlined in my opening remarks, it is about supply issues. We are seeing five to six times the amount of antibiotics being prescribed at the moment. That is because the UK Health Security Agency has issued guidance to GPs, A&Es and healthcare professionals to lower the threshold of when they would normally give antibiotics. We are seeing significantly increased use of antibiotics. That is in addition to the prophylactic use of antibiotics by directors of public health, if they have had an outbreak locally. That is why we issued the initial SSPs already a couple of weeks ago so that pharmacists had flexibility in how they dispensed that medication. It is why on Friday we issued the new SSPs, which allow amoxicillin, clarithromycin, flucloxacillin, cefalexin, co-amoxiclav and erythromycin to be issued instead, if pharmacists do not have Penicillin V on their shelves. We are being as flexible as possible to give pharmacists that scope.

We are monitoring this issue on a daily basis. May I reassure people that while these are higher than usual incidences for this time of year, overall for this season we are not yet at the 2017, 2018 levels, where we had a significantly higher number of deaths? Strep A occurs not just in—[Interruption.] Hon. Members do not want to listen. I think I have said enough.

[Michael Fabricant (Lichfield) (Con)]

I am pleased to hear that there are adequate supplies of penicillin and amoxicillin. My hon. Friend will be aware that some tetracyclines are less effective with certain ethnic groups. She is right in saying, is she not, that most strep A infections are not serious. Does she agree that we should be encouraging parents to give their children flu vaccinations? Usually, serious streptococcal infections occur when someone has been run down through a viral infection first.

[Maria Caulfield]

My hon. Friend is right to advise people to take their flu vaccination. What I was trying to say, but the Opposition did not really want to hear, was that strep A occurs in all age groups. Actually, the highest number of deaths we see are in over-65s. It is important to get the message out that this issue does not just affect children. My hon. Friend is right. The flu vaccine is something that should always be recommended for winter. He is also right that the alternative antibiotics that I read out have been recommended by UKHSA, and we have taken its clinical advice.

[Mr Speaker]

We now come to the shadow Secretary of State.

[Wes Streeting (Ilford North) (Lab)]

May I wish you, Mr Speaker, and all staff of the House a merry Christmas? I also thank the hon. Member for St Albans (Daisy Cooper) for securing this urgent question. I put on record my deepest condolences to the families of the children who have tragically passed away with strep A. The news that cases are surging has been deeply worrying for parents of children showing symptoms, and it comes at a time when the NHS is facing unprecedented pressure.

We first heard about shortages of antibiotics to treat strep A almost two weeks ago, but when my right hon. Friend the Leader of the Opposition raised the issue with the Prime Minister, he said:

“There are no current shortages of drugs available”.—[Official Report, 7 December 2022; Vol. 724, c. 333.]

At the same time, parents were going from pharmacy to pharmacy to find the antibiotics their children had been prescribed, and they simply were not available. Why did the Prime Minister not know that there was a problem, when it was plain to see for parents of young people across the country? Had the Government been aware of the problem sooner, surely they could have acted to secure supplies earlier? The Minister said that there has been no shortage, just a supply chain issue. For a parent turning up to a pharmacy and finding that it does not have the antibiotics, it does not make much difference whether this is called a shortage or a supply chain issue, as the antibiotics are not there. The Government must get a grip on this situation and be honest with the public about the reality on the ground.

In addition to the export ban, will the Minister tell the House exactly what the Government are doing to shore up supply of drugs needed to treat strep A? During the past couple of weeks, as desperate parents have been looking for antibiotics, prices have disgracefully shot up. Will the Minister assure the House that the Government will come down like a ton of bricks on any company found to be exploiting this situation by jacking up prices for medication?

This is about access to not just medicine, but GPs and A&E. Parents concerned about symptoms are advised to seek prompt medical advice, yet about one in seven patients cannot get a GP appointment when they need one, a record 2 million patients are made to wait a month before they see a GP and A&E departments are overwhelmed. So will the Minister assure parents of children with symptoms of strep A that they will be able to see a GP when they need to? Finally, given that there are strikes planned in the NHS this week, may I ask the Minister whether the Secretary of State plans to update the House tomorrow and explain the Government’s disgraceful inaction on that issue too?

