NHS Dentistry: Recovery and Reform

Neil O'Brien Excerpts

Wednesday 7th February 2024 Commons Chamber

[Victoria Atkins]

I hear the frustration in the hon. Lady’s question. This is a devolved area—as it is in Wales—and is therefore a matter for the Scottish National party. I assume the hon. Lady will continue her usual advocacy on behalf of her constituents to ensure that the SNP looks at what is happening in England and tries to do better for Scotland.

[Neil O’Brien (Harborough) (Con)]

I really welcome this plan; I welcome the extra £200 million, the new patient bonus, the measures to get dentists into areas that do not have them and the minimum UDA. These are all good things that will help people in Harborough, Oadby and Wigston to get a dentist. Can I ask the Secretary of State to press on with two things? The first is the move to a proper national funding formula. Dentistry is the only part of the NHS without a funding formula, which disadvantages shire and coastal areas with older populations. The second is the next round of contract reform—the move to band 2b is working, and dentists are using it, but there are patients with complex cases for whom a capitation-like payment would be much better, as the British Dental Association pointed out. I encourage the Secretary of State to start working on that difficult group so that we can get extra help for them too.

[Victoria Atkins]

I must thank my hon. Friend for all his work. I know how much how much effort and commitment he has put into these plans, and it shows the genuine—[Interruption.] Sorry; the hon. Member for Ilford North (Wes Streeting) is being a little ungracious. My hon. Friend the Member for Harborough (Neil O’Brien) has been part of the united work across Government to deliver these plans. I very much take on board his recommendations and encouragement. As I say, we see this plan as delivering 2.5 million more appointments for our constituents, but of course we want to look to the long term as well.

Oral Answers to Questions

Neil O'Brien Excerpts

Tuesday 17th October 2023 Commons Chamber

[Peter Gibson (Darlington) (Con)]

7. What recent assessment he has made of the effectiveness of emergency department opt-out testing for HIV.

[The Parliamentary Under-Secretary of State for Health and Social Care (Neil O’Brien)]

Provisional NHS data shows that opt-out testing has found around 700 cases of HIV during its first year. In total, it has found more than 2,000 cases of blood-borne diseases, including hepatitis B and C.

[Peter Gibson]

I welcome the Minister’s news on those figures. He will have seen the impact of opt-out testing—detecting more people, treating them earlier and saving the NHS money. However, if we are to meet our 2030 target on no new infections, we cannot delay a further roll-out of opt-out testing. Will he commit the resources needed to expand it in time for World AIDS Day on 1 December?

[Neil O’Brien]

I pay tribute to my hon. Friend for all his work on this important issue. We will assess all the evidence and reply before the end of the year. Opt-out testing is not the only thing we are doing to drive down HIV transmission. We have had a 40% rise in the number of people getting pre-exposure prophylaxis, and we have increased the number of people testing, with 20,000 free testing kits handed out this year. We are doing everything we can to meet that visionary goal to stop HIV transmission in this country.

[Jim Shannon (Strangford) (DUP)]

I thank the Minister for his answer to the question from the hon. Member for Darlington (Peter Gibson). It is clear that today, HIV is not the death sentence that it once was, because of the progress of medication and healthcare in prolonging life and improving quality of life. In Northern Ireland we are proactive, as the Minister will know, on PrEP and young people. We are doing progressive things through the Department of Health, Social Services and Public Safety in the Northern Ireland Assembly. Has the Minister had the opportunity to discuss with the Northern Ireland Assembly and the Health Department how we can work better together? I always say we are better together in every case.

[Neil O’Brien]

The hon. Gentleman is completely correct. He has been a fantastic champion on this issue. The UK is leading the world on this issue, hitting the UN’s 95-95-95 goals, driving down transmission and reducing stigma. People increasingly realise that as well as suppressing the virus, the treatment makes it impossible to transmit, transforming the lives of people with HIV.

[Greg Smith (Buckingham) (Con)]

8. What recent assessment he has made of the adequacy of the level of access to GPs in rural communities.

[The Parliamentary Under-Secretary of State for Health and Social Care (Neil O'Brien)]

We have increased funding for general practice by about a fifth in real terms since 2018. We have increased the workforce by about 30% since 2019 alone, with 2,000 extra doctors and 31,000 extra clinicians going into general practice. With the hard work of GPs, that has enabled about 15% more appointments than before the pandemic. In rural areas we are going further with things such as the targeted in-house recruitment scheme and the elements of the funding formula that favour rural areas.

[Greg Smith]

I am grateful to my hon. Friend for that answer, but I have repeatedly raised with Ministers the specific case of an innovative model from Long Crendon Parish Council to use land secured through planning gain to replace Long Crendon Surgery, which closed during the pandemic. There is an agreement for Unity Health to provide primary care services there, but no money to physically build. My right hon. Friend the Secretary of State has advised consistently that the money be sought from the integrated care board, but after prolonged talks it has said that there is no money. Will the Minister look at this innovative model again? It is a great way of building rural GP provision in the future, with a mind to his Department making it happen.

[Neil O’Brien]

I will absolutely look closely at that specific case. My hon. Friend has put a huge amount of work into Long Crendon. As he knows, we are already changing the national planning policy framework to enable more developer contributions to flow into such innovative projects. We have more GP practices than we did in 2010, but we continue to look at ways to go further.

[Suzanne Webb (Stourbridge) (Con)]

9. What steps he is taking to help prevent cardiovascular diseases.

--- Later in debate ---

[Mark Menzies (Fylde) (Con)]

15. What recent steps his Department has taken to increase the availability of NHS dentistry services.

[The Parliamentary Under-Secretary of State for Health and Social Care (Neil O’Brien)]

We are making NHS work more attractive to dentists. We have started to reform the contracts and create more UDA bands. We have introduced the minimum UDA value to help sustain practices where values are lower, and we are allowing dentists to deliver 110% of their UDAs. We are also reforming the rules to empower both clinicians and commissioners, for example by enabling therapists to start delivering medicines such as anaesthetics. We are rebasing contract values where they are underperforming, and we are growing the workforce with a record commitment to grow the number of dentists in training by 40%—a commitment never made by the Opposition.

[Mark Menzies]

UDA rates, the sum paid to NHS dentists for each unit of dental work undertaken, have long been deemed insufficient. Being based on figures from 2005, there are huge differences in rates between practices, with some receiving less than the NHS charges patients for the service. A recent 5% uplift was based on the Government estimate of a 3% rise in costs, a figure that local dentists tell me is more like 10% to 15%, compounding the losses that NHS dentists are already making. What steps is my hon. Friend taking to reform the UDA system and to stop the flow of dentists leaving the NHS?

[Neil O’Brien]

That is exactly why we have started to reform the UDA system. As well as the introduction of the first ever minimum UDA rate, which will help constituencies such as my hon. Friend’s, we have changed the rules nationally so that commissioners can take UDAs away from dentists who are underperforming and give them to those who want to do more NHS work. As a result, nearly a quarter more NHS dentistry is being done than a year ago.

[Chris Loder (West Dorset) (Con)]

16. What steps he is taking to increase access to NHS dentistry services in the south-west.

[The Parliamentary Under-Secretary of State for Health and Social Care (Neil O’Brien)]

In addition to the steps we are taking to drive up NHS dentistry everywhere, we are going further in the south-west, with NHSE commissioning additional urgent appointments. There are several hundred extra appointments every week.

[Chris Loder]

I thank my hon. Friend for his answer. It is not sustainable for the people of West Dorset who have needed dental care for some time when there is a £400 million national underspend in the dental care budget. The NHS and local dentists tell me that the incompatibility often relates to the national dental care contract, which is up for review. When does the Minister expect a solution to be found to this contract difficulty? Will he meet me and the NHS Dorset ICB to discuss the matter in detail to find a solution?

[Neil O’Brien]

Absolutely. I am keen to continue the conversation with my hon. Friend. These issues are exactly why, this summer, we legislated to allow rebasing and to end the inflexibility he describes. We are also in the process of ringfencing local dental budgets, because we do not want to see underspends. We want to see that money going to NHS dentistry.

--- Later in debate ---

[Suzanne Webb (Stourbridge) (Con)]

T3. Most supermarkets practise place-based and price promotions mainly on ultra processed food—food that plays a key part in feeding the obesity crisis. How can the Government best ensure that supermarkets promote affordable, unprocessed and sustainable foods, not foods high in fat, sugar and salt, and, importantly how can we ensure that supermarkets comply with the regulations?