[Maria Caulfield]

Let me reassure Members that, as I said in my opening remarks, there is no shortage of antibiotics to deal with strep A. There have been pressures on supplies; there have been five to six times the amount of prescriptions that are normally issued at this time of year. Let me give the House an idea of the sorts of figures we are talking about. This season, we have seen 74 deaths across all age groups in England, with 16 of them, unfortunately, having been deaths of children under 18—the vast majority have been among the over-65s. In the 2017-18 peak, we had 355 deaths of all ages, with 27 of those being deaths of children under 18. That just gives us an idea of the scale of the difference compared with the peak of 2017-18. We have put significant measures in place to expedite that supply. Manufacturers are ramping up production lines. Deliveries to pharmacies have been happening every day, but often when the supplies arrive there they go very quickly. That is why we have issued the SSPs already, so that pharmacies can allow the different medication to be dispensed, and the alternative antibiotics are there as well. May I also put on record my thanks to GPs and A&E staff, who have seen record numbers of people, particularly children, with concerns about strep A? We did lower the threshold to prescribe antibiotics and they have gone above and beyond in seeing as many children as they can, as quickly as possible.

[Robin Millar (Aberconwy) (Con)]

Group A streptococcus has been associated as a trigger for PANDAS—paediatric autoimmune neuropsychiatric disorders associated with streptococcal infections—a distressing autoimmune neuropsychiatric disorder in children. I welcome the planned PANDAS surveillance study, which will, no doubt, help assess the impact of this outbreak on children, but will the Minister meet me and other members of the all-party group that deals with this to discuss how we can develop and move towards a treatment pathway for PANDAS in the UK?

[Maria Caulfield]

I thank my hon. Friend for raising this important point. UKHSA is looking at the data on this outbreak and previous ones. I am happy to meet him to discuss that, particularly if he has details of treatment options he feels are not being pursued at the moment.

[Mr Khalid Mahmood (Birmingham, Perry Barr) (Lab)]

Does the Minister accept that no production lines in UK pharmaceutical suppliers are operating, because we have contracted out all our supplies to China and India, which manufacture all the drugs? Both countries have not signed up to the pharmaceutical inspection and co-operation scheme, which ensures homogenisation of good manufacturing practices. The UK manufacturers have to apply that whereas the overseas manufacturers do not. Therefore, we have over 10 manufacturers of pharmaceuticals who are not able to produce the right antibiotics because of the unfair discrimination against them by the Government. Will she ensure that this is put right before Christmas so that our local, British pharmaceutical manufacturers can produce the right antibiotics to give to all our children who need them so desperately?

[Maria Caulfield]

Perhaps if the hon. Gentleman had not been heckling me throughout my opening remarks, he would have heard that we are working with manufacturers and wholesalers across the country. Manufacturers are opening up new production lines and those supplies will be hitting pharmacy shelves very soon.

[Vicky Ford (Chelmsford) (Con)]

I recently visited Broomfield Hospital and was concerned to hear that the paediatric A&E was seeing three times as many children as was normal for this time of year. Given that strep A is often a complication of flu, which can be harmful to children, and given that the vaccine take-up, especially of two and three-year-olds, is so low, will my hon. Friend join me in urging all parents, especially those of two and three-year-olds, to go out and get that protection against both flu and strep A by getting their child the flu vaccine?

[Maria Caulfield]

My right hon. Friend is right to encourage parents to take their children for the flu vaccine. She is also right to highlight the level of demand in her local A&E. Parents are doing the right thing. If they are concerned about their children, they should get them seen as early as possible. For those in doubt about the symptoms: they are flu-like symptoms of sore throat, headache, fever, muscle aches and also a rash that can feel like sandpaper. If parents are concerned, they should seek medical advice.

[Ellie Reeves (Lewisham West and Penge) (Lab)]

It is currently suggested that parents contact 111 or book a GP appointment if they are concerned about strep A. Yet 111 workers are already stretched and millions of parents are struggling to get GP appointments, but with strep A there is no time to be wasted. What are the Government doing to ensure that diagnosis and treatment are expedited, because no more families should be facing the prospect of mourning this Christmas?

[Maria Caulfield]

The hon. Lady is right to raise that matter. Every day, we monitor the number of appointments with GPs, A&E visits, pharmacy visits and the impact that those are having on our stock levels of antibiotics, and the number of incidents of positive cases. Scarlet fever is a notifiable disease, so we are able to track this fairly easily, but she is right on this. GPs and A&E doctors are going above and beyond to see as many as possible of the people coming forward with concerns.

[Antony Higginbotham (Burnley) (Con)]

It is good to hear that there is no shortage of antibiotics, and I know that many parents in my constituency will be reassured by that. None the less, from speaking to constituents, I do know that they have had to travel further than normal to get the antibiotics that have been prescribed by a GP. What steps are the Government taking to make sure that antibiotics are delivered to a range of places, particularly those areas where there is a larger outbreak, because that is where they will be needed the most?

[Maria Caulfield]

My hon. Friend makes a valid point. While we do not have a shortage, there are, as I have clearly outlined, supply issues. When deliveries are made to pharmacies, those pharmacies very quickly run out because of the sheer scale of demand. I say to parents that the new SSPs issued on Friday will allow pharmacists to replace the prescription antibiotic with a number of antibiotics. If they go in with a prescription for penicillin B and are given amoxicillin, clarithromycin, flucloxacillin, cephalexin, co-amoxiclav or erythromycin, for example, that is because they are recommended as alternative antibiotics that can adequately treat strep A.

[Mr Speaker]

I call Jim Shannon.

[Jim Shannon (Strangford) (DUP)]

I am sorry, Mr Speaker, but you caught me unawares there. I was expecting to go up and down automatically until the very end.

I thank the Minister for her answers, but this is not only about strep A. Will she confirm that discussions have taken place with Army medics, so that they can step into the breach as GPs are under pressure? One parent in my constituency simply refused to leave the GP’s office until he was seen, and quite rightly so, as his daughter had scarlet fever and needed an immediate antibiotic injection. I do not blame the GPs, because it is clear that they need more support. Can this be made available? The Army medics are perhaps the solution.

[Maria Caulfield]

I am sorry to hear about the problems that the hon. Gentleman’s constituent has had in accessing help. We do recognise that there are serious pressures. Winter is a busy time for GPs in the best of years, but this year, with strep A, UKHSA and officials are encouraging parents to come forward, and parents are doing exactly the right thing. We are working with GPs, and NHS England is reaching out to primary care colleagues to see what additional support is needed to meet that demand.

[Stella Creasy (Walthamstow) (Lab/Co-op)]

I think the Minister’s definition of a “shortage” is different from that of parents. One parent in my constituency got in touch with me last week. She was a local mum of a 13-month-old boy who has been diagnosed with strep A. After a frantic search for antibiotics—during which the doctors changed the prescription—she managed, in her desperation, to get a third of the necessary prescription. Since then she has been trying pharmacies repeatedly to get the remainder. Today, she runs out, and she still does not have the drugs that she needs. What is the Minister’s message for that mum trying to keep that little boy safe?

[Maria Caulfield]

We recognise that there are supply issues with pharmacies. That is why pharmacists have had the flexibility since before last week to adjust doses and preparations. Since Friday they have also been able to issue alternative antibiotics. I would say to the hon. Lady’s constituent to go back to her pharmacist, who will be able to give her an alternative supply.

[Cat Smith (Lancaster and Fleetwood) (Lab)]

Parents right across my constituency have been raising concerns with me about the rise in strep A cases. I spoke to a reception class teacher last week who told me that more than half the reception class were off with a variety of winter diseases, including strep A. Parents tell me that when they see the symptoms, they struggle to get a GP appointment because of the logjam in the primary care system. What steps is the Minister taking to make more GP appointments available so that parents are not left waiting?

[Maria Caulfield]

Where there has been an outbreak in a local area, many directors of public health are starting children in classes or in schools with known cases on prophylactic antibiotics, preventing strep A in the first place. If the hon. Lady has a case in her constituency, I urge her to talk to her director of public health; it is a clinical decision, but they may be able to start pupils in those classes on prophylactic doses.