[The Parliamentary Under-Secretary of State for Health and Social Care (Neil O'Brien)]

We have already brought in restrictions on the places that unhealthy food can be sold to stop pester power. That is on top of other measures that we are taking on obesity such as the sugar tax, calorie labelling, the extra money for school sport, and the extra facilities for young people. It is a serious issue and one on which we are taking urgent action.

[Clive Lewis (Norwich South) (Lab)]

I was going to ask a question about the shocking statistic of 85,000 people on the waiting list at Norfolk and Norwich University Hospital, but so poor was the Secretary of State’s response to the question of my hon. Friend the Member for Ilford North (Wes Streeting) about the dental desert that I will tell him a quick story. Ukrainian refugees who come to my constituency are travelling back to war-torn Ukraine to have their teeth seen to because there is a better dental service there than in Norfolk and Norwich. What does he have to say to that?

--- Later in debate ---

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

T7. I thank Ministers for their earlier helpful replies about NHS dentistry, but I am afraid the situation in Weston-super-Mare remains extremely worrying. Local residents regularly say there is not a single local dentist accepting new adult NHS patients, and many practices have actively reduced NHS work since the pandemic. I have pushed both NHS England and the local integrated care board, but all we have so far are PowerPoint presentations rather than bookable appointments. What hope can the Secretary of State offer to Westonians who have paid their taxes, but are not getting any NHS dentistry in exchange?

[Neil O’Brien]

My hon. Friend is right. The amount of NHS dentistry being delivered in his ICB has gone up in the last year, but we want to go further. The NHS has recently commissioned additional children’s orthodontic capacity within his ICB, but through the actions we are going to take, we will go further.

[Mr Speaker]

I call Judith Cummins with the final question.

No and Low-alcohol Alternatives: Labelling Guidance Consultation

Neil O'Brien Excerpts

Monday 16th October 2023 Written Statements

[The Parliamentary Under-Secretary of State for Health and Social Care (Neil O'Brien)]

This Government set out in the 2019 Green Paper, “Advancing our health: prevention in the 2020s”, commitments to work with industry to deliver a significant increase in the availability of alcohol-free and low-alcohol products by 2025 and to review the evidence to consider increasing the alcohol-free descriptor threshold from 0.05% ABV up to 0.5% ABV, in line with some other countries in Europe. We remain committed to this goal, and I am proud to announce that on 28 September we launched a public consultation, “Updating labelling guidance for no and low-alcohol alternatives”.

Reducing the harms associated with excess alcohol consumption remains a priority for this Government. As of 2021, approximately 10 million, or one in five adults in England drank above the UK chief medical officer’s low-risk drinking levels, significantly increasing their risk of health problems.

Making alcohol-free and low-alcohol products more available will increase consumer choice. It will help to promote the options of lower-strength alternatives to consumers, and changing the alcohol-free descriptor threshold in non-statutory guidance could support further innovation in the sector. We are seeking views on this potential change, as well as a number of other potential changes to Department of Health and Social Care voluntary guidance on labelling of alcohol-free and low-alcohol products, to provide greater consistency for producers, retailers and hospitality, and clarity for consumers.

DHSC will consider which, if any, changes should be made to the guidance following the consultation to support its policy aim to reduce excess alcohol consumption and associated harm among people who regularly drink above the UK chief medical officer’s low-risk drinking guidelines.

I encourage all those with an interest—the alcohol industry, public health organisations, and consumers themselves—to share their views with us through responding to this important consultation.

[HCWS1057]

Stopping the Start: A Smokefree Generation

Neil O'Brien Excerpts

Monday 16th October 2023 Written Statements

[The Parliamentary Under-Secretary of State for Health and Social Care (Neil O'Brien)]

October 2023 the Prime Minister announced a bold and ambitious plan to create a “smokefree generation”, and the Government published the Command Paper “Stopping the start: our new plan to create a smokefree generation”. This Command Paper sets out:

Plans to bring forward legislation to make it an offence to sell tobacco products to anyone born on or after 1 January 2009. In effect, this would mean that the age of sale of tobacco products will increase by one year each year, so that children turning 14 years old or younger this year will never be legally sold tobacco, phasing out tobacco over time and preventing future generations from ever taking up smoking.

A package to support current smokers to quit smoking, including by more than doubling funding for stop smoking services with £70 million additional funding per year, and £5 million this year and £15 million each year after for anti-smoking marketing campaigns.

Measures to tackle youth vaping. While the legal age of sale for vapes is 18, and will remain so, youth vaping has tripled in the last 3 years. The Government announced that they will consult on measures to reduce the appeal and availability of vapes to children, including restricting flavours, regulating point-of-sale displays, regulating vape packaging, and restricting the sale of disposable vapes.

Plans to strengthen enforcement, including £30 million new funding each year for enforcement agencies.

Smoking is the single biggest cause of preventable illness and death and one of the biggest drivers of health inequalities across the country. It is responsible for disability and death throughout the life course, from increasing stillbirths to asthma in children, to dementia, stroke and heart failure in older age. Smoking causes around one in four cancer deaths in the UK and leads to 64,000 deaths per year in England. It costs the country £17 billion per year and puts huge pressure on the NHS, with almost one hospital admission every minute attributable to smoking and up to 75,000 GP appointments each month taken up by smoking-related illness in England.

It is therefore imperative that we take action, and these changes amount to one of the most significant public health interventions by the Government in a generation.

Following the Prime Minister’s announcement and the publication of the Command Paper, the government launched a formal consultation on 12 October 2023, “Creating a smokefree generation and tackling youth vaping”, to gather the strongest possible evidence on how best to implement these proposals. The consultation asks for views on three areas:

Creating a smokefree generation: the consultation gathers views on the smokefree generation policy and its scope to inform future legislation.

Tackling youth vaping: the consultation gathers views on several options to ensure we take the most appropriate action to tackle youth vaping while ensuring vapes continue to be available for current adult smokers to help them quit. The proposals in the consultation include restricting vape flavours, regulating point of sale displays of vapes, regulating packaging and presentation of vapes, and considering restricting the sale of disposable vapes. In addition, the consultation gathers views on the affordability of vapes and the role of a new duty on vapes.

Enforcement: the consultation asks about introducing new powers for local authorities to issue on-the-spot fines—fixed penalty notices—to enforce age of sale legislation of tobacco products and vapes.

The consultation will be open for a total of eight weeks and will close on 6 December 2023.1 am pleased to say the consultation has received widespread support, and the Scottish Government, Welsh Government, and the Northern Ireland Department of Health have all given it their backing and agreed to a joint consultation.

Responses to the consultation will inform the measures that are taken forward and I will provide an update to the House on the response to the consultation in due course. Following consultation, we intend to introduce a Bill as soon as parliamentary time allows.

[HCWS1059]

Tissue and Cell Donation

Neil O'Brien Excerpts

Monday 18th September 2023 Written Statements

[The Parliamentary Under-Secretary of State for Health and Social Care (Neil O'Brien)]

The findings of the Government commissioned review into donor selection policies, that was carried out by the ‘For Assessment of Individualised Risk’ (FAIR) Steering Group, led to the implementation of changes in summer 2021 to address inequalities in blood donation. These changes mean that anyone who attends a blood donation centre regardless of sex or sexuality will be assessed for eligibility according to individual risk.

It is almost two years since the implementation of the changes for blood donation and I am pleased to announce today the publication of recommendations in the FAIR III report for tissue and cell donation. The report highlights an individualised risk-based approach for living tissue and cell donation—surgical bone, amnion, stem cells and cord blood—and deceased tissue donation. The Government have now reviewed the evidence presented by the FAIR III Steering Group, together with the advice of the Advisory Committee on the Safety of Blood, Tissues and Organs, and has accepted this recommendation.

This change will provide equity in access to donation for men who have sex with men across the UK, aligning with changes to blood donor selection related to sexual behaviours and the Government’s commitment to address health inequalities, as set out in the Levelling Up White Paper and the NHS Long Term Plan.

The Government wish to pay tribute to the tissue and organ donation experts and the patient and donor family representatives on the Steering Group, as well as health and academic colleagues whose valuable engagement led to the development of this important evidence-based report.

The Government are also grateful to the Joint United Kingdom Blood Transfusion and Tissue Transplantation Services Professional Advisory Committee, the Advisory Committee on the Safety of Blood, Tissues and Organs and NHS Blood and Transplant for their work in developing recommendations that are based on robust evidence from epidemiology, behaviour and psychosocial data and engaging with service users and providers.

The Department of Health and Social Care is working with NHS Blood and Transplant and the Devolved Governments to implement this change. We will have monitoring mechanisms in place to ensure the safety of donors and patients, including continued monitoring of infections. The changes will be reviewed in 12 months.

[HCWS1032]

Community Pharmacies

Neil O'Brien Excerpts

Thursday 14th September 2023 Westminster Hall

[The Parliamentary Under-Secretary of State for Health and Social Care (Neil O’Brien)]

It is a pleasure to serve under your chairmanship, Sir Mark, and I congratulate my hon. Friend the Member for Waveney (Peter Aldous) on securing this important debate. I start by echoing his thanks to our hard-working pharmacists, who do such a brilliant job. He raised six main points in his speech, and I can confirm that we are working on all of them.

Community pharmacies play a crucial role in our health system and a greater role in looking after people’s health than ever before. Pharmacies are easily accessible, and about nine in 10 people who visit one are positive about the advice they receive. The Government are investing in pharmacy to do much more. The delivery plan for recovering access to primary care announced an investment of up to £645 million in a new Pharmacy First service—a whole new NHS service will be created—as well as an expansion of the existing blood pressure check and contraception services. Pharmacy First will enable patients to see a community pharmacist for seven common conditions and be supplied with prescription-only medicines without the need for a GP. We are consulting Community Pharmacy England on the proposals in that delivery plan, with the aim of starting Pharmacy First this winter.

Pharmacy First builds on the community pharmacy contractual framework 2019 to 2024 five-year deal. That deal commits £2.592 billion a year to the sector and sets out how community pharmacy will be more integrated into the NHS, delivering more clinical services and effectively becoming the first port of call for minor illness. Under that deal, we have introduced minor illness referrals from GPs to community pharmacies, which have been a great success. A&E and NHS 111 can also now refer patients for an urgent medicine supply without a prescription from their GP. More than 2.8 million consultations have been provided at community pharmacies for a minor illness or urgent medicine supply since the start of those services.

We also introduced blood pressure checks, and community pharmacies have delivered 1.4 million checks since October 2021 and more than 150,000 in May 2023 alone. Huge numbers of potentially life-saving checks are being done. NHS England estimates that in 2023, more than 1,300 heart attacks and strokes will be prevented thanks to those checks, so I repeat my thanks to this fantastic sector.

In April this year, we introduced an oral contraception service, making it easier for women to access contraception.

In addition, community pharmacies now support and advise more than a quarter of a million people a month when they start new medicines, through the new medicine service, and 10,000 patients every month who have had their medicines changed following a visit to hospital, through the discharge medicines service. That supports medicines adherence, prevents GP visits and hospitalisations, and gives people a much better sense that they are taking the right medicines.

Community pharmacies are also playing a growing role in our vaccination programmes. Last winter, they administered 29% of adult flu vaccinations and more than a third—36%—of covid-19 vaccinations.

We have talked about the funding issue. In addition to the £2.592 billion a year, we added an extra £50 million last and this financial year, and we have made the additional sum of money that I mentioned available for Pharmacy First and the expansion of existing services. On top of that, we pay separately for flu and covid vaccinations, which, as I suggested, provide an increasingly important income stream for pharmacies.

The current five-year deal is of course coming to an end, and we will need to consider what comes next for pharmacy. As part of that, NHS England has committed to commissioning an economic study to better understand the cost of delivering pharmaceutical services. That study will feed into any future funding decisions on community pharmacy.

Several hon. Members raised the issue of the number of pharmacies, and we monitor that very closely. Our data shows that despite a number of pharmacies closing since 2017, there are about 10,800 pharmacies today, which is still more than in 2010. Despite the things that have happened to other high street businesses, we still see that there are more pharmacies and there are an awful lot more pharmacists—I will come on to that when we talk about the workforce.

However, rather than focusing merely on numbers, we should look at access. We know that 80% of the population live within 20 minutes’ walk of a pharmacy, and that there are twice as many pharmacies in more deprived areas. The right hon. Member for Knowsley (Sir George Howarth) is right that they play a crucial role in providing access in deprived areas. We ensure that that continues to be the case. Proportionally, the closures that we have seen reflect the spread of pharmacies across England.

We are seeing changes in the market, with some of the large pharmacy businesses divesting. That has an impact on the make-up of the sector: we are seeing the number of small independent pharmacies increase, while the number of pharmacies that are part of bigger businesses decrease. We are monitoring the market very closely as it evolves.

As my hon. Friend the Member for Waveney mentions, through the pharmacy access scheme, we are financially supporting pharmacies in areas where there are fewer pharmacies and where there might be a challenge in getting access. To address the disproportionately high rate of closures of pharmacies that must be open for a minimum of 100 hours—the so-called 100-hour pharmacies—legislation was amended in April to allow those pharmacies to reduce their hours to a minimum of 72, which is still a huge number of hours to be open. That will support those pharmacies to remain open, providing extended hours, particularly for weekend access.

The same legislation gave integrated care boards the possibility of introducing local hours plans. That enables the local co-ordination that will ensure that there is something available locally at all times when people need it. It allows temporary closures in an area if there are significant difficulties with access and ensures that a pharmacy is always open somewhere in an area.

Some pharmacies struggle to find staff, and in some instances they have had to close temporarily, because a pharmacy cannot open without a pharmacist. There is more demand than ever for pharmacy professionals—an issue raised by various hon. Members, including the hon. Member for Bradford South (Judith Cummins) and my right hon. Friend the Member for Tatton (Esther McVey). Since 2010, the number of registered pharmacists in England has increased by 82%, from 28,984 to 52,780. That means nearly 24,000 more pharmacists registered in England this year than in 2010. It is a huge increase, even compared with the huge increases elsewhere in the NHS.

On top of that, we have published the “NHS Long Term Workforce Plan”, backed by more than £2.4 billion to fund further additional increases and more training places over the next five years. The plan sets out the steps that the NHS and education providers will take to deliver an NHS workforce who meet the changing and growing needs of the population over the next 15 years. Our ambition is to increase training places for pharmacists by nearly 50%—building even further on what we have already done—to around 5,000 by 2031-32, and to grow the number of pharmacy technicians.

Employers clearly have a key role in retaining staff and making jobs in community pharmacy attractive. To support employers, we are investing in training to help private contractors to deliver high-quality NHS services. NHS England has provided a number of fully funded training opportunities for pharmacists and pharmacy technicians—the hon. Member for Coventry North West (Taiwo Owatemi) raised an interesting and important point on this matter. That is why we are providing 3,000 independent prescribing training places—applications for this year are now available to pharmacists—and, on top of that, another 1,000 fully funded training places for designated prescribing practitioners, or DPPs. As well as growing the number of people entering the workforce, we are making provisions to upskill those who are already in the workforce. We are as just excited as other hon. Members present about the huge potential of independent prescribing in pharmacy to build even more on what we are doing to grow the range of services in community pharmacies.

I have talked about what we are doing on funding and the workforce, but I also want to talk about structural reform and efficiencies, and enabling pharmacists to do more with the skills they have—an important point raised by a number of hon. Members. The plan for primary care sets out some of the things we are doing, including modernising legislation to make it clear that pharmacists no longer have to directly supervise all the activities of pharmacy technicians, who are, in fact, registered health professionals in their own right.

Hon. Members are right to point out that the nature of work in pharmacy has changed, and we must change the legislation to match that. We also plan to enable any member of the pharmacy team to hand out appropriately checked and bagged medicines in the absence of a pharmacist, remedying frustrating instances where patients are delayed, having to wait perhaps because the pharmacist has popped out for lunch. We are also consulting on changes to the legislation to enable pharmacy technicians to use patient group directions, which would enable pharmacy technicians to do more.

Last week, the House debated legislation to give pharmacists the flexibility to dispense medicines in their original packs, so that pharmacists use their high-end clinical skills rather than spending time snipping out blister packs, which is not a good use of their time. We are progressing legislation to enable hub-and-spoke dispensing—the Chair of the Health and Social Care Committee, my hon. Friend the Member for Winchester (Steve Brine), rightly mentioned that—following public consultation on the changes.