[Chi Onwurah (Newcastle upon Tyne Central) (Lab)]

On Friday, with my local pharmaceutical committee, I visited Whitworth Pharmacy in Elswick in my constituency and saw the fantastic work it does to support health in the community. I also saw the empty shelves where the antibiotics that would normally be used to treat strep A should be. The Minister does not seem to realise that a supply issue means a shortage on the shelves. I learned too that pharmacies are being asked to pay up to £19 for a box of antibiotics that would normally cost £2, and there is no commitment from the Government to reimburse that amount. What immediate assurances can she give that local pharmacies will not be priced out of supporting their communities?

[Maria Caulfield]

Let me be absolutely clear that no supplier should be using this as an opportunity to exploit the NHS. The Competition and Markets Authority is looking at any complaints about price increases and we are working with the Pharmaceutical Services Negotiating Committee at pace to review the concessionary price arrangements and see how they can be improved.

[Clive Efford (Eltham) (Lab)]

If parents right across the country are reporting to their MPs that they are having to go from pharmacy to pharmacy to get the right antibiotics, there is a shortage. If pharmacies are reporting that they are running out of supplies as soon as they come in because they already have high demand, there is a shortage. It was not until last Thursday that the serious shortage protocols were introduced. I raised this issue with the Government on 6 December at health questions, and I was told that there was no shortage. As well as repeating her answer that there is no shortage, can the Minister give us an assurance that the antibiotics are available in liquid form, which is suitable for children?

[Maria Caulfield]

Just to confirm, the five SSPs issued on Friday were in addition to the three issued previously. If colleagues are having problems with the pharmacies in their constituencies not getting stock, I must say that I held a cross-party meeting with MPs on this very issue not so long ago and a handful of colleagues attended. My door is open and, if people are having problems in their constituencies, I ask them to please come and see me, because we have mechanisms in place to deal with that—but I need colleagues to let me know when we hold cross-party meetings.

[Mike Amesbury (Weaver Vale) (Lab)]

Last week Hannah, a young mum from the Runcorn part of my constituency, visited nine different pharmacies looking for the appropriate medication for her four-year-old little boy. It was not available, because there is a shortage. It is time to be clear and transparent about that. The Minister should not be in denial about the reality; she should give those parents and their children reassurance by getting a grip of the situation.

[Maria Caulfield]

I can give parents struggling to get those antibiotics the reassurance that pharmacies are now able to dispense alternative antibiotics. I have read them out, but I can do so again: amoxicillin, clarithromycin, flucloxacillin, cefalexin, co-amoxiclav and erythromycin. We have taken action to make sure that those antibiotics are available to parents.

[Hilary Benn (Leeds Central) (Lab)]

There appears to be some confusion about the difference between an insufficiency of stocks and supply difficulties. Just for absolute clarity, given that the Minister has reported to the House today that demand has gone up five or six times, are there currently sufficient or insufficient stocks in the country to meet that increased demand?

[Maria Caulfield]

There are sufficient stocks in the country to meet demand.

[Rachael Maskell (York Central) (Lab/Co-op)]

The deputy chair of the British Medical Association’s general practitioners committee told the Health Committee two weeks ago about the challenges faced by GPs in accessing appropriate pharmaceuticals. What are NHS planners doing to ensure that logistics are getting stocks to the appropriate place in a timely way? With strep A, we just cannot wait.

[Maria Caulfield]

Absolutely. That is why wholesalers have expedited deliveries and increased the number of deliveries that are going to pharmacies. We are working with NHS England, with UKHSA and with pharmaceutical bodies to make sure that those supplies are getting to them. But we recognise that even with the expedited and extra deliveries there is still demand on supplies, which is why the SSPs have been issued—so that pharmacists can dispense not just alternative preparations of what has been prescribed, but alternative substitutes.

[Stephanie Peacock (Barnsley East) (Lab)]

Parents in Barnsley are really worried. The Minister has said more than once that there is no shortage, but I say gently to her that that is not the experience of many of my constituents. They do not need her to refer to that simply as a supply issue; they want to hear what the Government are doing to tackle the shortage and to ensure that there are no regional disparities in access to medicine.