Finally, we are also working with medicine suppliers to identify medicines that could be reclassified from being available only on prescription, known as “POM”, to being available in a pharmacy, known as “P”.

This is a huge package of structural reforms and a huge liberalisation of the structure of pharmacy, enabling pharmacists with ever-growing clinical skills to do more and not be caught up in bureaucracy.

The Government are thinking beyond that about what pharmacy can do in the longer term. Hon. Members are right that Pharmacy First, the fantastic new NHS service, could be added to over time. NHS England is also starting independent prescribing pilots, with a view to implementing pharmacy prescribing services in the future, based on what we learn from them. That has huge potential to take further pressure off GPs and make the best possible use of all the new skills in the pharmacy workforce.

The Chair of the Health and Social Care Committee, my hon. Friend the Member for Winchester, raised an important point about access to PrEP, as an example of an advanced service that pharmacies could provide. As he will know, partly because of his work in initiating this, the PrEP access and equity task and finish group was established in 2022 as a sub-group of the HIV action plan implementation steering group, to improve access to PrEP. That steering group is working to develop a PrEP road map based on the task and finish group’s recommendations. I can say today that the road map will be out before the end of the year, and it will deal with how we will work through all the knotty issues in enabling community pharmacy to provide PrEP.

I thank my hon. Friend the Member for Waveney for raising these hugely important issues, which are crucial to community pharmacy. The sector is doing more than ever before, seeing more people, providing a wider range of services and becoming more clinically advanced than ever. There are pressures in the sector, but we are injecting further funding. We have grown the workforce hugely. We will continue to build on what community pharmacists do to further improve community pharmacy across the country.

[Taiwo Owatemi]

Will the Minister give way?

[Neil O’Brien]

I will pause at the point of my peroration, because there is a question.

[Taiwo Owatemi]

There is a question: will the Minister return to my earlier question about whether he can come to the APPG to meet key pharmacy stakeholders?

[Neil O’Brien]

That is a brilliantly timed question, to which the answer is yes.

LGBT+ People and Spouses: Social Care

Neil O'Brien Excerpts

Tuesday 12th September 2023 Westminster Hall

[The Parliamentary Under-Secretary of State for Health and Social Care (Neil O'Brien)]

It is a pleasure to serve under your chairmanship, Sir Robert. I apologise if this important debate is interrupted by a vote. I also apologise for the fact that my colleague the Minister for Social Care, my hon. Friend the Member for Faversham and Mid Kent (Helen Whately), has been in a car accident and cannot be here today.

I pay tribute to the hon. Member for Dulwich and West Norwood (Helen Hayes) for securing this debate on a hugely important issue, which is only likely to grow in importance over time. I express my sympathy to Ted for the appalling, abhorrent experience that he and Noel suffered. I am glad that compensation has been paid, although it is not enough, and I am happy to continue to discuss that case with the hon. Lady and her constituent after this debate.

People have a right to live in safety, free from abuse and neglect, and they should expect high-quality care and tailored support to meet their personal care needs. Nobody should be disadvantaged due to their background, sexual orientation, gender identity, culture or community.

The hon. Member for Denton and Reddish (Andrew Gwynne) has mentioned some of the guidance and the clear recent legislation we have passed to ensure that is the case. Care workers, social workers and everyone working in social care need to be sensitive to people’s individual needs and circumstances, including their sexual orientation and gender identity. It is vital they have the confidence to discuss individuals’ differences to find out how they can best provide care and meet individuals’ needs.

I want to thank our amazing social care workforce, who work tirelessly to deliver high-quality care to individuals. It is important to recognise the hard and brilliant work of the social care workforce, even though today we are talking about some horrendous failures in social care, where things have not gone right, as highlighted in a report by Compassion In Care that has been mentioned several times and which is called “Stripped of all Pride”. I read the report and found it absolutely harrowing. Some of the cases discussed are almost unbelievable. The report shines a spotlight on how LGBT people are subject to prejudices and biases, potentially from the workforce and, if they are in the workforce, from people receiving care. I want to pay tribute to the whistleblowers who spoke to that people working on that report for speaking out against the abuse and vulnerability they face, not just in the case of Ted and Noel but across the country. It is vital that LGBT people are free to live and work in care homes where the culture is inclusive and respectful.

Many people who require care and support may not have children; not just LGBT people but, as the hon. Member for York Central (Rachael Maskell) pointed out, other people too. It is essential that we have strong systems to protect them and we do not just rely on other friends and family members to pick up discrimination or abuse.

Care providers have a key role in safeguarding, and all the relevant care professions are subject to employer checks and controls. Guidance from the National Institute for Health and Care Excellence is clear that care homes must have a safeguarding lead and that they should make sure everyone knows who that is. As part of its inspection regime, the Care Quality Commission checks that care providers have effective systems to keep adults safe from abuse and neglect. I will set out some of those robust processes.

Local authorities have a duty to investigate safeguarding concerns under the Care Act 2014. Anyone who is concerned that an adult with care or support needs is at risk of or experiencing abuse or neglect should contact the provider and the adult safeguarding team in the relevant local authority. If someone is in immediate danger or it is believed that a crime, including hate crimes, has been committed people should contact the police too. Any form of abuse or neglect is unacceptable, and we need a focused and effective safeguarding system.

All social care providers already have a duty to be respectful of an individual’s protected characteristics, including their sexual orientation, and make sure that their staff have the appropriate training to cater for the individuals in their care. In its role, the CQC takes a preventive approach to people experiencing prejudice or abuse, and looking at the quality of care for LGBT people in adult social care has been one of its equality objectives over a number of years. It is important that those who may be more likely to experience discrimination are listened to and have their needs understood by the local authority. That is why, from now on, the CQC will assess equity in outcomes and consider how local authorities ensure that people with protected characteristics under the Equality Act 2010 are understood. The new duty we have created for the CQC to assess local authorities’ delivery of their Care Act duties went live in April 2023, and that will make a big difference in ensuring that those at the authority level are thinking actively and working on this vital issue.

CQC assessment of local authorities will increase transparency so that those who might be more likely to experience discrimination, such as LGBT people, are able to hold their local authority to account. It is not just about raising and enforcing standards; it is about having the resource to provide a good service. That is why I am making the record increase in social care funding that we have set out, with an extra £7.5 billion overall, including nearly £600 million for the workforce development plan, so that we have a high-quality social care workforce as well as strong rules.

Leadership is key to developing an inclusive culture. The funded delivery partner of the Department of Health and Social Care, Skills for Care, has produced resources for care providers to help to develop a stronger awareness of the importance of equality and diversity standards. That helps social care leaders and their teams develop an inclusive and confident approach to diversity. I am aware that there are some providers that cater specifically to the LGBT community, which I think is great, and I want to recognise their important work. The hon. Member for Dulwich and West Norwood mentioned Tonic and I pay tribute to it and others across the country for their work. However, it is not just about them; it is about making sure that social care settings are suitable for everyone, whatever the setting.

I thank the hon. Members who have taken part in this important debate today and for shining a light on this important issue.

[Mr Jonathan Lord (Woking) (Con)]

I congratulate the hon. Member for Dulwich and West Norwood (Helen Hayes) on securing this debate, and on her moving and thoughtful speech. A lot has been said about driving such behaviour out of social care settings, but I wonder whether the Minister might say a little bit about the role that the police might have. We all want a fantastic ethos from social care settings, from local government and from national Government, but even with reasonable recruitment policies and so on, if there are bad apples in the sector, the damage they can do to vulnerable people over years or decades can be quite devastating. We need to make sure that those people are driven out if they get a police record, and are never able to enter that sector again.

[Neil O’Brien]

Absolutely. The police take this issue more and more seriously, which is vital. Some of the things that we have been talking about today, including in the “Stripped of all Pride” report, are clearly criminal offences, and it is important that we bring to justice all the people who do them. There is always much more to do, but the Government take this matter deadly seriously; it is horrific and appalling to hear about some of the treatment that people have experienced, and we are determined to stop that, using every single tool we have.

HIV Action Plan Annual Update 2022-23

Neil O'Brien Excerpts

Tuesday 18th July 2023 Westminster Hall

[The Parliamentary Under-Secretary of State for Health and Social Care (Neil O'Brien)]

I pay tribute to my hon. Friend the Member for West Bromwich East (Nicola Richards) and to all other hon. Members present. A number of them have played leading roles in campaigning on this issue.

This afternoon, we have had an excellent debate, hearing important contributions about particular aspects of the challenge: my right hon. Friend the Member for Romsey and Southampton North (Caroline Nokes) on the dimension for women; the hon. Member for Brighton, Kemptown (Lloyd Russell-Moyle) on the opportunities for home testing; and the hon. Member for Vauxhall (Florence Eshalomi) on the importance to her constituency. We heard about the inspirational work of centres such as 56 Dean Street from my hon. Friend the Member for Cities of London and Westminster (Nickie Aiken) and about the searing personal experience of friends and families of people suffering and dying of this terrible disease from my hon. Friend the Member for Darlington (Peter Gibson).

[Andy Slaughter (Hammersmith) (Lab)]

I apologise, as I have not been present for the whole debate. May I mention one other clinic, 10 Hammersmith Broadway? I visited it recently and was hugely impressed by the staff and their partners in the community, such as the Terrence Higgins Trust. It is clear, however, that they are under increasing stress. The problem is that it only takes an emergency like the outbreak of mpox, or STIs going up, and routine services such as providing PrEP go on to the back foot. Will the Minister look at that, particularly in high-prevalence areas, because the limited cost is not worth the great risk involved?

[Neil O'Brien]

I am happy to look into that. We provided extra funding

in respect of mpox, but I will look into the issues the hon. Gentleman raised.

This debate is an opportunity to restate our joint commitment to tackling HIV and to reflect on the progress we have made since 2019, when the Government first announced our ambition to end new HIV transmissions, new AIDS diagnoses and new HIV-related deaths in England by 2030. As all Members know, 30 years ago AIDS was a fatal illness; today, when they are diagnosed early and have access to antiretrovirals, the majority of people with HIV in England can expect a near-normal life expectancy. People who are diagnosed with HIV can expect to receive HIV care that is world class, free and

open access.

We have come a long way. Despite the unprecedented and challenging backdrop of the covid pandemic, England has seen a 33% fall in new HIV diagnoses since 2019, and fewer than 4,500 people live with undiagnosed HIV. The vast majority of those diagnosed are on high-quality treatment and are now unable to pass on the virus—still not enough people know that. Our successes have been possible only through clear national leadership and strengthened partnership working.

I am incredibly grateful to Professor Kevin Fenton, the Government’s chief adviser on HIV, who chairs the HIV action plan implementation steering group, which has representation from the key partners involved in the delivery of the HIV action plan, including local government, the UK Health Security Agency, the NHS, professional bodies and our voluntary and community sector. The group has met quarterly throughout the year to monitor progress on our commitments and ensure that appropriate action is taken to help us to move forward on our objectives.

Within the steering group’s remit, we have established a community advisory group, comprising representatives from a wide range of community and voluntary groups, from which we have a lot to learn, and four task and finish groups to support PrEP access and equity, workforce, HIV control strategies in low-prevalence areas, and retention and engagement in HIV care. The groups provide vital, comprehensive and timely advice and help us to remain on track to meet our 2030 goal.

Many areas of the country have replicated the national action regionally by providing leadership and oversight of the work that is under way within local systems. For example, we have seen the development of regional HIV action plans in areas such as the south-west, multi-agency working groups in the midlands, and stocktakes of testing activity and action via sexual health networks in the south-east, the north-east and Yorkshire.

[Peter Gibson]

I am interested to hear the stories the Minister is telling about regional action plans; do they include opt-out testing?

--- Later in debate ---

[Neil O’Brien]

I will come on to opt-out testing in a moment.

We are incredibly grateful for the work of the UK Health Security Agency, which is a world-class organisation that runs high-quality data-collection and surveillance systems to help us to better understand the scale of the challenge. In December 2022, the UKHSA published the first monitoring and evaluation report on the HIV action plan, which indicated that the achievement of our ambitious commitments, including the interim commitment to an 80% reduction in transmissions by 2025, is within our grasp, and we should be encouraged by the progress that has been made.

As various Members pointed out, progress in the UK is increasingly recognised internationally at different HIV global forums, such as the UNAIDS and WHO international boards. The proof of that is that the UK met the UNAIDS 95-95-95 targets for the second time in 2021: 95% of HIV-positive individuals were diagnosed; 99% of those diagnosed were receiving treatment; and 98% of those receiving treatment were being virally suppressed and unable to pass on the disease.

Transparency and accountability are a key cornerstone of our plan, which is why we also committed to update Parliament each year on the progress made towards our ambition to end new HIV transmissions. In particular, we are committed to ensure that underserved populations benefit equally from the improvements made in HIV outcomes, including by scaling up our prevention efforts and increasing access to PrEP. We have already invested £33 million to roll out PrEP across sexual health services over the past two years, and PrEP is now being commissioned as a routine service through the public health grant. However, we know that there is more to do to improve PrEP access and equity for key groups, and we are in the process of developing a road map based on the input of the PrEP task and finish group that I mentioned, to improve PrEP provision and help us to reach those who are under-represented in PrEP access.

The hon. Member for Brighton, Kemptown raised the issue of the blood test, which I will absolutely take away and look at. On the specific point about timing made by my hon. Friend the Member for Darlington (Peter Gibson) and by my right hon. Friend the Member for Dumfriesshire, Clydesdale and Tweeddale (David Mundell), the HIV plan implementation steering group is working to develop a road map based on the task and finish group’s recommendations, to help to guide our movement forward. Our work will be informed by the findings of research on the use of HIV PrEP commissioned by the English HIV and sexual health commissioners group. In particular, we want to understand the barriers for underserved groups that access PrEP and how they can be mitigated.

It is expected that the research will be published this month—of which there is, of course, not much left. Members will see that very shortly, because we know the urgency of this issue, and I have been struck by Members’ testimony today about what is happening in respect of private access and the need for people to access PrEP in a timely and smooth way.

A number of hon. and right hon. Members raised the issue of the opt-out testing programme. I have met some of the people who have already benefited from that incredible programme, which powerfully underlines its huge benefits. Preliminary results from the pilot are promising, and we are still considering the full evidence from the first year of the programme, alongside the data on progress towards our ambition of ending new transmissions. Through the HIV action plan, DHSE is investing £3.5 million in our national HIV prevention programme from 2021 to 2024, to raise awareness of ways to prevent the spread of HIV and other sexually transmitted infections among the most affected communities.

As part of that programme, we deliver National HIV Testing Week in partnership with the Terrence Higgins Trust. In 2023, it distributed almost 22,000 free HIV testing kits ordered by the public. The self-testing kits provide instant at-home results and are available for the very first time. A targeted summer campaign is currently being delivered through the brilliant work of our partners at the Terrence Higgins Trust. The campaign has been carefully developed and tailored through strong audience insight evaluation to help us reach those most at risk, and it aims to increase testing among key groups, particularly young people and people of African heritage. It also aims to promote awareness of good sexual health practices to prevent transmission of other sexually transmitted infections. To reassure my right hon. Friend the Member for Romsey and Southampton North, we are working with the Department for Education on its RHSE review, and have been doing so since March, so I absolutely recognise the importance of the point that she made.

Achieving our 2030 goal will require sustained commitment from many partners across the health system and beyond—in education, for example—and the HIV action plan describes the role that each partner will play in this vital endeavour. The success of recent years, and the scale of the task that remains, should give us the belief and the drive to go further in the years ahead. Let us continue working together to ensure that we are the generation that ends HIV once and for all.

Under-age Vaping

Neil O'Brien Excerpts

Wednesday 12th July 2023 Commons Chamber

[The Parliamentary Under-Secretary of State for Health and Social Care (Neil O’Brien)]

Protecting children from the risks of vaping is a key Government priority. We regulate vaping, with a minimum age of sale of 18; advertising restrictions, such as a ban on TV and radio; and a cap on nicotine levels and tank sizes. However, in the past two years there has been an increase in children vaping, which is why we have already taken action and will take further actions.