[Maria Caulfield]

I do not want to repeat myself, but we have been clear. We have been working with manufacturers and wholesalers to up production and expedite deliveries to pharmacies, but we recognised fairly early on that that was not going to be enough to meet demand. That is why we already had SSPs in place, so that pharmacists had some flexibility. But we recognised that that was not enough, so on Thursday and Friday we issued five new SSPs so that pharmacists had the flexibility to dispense alternative antibiotics that are as good at dealing with strep A as penicillin V. We will go further. We have more manufacturing plans to increase supply, and we also have alternative provision coming onstream in the next few days, about which I can update the House as well, so we are not just resting on our laurels. We will do whatever it takes to get those antibiotics to those who need them.

[Grahame Morris (Easington) (Lab)]

The Minister said that there are supply issues but no shortage. I am trying to be helpful here, so may I make a suggestion to improve domestic supply? I recently visited Bristol Laboratories in Peterlee in my constituency—I pay tribute to its management and workforce for their hard work—which has the facilities and the flexible capacity to supply generic medicines to the NHS at relatively short notice. It would seem advantageous to meet Bristol Laboratories and similar manufacturers. UK domestic production capacity for such medications is vital, as was demonstrated during covid. If we do not protect our sovereign manufacturing capability, we risk the UK being at the back of the queue if and when the next global supply shortage or demand surge hits.

[Maria Caulfield]

If the hon. Gentleman forwards to me the details, I will happily look at that. I would just point out that, as of 12 December, a number of European countries, including Ireland, France, the Netherlands and Sweden have indicated an increase this winter, particularly since September. Antibiotics and amoxicillin are both reported to be in short supply in those countries. This issue is not related solely to the United Kingdom.

Ian Paterson: Patient Safety and Government Implementation Plan

Maria Caulfield Excerpts

Thursday 15th December 2022 Written Statements

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

On 16 December 2021, the Government published their response to the findings of the inquiry into the issues raised by disgraced surgeon, Ian Paterson. We reiterated the apologies of the Government to the patients affected and those close to them and committed to ensuring we did more to protect patients in the future.

In line with this commitment, the Government accepted the overwhelming majority of the recommendations made by the inquiry and set out an implementation plan of 40 actions to put those recommendations into effect. Finally, we committed to providing a further update on the progress of this implementation plan in 12-months’ time. I am happy to be able to publish this report fulfilling that commitment today.

All the relevant bodies within the health sector have been united in understanding that these changes are essential. We all agree that patients cannot be failed in the same way again. On behalf of the Government, I want to thank every organisation that has engaged in this process for their commitment to making improvements. I would especially like to thank the representatives of patient groups impacted by Ian Paterson, who have campaigned tirelessly to ensure their experiences do not go unheeded. They have continued to be a source of inspiration and expertise throughout the implementation period.

I am pleased to report that good progress has been made across the implementation plan which we set out in December 2021. The report published today provides full details of this progress against the four themes of the Government’s response as laid out in the implementation plan. In this statement, I will highlight some of the most important developments under each of these themes.

Patient-centred information

Patients now have more access to information relevant to their treatment than they did during Ian Paterson’s time practising. This includes access to information about the performance of consultants working for independent sector healthcare providers, and specialties in the NHS. These continue to be added to, so patients will have more, and better, access to independent information before choosing a consultant. NHS England (NHSE) will work with the professions so that meaningful consultant-level information on the numbers and types of procedures performed should be made publicly available. If patients choose to be treated in the independent sector, there is now more information about what to expect, with further information to be made available over the coming year.

Patients now have the right to access their treatment records and clinicians are aware of the need to write to patients directly following a consultation or treatment, rather than only writing to their GP. This information gives patients a record of their condition, and test results to reflect on, or to seek a second opinion if required. This is reinforced by ensuring patients gets the time they need to consider treatment options and have access to a range of new resources to help them consider their options; options that patients will also be able to discuss with medical professionals who are equipped to handle these conversations.

Making challenge heard

Doctors across more specialties now have independent data on their practice available and will be required to use this as part of their appraisal and revalidation processes. This will help to identify issues and fix them. Staff in the health system also have more opportunities to make their voices heard about a patient’s care, including through clarified guidance and assessment of multidisciplinary team use as a forum.

Care Quality Commission (CQC) updated its guidance on complaints processes in early 2022. It is now easier for patients to raise concerns about treatment they receive and access independent resolution of their complaint if they are unsatisfied with the provider’s handling. As part of the implementation of the NHS patient safety strategy, NHSE has introduced measures to advance safety and the response to harm. The Government have appointed the first ever patient safety commissioner for England, Dr Henrietta Hughes OBE.

Ensuring accountability

CQC published the new single assessment framework in July 2022, which sets out what good care looks like, and National Quality Board published national guidance on system quality groups, setting out the requirements for quality governance in integrated care systems.



Alongside this, we have seen significant culture change in the independent sector, now leaving no doubt that independent providers must take responsibility for maintaining high standards of care in their facilities, irrespective of how the medical professionals involved are engaged by them (through employment or practising privileges). This has been supported by Independent Healthcare Providers Network’s refresh of the medical practitioners assurance framework in September 2022. NHS Resolution launched new exclusion guidance in April 2022.

Putting things right

Patients who are impacted by potential issues with their care will be reviewed through recall processes which are now better informed of how to put patients at the centre of their focus. The new national recall framework was published in June 2022 to facilitate this.

Patients will continue to receive apologies from healthcare professionals and providers for potential issues with their care when appropriate. Enhanced training and resources are now available to clinicians to ensure these apologies are delivered effectively and meaningfully.

The Government are working to ensure that any future changes to indemnity and insurance arrangements will be made using the best evidence base available. This includes a thorough assessment of the impact on patients, healthcare professionals, providers, and the wider market; with the aim of improving the position for patients when receiving treatment from any regulated healthcare professional, regardless of the setting. The Government’s ambition is that when this work concludes, patients have confidence that they can access appropriate compensation if harmed while receiving care, including when harm arises from criminal/intentional acts or omissions. The summary of responses to the consultation on appropriate clinical negligence cover for regulated healthcare professionals will be published alongside this implementation update on 15 December 2022.

The Government will be continuing to ensure this work is built upon, as part of our wider commitment to ensuring patient safety and high standards of care across the health system. We understand that there is no room for complacency when it comes to patient safety and, together with the patient safety commissioner, will make sure this is one building block towards a health system in which patients and those close to them can have the maximum possible confidence.

Copies of the Government’s full implementation update will be available at: https://www.gov.uk.

[HCWS455]

Vaccines: Potential Harms

Maria Caulfield Excerpts

Tuesday 13th December 2022 Commons Chamber

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

I thank my hon. Friend the Member for North West Leicestershire (Andrew Bridgen) for securing the debate. It is important that all Members get to discuss and debate such issues, and they are entitled to their opinion.

I have to say that I strongly disagree with my hon. Friend, not only in the content of his speech, but in the way he derided doctors, scientists and nurses. Many of us worked through the pandemic and saw at first hand the devastation that covid caused. There is no doubt in my mind that, despite the personal protective equipment, social distancing and infection control, the thing that made the biggest difference in combating covid was the introduction of the vaccine.

Safe and effective vaccines have underpinned our strategy for living with covid. Covid has not gone away, but we are living with it in a way that was not possible this time last year. Vaccines have saved thousands of lives, reduced the pressure on the NHS, and allowed the economy and society to reopen, not just in this country but in countries across the world. In countries with lower vaccination rates, their ability to open up, move on and live with covid was reduced.

Across the piece—not just for covid—vaccines remain our biggest line of defence, particularly during a challenging winter period. We see with our seasonal flu vaccine roll-out and our covid programme that getting the most vulnerable people vaccinated—

[Andrew Bridgen]

Will the Minister give way on that point?

[Maria Caulfield]

I will not. I have just three minutes to respond to the many points that my hon. Friend made.

It is important to put on the record that all the vaccines used in the UK are safe, and we have some of the highest safety standards in the world, with the MHRA globally recognised for requiring high standards of safety. I have worked in clinical research, and I can say categorically that the data is not hidden from the public or the MHRA; it is inspected rigorously and can be reinspected at any time.