Despite its effectiveness as a tool for adults to quit smoking, we are concerned about the risks that vapes pose to children and non-smokers. Vapes are not risk-free. Nicotine is highly addictive and can be harmful, and there are unanswered questions on the longer-term use of vaping. As Professor Chris Whitty, the chief medical officer says:

“If you smoke, vaping is much safer; if you don’t smoke, don’t vape”.

So earlier this year, in April, I announced new measures to step up our efforts to stop children getting hooked on vaping. First, I announced a new specialised illicit vapes enforcement squad. It is a dedicated new team to tackle underage vape sales and the illicit products that young people have access to, hold companies to account and enforce the rules. We are providing £3 million of new funding to trading standards, which will help to share knowledge and intelligence across the country; undertake test purchasing; disrupt illicit supply, including by organised crime gangs; remove illegal products from our shelves and at our borders; and undertake more testing to ensure compliance with our rules, bolstering the training capacity of trading standards. We have already made firms withdraw products where they do not comply with the rules. With the new squad, more companies that fail to comply with the law will be held accountable. I am pleased to announce that the National Trading Standards has begun its operation—that directly answers the question asked by the hon. Member for Denton and Reddish (Andrew Gwynne)—and is gathering intelligence, training staff and bolstering capacity to begin its fieldwork.

In April, I also launched a call for evidence on youth vaping, to identify opportunities to reduce the number of children accessing and using vape products, and to explore where Government can go further. Our call for evidence explored a range of issues about how we ensure regulatory compliance. It was partly about the appearance and characteristics of vapes, including colours and flavours, and partly about their marketing and promotion, particularly the role of social media. Our call for evidence closed on 6 June and the Government are urgently and carefully examining the response.

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

I know that the Minister is committed to closing that loophole that allows vaping companies to give children free samples, but, as we have all discussed, this is about the direct gateway effect between people vaping and then smoking. Parents in Walthamstow they are convinced that more children will end up smoking as a result of being able to access vaping in any form at all. So why are the Government consulting on limiting access to vaping for under-18s, rather than just stopping it altogether?

[Neil O’Brien]

We are trying to stop access to vapes for the under-18s—it is literally illegal. We are trying not only to enforce the law but to reduce demand, as we have been discussing in this debate. We are not in disagreement about what the objective is: we do not want any kids to smoke or to vape—it is as simple as that.

[Daisy Cooper]

The Minister said that this is “literally illegal”. According to the director general of the UK Vaping Industry Association, 40% to 50% of the disposable vapes market is made up of illicit products. So does the Minister agree that as well improving the regulation of vapes within the legal market that we have heard about so far, we must also see improvements to border security, to clamp down on illicit vape sales?

[Neil O’Brien]

I completely agree with the hon. Lady on that point; this is exactly what our enforcement squad is doing, and I completely agree about the importance of doing it.

On the call for evidence, we will be producing our response in early autumn, identifying and outlining areas where the Government will go further. The key point is that we need evidence to take effective action to stop children vaping. While that call for evidence has been running, we have already taken further steps. At the end of May, the Prime Minister announced several new measures to support our efforts to tackle youth and kids’ vaping. That included closing the loophole in our laws that has been allowing companies to give out free samples of vapes to under-18s, which ASH estimates could total as many as 20,000 a year. He also announced that we will overhaul the rules on selling nicotine-free vapes to under-18s and on issuing fines to shops selling vapes to the under-18s.

The Prime Minister also announced that we will update the school curriculum, to emphasise the health risks of vaping within relationships, sex and health education lessons, just as schools currently do for smoking and drinking, so that kids understand the risks of vaping. We will be writing to police forces to ensure dedicated school liaison officers across the country are using the new resources available to keep illegal vapes out of schools.

I want to use this opportunity to outline the work we are doing to successfully reduce smoking, not least because the Opposition Front-Bench spokesperson touched on it. In the 1970s, more than 40% of people smoked, and it was still 21% in 2010. Since then, we have taken a series of steps, including doubling excise duties and introducing a minimum excise tax on the cheapest cigarettes, that have helped to drive down smoking to a record low of just 13% in England.

We have gone from 21% to 13%, but of course we want to go further. In 2019, we announced our ambition for England to go smoke-free by 2030, which is considered to be 5% or less. Over the past decade, we have made significant progress towards making England smoke free. We have continued to invest in local stop-smoking services, to help smokers get the right support for them. We continue to work in support of the NHS. Last year alone, we provided £35 million to the NHS long-term plan commitments on smoking.

Youth smoking rates are now at their lowest rates on record. In 2021, just 3.3% of 15-year-olds were regular smokers, although of course we want to reduce that figure even further. Through the new measures I announced in April, the Government will be supporting many more smokers to quit through the tobacco reduction strategy. Some 1 million smokers will be encouraged to Swap to Stop, swapping cigarettes for vapes under a new national scheme that targets those who are most at risk and gives them free vapes. That is first scheme of its kind in the world. It is based on experience from the successful local pilots, and is an evidence-based initiative.

Likewise, we will offer innovative, but evidence-based, financial incentives for all women to stop smoking in pregnancy. Again, this is based on evidence that has been gathered during local pilot schemes and the strategy will be implemented at a national level. Shortly, we will launch a consultation on cigarette pack inserts to provide further information to support smokers to quit, which is something Canada has done successfully.

Further, those who supply tobacco for sale in the UK must be registered for tobacco track and trace, and obtain an economic operator ID. We brought in that scheme to tackle illegal tobacco, but we now want to use the existing system in a new way, to help strengthen enforcement and to target the illicit market. From now on, when people are found selling illicit tobacco, we will not just seize their products but remove their economic operator ID, so they will no longer be able to buy or sell tobacco. We are exploring how to share information with local partners about who is registered on the track and trace system, so that they know who is and who is not legally entitled to sell tobacco in their areas, helping to drive enforcement.

We are committed to doing all we can to prevent children from starting to vape and we are already taking robust action in a range of areas. We are actively working on ways that we can go further, but it is essential that those methods are evidence based and that we have measures that will be effective.

[Barbara Keeley]

The Minister will have heard the figures given earlier: my hon. Friend the Member for Denton and Reddish (Andrew Gwynne) said that 30% of secondary school pupils in Yorkshire and Humberside have tried vaping and I said that the figure for the north-west was 29%. I quoted the Royal College of Paediatrics and Child Health saying that youth vaping is “fast becoming epidemic”. He is talking about an evidence-based plan, but what is the situation around evidence? My local area still has very high levels of smoking, but we are now seeing the same pattern tracking in vaping among young people as we did in smoking. Does he agree that there needs to be different and further action in those places where the figures are so bad?

[Neil O’Brien]

The theme of my speech is that we have already taken action and we will continue to take action, but that it has to be evidence based. A range of suggestions has been made during the debate, and I am sure there will be more, about different things to do with flavours, packaging, colours and marketing. There needs to be evidence and definition about those things. Some people will probably say that we should ban all flavours; some will say, “Let’s ban all coloured vapes”; some will say that we should have plain packaging or vapes should be hidden from view. We will need to take an evidence-based view on all those issues, rather than just assuming that one knows the answer immediately.

It is not totally obvious to me what the position is of the Opposition Front Bench team on any of those issues—whether they would ban all colours, ban all flavours, demand plain packaging, or want the same kind of restrictions as there are for cigarettes in terms of where they are placed in shops. I am happy to take an intervention if the shadow team have answers to those questions. Is it a yes or a no to those things?

[Andrew Gwynne]

What we are here to talk about today is advertising and packaging. I made it very clear in my contribution that the next Labour Government would act robustly on both those issues.

[Neil O’Brien]

Act robustly? I think we all want to act robustly. The shadow Minister said in his speech that he did not like banana-flavoured vapes, but would they be banned? I am happy to take an intervention if the shadow team have an answer. I do not think that we have an answer. That, ladies and gentlemen, is why we need to have evidence. We need to have an evidence-based approach, and we need to have not just the evidence about what drives these things, but clear definitions of these things on which we can actually take action. We have to be clear about what we are and are not doing within all these fields.

All I was trying to do is to demonstrate that, while we are committed to taking action—I feel very strongly about taking action on this—and while we have done a whole range of different things on this point, we need evidence to make good policy, which is why we are having a call for evidence.