Each of our covid vaccine candidates is assessed by a team of scientists and clinicians on a case-by-case basis, and it is only once a potential vaccine has met robust standards of effectiveness, safety and quality that it is approved for use. That is the case for all medicines, not just covid vaccines. Extensive data shows that the vaccine is safe and highly effective in reducing the deaths that we sadly saw during the pandemic. That does not end when the vaccine is approved; surveillance of vaccines continues, as it does with any medicine, and any adverse reaction is recorded on a regular basis. That does not stop following approval.

My hon. Friend talked about the yellow card reports. Those have been in place for many years. Anyone who has a side effect from any medicine can make a yellow card report. When I was first starting out in nursing, that was a physical yellow card; it is now online. Anyone can submit any suspected adverse drug reaction. The MHRA will collate and review them, and it has in the past gone on to suspend the licence of a medicine if it has concerns. That is something that it can do for any vaccine, including any covid vaccine.

The nature of the yellow card reporting system means that some reported events are not always proven side effects. A side effect can be reported; the MHRA will then go and look to see whether it is actually related to that medicine, and there is a list of probabilities of how likely it is that the side effect is related to that medicine. There is comprehensive surveillance to alert us to any unforeseen adverse reactions to vaccines and to enable us to act swiftly when required.

We know that there are some circumstances where individuals have sadly experienced harm with a possible link to a vaccination. I recognise how difficult that is for those individuals and their families. We have put measures in place to monitor any possible side effects and to commission further research that will help us better understand how to diagnose and treat those who have suffered or continue to suffer any ill effects from a covid-19 vaccine. That is the case for any medicine—even with a simple medicine such as paracetamol, people can get side effects—and that is why every medicine that is prescribed and dispensed has a patient safety information sheet listing the most likely side effects and encouraging people to report any that may not be included.

[Danny Kruger]

Will the Minister give way?

[Maria Caulfield]

I will give way quickly, because I have only a couple of minutes.

[Danny Kruger]

I am grateful. The Minister’s predecessor had asked the Joint Committee on Vaccination and Immunisation to review the evidence behind the decision to roll out the vaccine to children. Can she update the House or write to us to explain where that review has got to? Does she agree that the JCVI should be looking at the vaccination of children?

--- Later in debate ---

[Maria Caulfield]

I will write to my hon. Friend with an update on that report. It was touched on that the MHRA has licensed the vaccine for babies, but that has not yet been approved by the JCVI, so that is just a licence rather than a recommendation to roll out. However, I am happy to send him the details of that report.

I want to put on the record that the covid vaccines have saved tens of thousands of lives and prevented hundreds of thousands of people from being hospitalised. I completely disagree with my hon. Friend the Member for North West Leicestershire that there is a whole conspiracy of doctors, nurses and scientists—they have done nothing but work hard to get us through the pandemic.

[Andrew Bridgen]

rose—

[Maria Caulfield]

I will give way for one brief point.

[Andrew Bridgen]

I thank the Minister for giving way on that important point. The claims about the number of lives saved worldwide by the vaccination are sponsored by vested interests. The modelling is the lowest form of scientific evidence—in fact, it is more science fiction than science fact.

[Maria Caulfield]

I completely disagree. I worked on the covid wards with patients who were dying from that virus. We had infection control measures, antibiotics, dexamethasone—a steroid—and every known facility available, and the only thing that made a difference was when those vaccines were introduced. They do not necessary stop people from getting the virus, but they certainly reduce its intensity and the likelihood of someone dying from it.

I completely debunk the conspiracy theories about a whole group of people benefiting financially from the roll-out of the vaccine and would gently say to my hon. Friend that if he has evidence, there are mechanisms in place for raising concerns, as we have seen with other drugs. Only today, I was before the Health and Social Care Committee talking about sodium valproate—we also had an Adjournment debate on that last week—where there are genuine safety concerns. The MHRA is taking that extremely seriously. It is not worried about pharma concerns; its first priority is patients, and it is exactly the same with the covid vaccine. So if there is evidence—I am not saying that there is not—it absolutely must go through the proper channels so that it can be evaluated.

We have launched a nationwide campaign to encourage people to come forward this winter to get their booster. I recommend that people do that safe in the knowledge that the vaccine is safe for people to have.

Question put and agreed to.