[Daisy Cooper]

The Minister will know that the Government commissioned the Khan review, which reported on 9 June 2022—a year ago. The Khan review took the evidence. It had the consultation and it made very firm recommendations about certain things that the Government should do. Why are we here again? Why are we consulting? Why can the Government not just follow the recommendations in the Khan review?

[Neil O’Brien]

On driving up support for people to Swap to Stop, we are following the recommendations. On the things that we have been discussing in this debate, a whole set of other questions have been raised, on which our call for evidence explicitly invited evidence, because we want to have an evidence-based policy.

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

I am grateful to the Minister for giving way, because I want to turn to the evidence. We know that, when we had plain packaging and removed advertising around cigarette sales, we saw a significant decrease in the use of those products, particularly among young people. We also have other evidence: Israel introduced plain packaging in 2020 and Finland in 2022. There is plenty of evidence out there on the implications of plain packaging, so why will the Minister not use that evidence and implement things?

[Neil O’Brien]

We are garnering evidence on every different aspect of this policy question. In my remarks today, I have tried to illustrate some of the questions that we are thinking about at the moment, which I am sure we will hear more of during the debate. I was simply trying to make the point that we need definitions of things and we need evidence before we take action.

In conclusion, we are committed to doing all we can to stop children from vaping—that is a personal priority of mine. We are also committed to stopping youth smoking. In order to meet our smoke-free 2030 ambition, we are committed to doing all we can to stop people from starting to smoke in the first place, and to give people the support that they need to quit and save their lives.

Oral Answers to Questions

Neil O'Brien Excerpts

Tuesday 11th July 2023 Commons Chamber

[Daisy Cooper (St Albans) (LD)]

6. What assessment he has made of the potential impact of guidance issued by District Valuer Services on the availability of city-centre GP premises.

[The Parliamentary Under-Secretary of State for Health and Social Care (Neil O'Brien)]

While it is a very long-standing system, we keep the approach to funding for GP premises under review. We have taken action in the primary care recovery plan to improve access to section 106 funds, so that new homes always come with the GP infrastructure that is needed.

[Daisy Cooper]

The Secretary of State and his Ministers will know that I first raised this issue in the Chamber on 6 June this year. Integrated care boards, GPs, and now the medical property sector are all telling me that the Treasury rules are out of date and are a massive block to securing much-needed primary care premises in the right places, particularly in city centres such as St Albans. When I have asked the Department via written parliamentary questions for its assessment of how much of a problem this issue is, the Department has told me that it just does not know. Could the Minister please tell us when he will be speaking to colleagues in the Treasury to resolve this issue, so that we can make sure that GP premises are secured where people need them most?

[Neil O'Brien]

We talk all the time. I am conscious that there are 60% more full-time patient-facing staff in the hon. Lady’s constituency than there were in 2019, which of course puts pressure on premises. The capital allocation for her local ICB between 2022-23 and 2024-25 was £200 million, so the money is there, but I am happy to continue the conversation about how we get the premises in the places where we need them.

[Chris Green (Bolton West) (Con)]

7. What recent progress he has made on increasing the range of services in pharmacies.

[The Parliamentary Under-Secretary of State for Health and Social Care (Neil O'Brien)]

We have already been growing the range of NHS services available in pharmacies: we have set up the community pharmacist consultation service, the discharge medicines service, the new medicine service, the blood pressure check service, smoking-cessation services and the contraception service. We are now investing £645 million to go further through the new Pharmacy First scheme for common conditions.

[Chris Green]

I thank my hon. Friend for his answer, but does he agree that the services offered by pharmacies can be made more efficient? For example, 62 million prescription items are subject to “split and snip” per year. That is where, to get the right number of pills, a pack has to be manually opened up for a couple of pills to be snipped out, then repackaged and relabelled before being reissued. The spare pills are often thrown away. Can that system not be better?

[Neil O'Brien]

My hon. Friend is completely correct. That is why at the end of last month we laid a statutory instrument before the House to fix the system, so that pharmacists can spend more time using their skills to provide high-end clinical services and less time snipping blister packs.

[John Cryer (Leyton and Wanstead) (Lab)]

Given the national shortage of GPs, does the Minister recognise that there is a potential danger in asking pharmacists to take on the duties of GPs—duties that they are not necessarily qualified to undertake—especially given the already large workload undertaken by pharmacists?

[Neil O'Brien]

We absolutely recognise the need for patient safety, which is why there will be clear patient group directions and clear pathways about what pharmacists do. They are not taking on the role of GPs, but are providing additional services that will make things more convenient for all of our constituents.

[Dame Maria Miller (Basingstoke) (Con)]

I warmly welcome the Government’s commitment to investing £645 million to enable pharmacists to provide for far more common conditions. I have already visited one of my own local surgeries, the Shakespeare Road medical practice, and seen at first hand how pharmacists are already working in GP surgeries to try to reduce waiting times. Surely, more surgeries should be doing the same, involving pharmacists with enhanced roles in order to cut waiting times in a manner that is safe.

[Neil O'Brien]

My right hon. Friend is completely correct. That £645 million, of course, comes on top of the £100 million that we have already put in. We have grown the pharmacy workforce hugely—there are 82% more pharmacists now than in 2010—and we are also enabling those people with their high-end skills to do more by reforming regulations. That is not just the blister packs issue; we are enabling them to do convenient things such as hand out bagged medicines even if the pharmacist is not present.

[Mr Gregory Campbell (East Londonderry) (DUP)]

Will the Minister undertake to liaise closely with local community pharmacy representative groups to ensure that the excellent work they have been doing can be maximised, particularly given that the NHS is under severe pressure at the moment?

[Neil O’Brien]

Absolutely, and I always try to learn lessons from right across the UK. In fact, some of the ideas for reforms have come from listening to local partners. For example, our reforms to enable modern ways of working, hub-and-spoke dispensing and empowering pharmacy technicians have come from talking to those local partners.

[Mr Speaker]

I call the shadow Minister.

[Karin Smyth (Bristol South) (Lab)]

People across the country rely on local, accessible pharmacies, but whether it is high street closures or supply problems leading to the absurd situation where women are phoning or visiting multiple pharmacies for a prescribed dose of hormone replacement therapy and other drugs, the Government are again letting people down. They have repeatedly announced plans to expand the role of community pharmacies, but have failed to update legislation that could possibly help. They keep collapsing the business in this place, so we have time to sort it. Why will they not do so?

[Neil O’Brien]

I have given a flavour of the four different reforms we are making. To give the wider picture, there are more pharmacies in England than there were in 2010, there are 24,000 more pharmacists in England than there were in 2010 and we are putting in £645 million to provide a bunch of services that were not there when Labour was in office. We are very happy to take lessons from the pharmacy sector, but not from the Labour party.

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

8. What steps he is taking to help improve the effectiveness of brain cancer treatments.

--- Later in debate ---

[Kate Osborne (Jarrow) (Lab)]

10. What steps he is taking to help tackle health inequalities.

[The Parliamentary Under-Secretary of State for Health and Social Care (Neil O’Brien)]

We are tackling the root causes of health inequalities. We have doubled the duty on cigarettes and brought in a minimum excise tax on the cheapest cigarettes. That has helped to drive down smoking rates from 21% to a record low of 13%. We are going further, helping a million smokers with our scheme to get people to stop smoking and start vaping. We have provided £40 million to start rolling out new weight-loss drugs and, in the major conditions strategy, we will talk further about how we will tackle health inequalities.

[Kate Osborne]

People in the north-east die younger than people in the rest of England and spend more years in ill health. Increased NHS waiting times leaves them on medication for longer. The north-east has the highest level of people living in poverty, leaving many of my constituents unable to afford prescription charges. Some have told me that they are taking paracetamol instead of prescribed medication, worsening health inequalities. Will the Minister commit to scrapping these unfair prescription charges?

[Neil O’Brien]

Nine out of 10 prescriptions are not paid for, but free at the point of delivery. On the various important points that the hon. Lady makes, tackling health inequalities is hugely important to us. That is why we are creating 160 extra community diagnostic centres, which are targeted at areas of the highest deprivation. It is why we are rolling out targeted lung health checks in 43 areas of the most deprivation. It is also why we are providing cost of living support worth about £3,300 for the average household in this country. It is one of the most generous schemes anywhere in Europe, exactly to tackle those cost of living pressures and health inequalities.

[Mr Louie French (Old Bexley and Sidcup) (Con)]

My hon. Friend will be aware that health inequalities can also be geographical within the south-east, with boroughs such as Bexley having historically received less funding than other parts of London. Does he therefore agree that further investment in the fantastic Queen Mary’s Hospital Sidcup would address that issue and improve health outcomes for people in south-east London?

[Neil O’Brien]

My hon. Friend is assiduous in making the case for his constituency. Ministers of course will meet him to discuss this matter. I know he is closely following the progress of the CDC bid, which we have been talking about. Those diagnostic centres are doing fantastic work to get earlier diagnosis and save more lives, particularly in areas of deprivation.

[Mr Speaker]

I call the shadow Minister.

[Andrew Gwynne (Denton and Reddish) (Lab)]

From this complacent Minister’s replies already, one would think that health inequalities in England were improving, not widening. Last year, 11,000 people, including 312 children, were hospitalised for malnutrition in the United Kingdom. That is the highest number since comparable records began. Why are so many people in Britain going hungry under the Tories?

[Neil O’Brien]

We need to have care in discussing these subjects. Eating disorders are a sensitive subject and the statistics the hon. Gentleman is quoting are a mix of different things. I have already talked about the £3,300 of cost of living support that this Government are providing to the average UK household, with more targeted help for more vulnerable households. It is something we are seized of and are working on.

[Mr Speaker]

I call the SNP spokesperson.

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

Millions of people with disabilities or serious medical conditions rely on specialist equipment, such as ventilators or home dialysis, which personally costs them more money to run, while giving considerable savings to NHS hospitals. Will the Minister urge Cabinet colleagues in the Department for Work and Pensions to help to tackle health inequalities by ensuring that those people receive a fair and timely reimbursement for those additional costs, which are essential to run the equipment to help keep them alive?

[Neil O’Brien]

Absolutely. We are conscious of the additional needs of people who have equipment like that. By the end of June, the Government had covered nearly half of a typical household’s energy bill through the support schemes we put in place, but we are always looking at what more we can do to help vulnerable households.

[Ian Byrne (Liverpool, West Derby) (Lab)]

11. What assessment his Department has made of the potential impact of primary care service closures on public health.

[The Parliamentary Under-Secretary of State for Health and Social Care (Neil O’Brien)]

Each integrated care board is required to ensure access to GP services for all. Overall, more people are being seen in general practice than ever before—about 10% more than before the pandemic—but where some practices close, the local ICB has to ensure that patients are transferred smoothly to other practices.

[Ian Byrne]

Park View medical centre in West Derby, one of the most deprived areas of my city, is facing imminent closure, and there has been a lack of transparency and accountability throughout the process when dealing with the ICB to get the decision reversed. In the Minister’s reply to my letter, he said it was essential that, if a GP surgery closes, it does not lead to a reduction in the quality of care for patients in the locality. Park View patients have been clear that dispersal to other surgeries would be catastrophic, especially when all GPs are already facing huge pressures. Will the Minister urgently intervene to halt the closure due to the legal insufficiency of the consultation process and meet me and patients?

[Neil O’Brien]

I have looked carefully at that case, on which the hon. Gentleman has been campaigning. The incumbent provider chose not to bid for the future contract for Park View medical centre, and NHS Cheshire and Merseyside decided that the best thing was to help patients to transfer to neighbouring practices. Patients will only be transferred to practices rated as good, and there are 10 other practices rated as good within a 1-mile radius of Park View. Since 2019, there has been an increase in the number of patient-facing staff of about 50% in the constituency. That means there are more people in his GP surgeries. We are working hard to ensure high-quality GP services in his constituency.

[Virginia Crosbie (Ynys Môn) (Con)]

Health is devolved to Labour in Cardiff. Ynys Môn is represented by five Members of the Senedd, yet health represents a third of my postbag, particularly relating to access to primary care in Holyhead. Does the Minister agree that families in Holyhead are not getting the healthcare they need and deserve?

[Neil O’Brien]

Yes, it is true, I am afraid. People are about twice as likely to be waiting for treatment in the Welsh NHS. Waits are also longer in Wales, with 30,000 people waiting more than two years for treatment, even though those have been eliminated in England. England spends more on general practice than Scotland or Wales, despite the fact that Wales has 20% more funding, and England has also grown spending on general practice faster than either Scotland or Wales. We are highly focused on getting good primary care services in England. There are always lessons that we can learn from each other, but there are definitely lessons that Welsh Labour can learn from the English NHS.

[Neale Hanvey (Kirkcaldy and Cowdenbeath) (Alba)]

12. What steps his Department is taking to create a vaccine development and evaluation centre.

--- Later in debate ---

[David Johnston (Wantage) (Con)]

T2.   I have campaigned for more health services for my constituents since I was elected, and 97% of those who responded to my recent health services survey felt that we did not have enough doctors for the number of people in the constituency. Will my hon. Friend meet me to discuss how to sort this out and get my constituents the health services that they deserve?

[The Parliamentary Under-Secretary of State for Health and Social Care (Neil O’Brien)]

We are conscious that more is going on in general practice than ever before. There are 10% more appointments than before the pandemic, as well as 29,000 extra clinicians and nearly 2,000 more doctors, but we are conscious of the pressures that puts on the estate locally. I would be very happy to meet and have further conversations with my hon. Friend.

[Kirsten Oswald (East Renfrewshire) (SNP)]

T3. I am sure that the Secretary of State shares my concern that school nurses report increasing rates of children presenting with health issues resulting from poor nutrition. In Scotland, the SNP Government have rolled out universal free school meals for all pupils in primary years 1 to 5 and special schools, and the expansion of the programme continues. What discussion has the Secretary of State had with Cabinet colleagues about following Scotland’s lead and expanding free school meal provision in England to improve children’s health and wellbeing?

--- Later in debate ---

[Steven Bonnar (Coatbridge, Chryston and Bellshill) (SNP)]

A recent report by the Trussell Trust warns that people facing hunger are more likely to be affected by spiralling debt and a decline in their physical and mental health. The same report shows that one in seven people in the UK faced hunger in the last year due to a lack of money. Will the Minister make representations to his colleagues at the Department for Work and Pensions about increasing support for low-income households, thereby improving public health outcomes for all?

[Neil O’Brien]

It is to protect public health that we have provided cost of living support worth £3,300 on average per household, and that is why we have been paying about half of people’s average electricity and other energy bills. However, we always look at further things we can do to drive improvements in public health.

[Andrew Lewer (Northampton South) (Con)]

T7. What steps is the Department taking to prevent chronic kidney disease, given that the recent report published by Kidney Research UK predicts a significant rise in cases of kidney failure in 10 years’ time?

--- Later in debate ---

[Jason McCartney (Colne Valley) (Con)]

T8. Many of my constituents are still struggling to get NHS dental appointments, so what is happening right now—this week, this month—to increase the availability of NHS dental appointments for them?

[Neil O’Brien]

I know how intensely my hon. Friend is campaigning on this issue. The amount of NHS dentistry being delivered has gone up by a fifth over the last year, partly as a result of the reforms we are already rolling out. He will have seen in the workforce plan that we are going to increase training places for dentists by 40% so that we have the NHS dentists we need. However, that is not all we will do, and our forthcoming dental plan will take further steps.

[Debbie Abrahams (Oldham East and Saddleworth) (Lab)]

We have known for a while that our life expectancy is shorter than it was in 2010. However, we are now seeing impacts on children in the UK, who are about 7 cm shorter at five compared, for example, with the children of our neighbours in Holland. What is the Secretary of State doing on this issue, and will he support the all-party parliamentary group on health in all policies in assessing the impacts on health and health inequalities?

[Neil O’Brien]

Of course we are taking action to improve public health, and that includes children’s nutrition. That is why we are spending £150 million on healthy food schemes, such as the school fruit and vegetable scheme, the nursery milk scheme and Healthy Start. It is also why we are investing £330 million a year in school sport and the PE premium and a further £300 million through the youth investment fund. We will continue to take action on this key issue.

[Mr Jonathan Lord (Woking) (Con)]

I am delighted that a new diagnostic centre is shortly to be built at our terrific Woking Community Hospital, very close to Woking town centre. Does the Minister agree that providing state-of-the-art diagnostic care right in the heart of the community can cut NHS waiting lists, reduce carbon emissions and, most importantly, help to optimise health outcomes for patients?