National No Smoking Day

Neil O'Brien Excerpts

Thursday 9th March 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, Mr Efford. I thank my hon. Friend the Member for Harrow East (Bob Blackman) for securing this important debate. He spoke brilliantly, marshalling his argument and speaking from terrible personal experience. I thank him for not just his speech, but his advice more generally. I thank other Members for their thoughtful contributions. The hon. Member for North Tyneside (Mary Glindon) made an important point about the huge potential of vaping to help people stop smoking because it is much safer, but we must balance that against the important point made by the hon. Member for York Central (Rachael Maskell) about the need to prevent non-smokers, particularly children, from starting vaping. The hon. Member for Blaydon (Liz Twist) made an important point about the regional and local impact of smoking, and its negative impact on levelling up. She is quite right. I notice that the north-east is well represented here today, as well as north London. I thank all hon. Members for their contributions.

Yesterday was No Smoking Day, which presents a timely opportunity to have this conversation. Since I spoke at the last Commons debate on a smokefree 2030 in November, adult smoking rates in England have gone down to 13%, an all-time low. That continues the downward trajectory in smoking rates over the past few decades, moving from 45% in the 1970s to 20% in 2010 to 13% now. As several hon. Members have pointed out, our efforts to reduce smoking are a public health success story and are widely recognised as some of the most comprehensive in the world.

In 2021-22, we invested £68 million in local authority stop smoking services through the public health grant, and nearly 100,000 people quit with their support last year. I am proud to say that we have recorded more than 5 million successful quits since stop smoking services were established across England in 2000. That is 5 million lives that have been saved or improved as a result of quitting smoking.

Last year alone, the NHS invested £35 million in tobacco-dependency treatment. The NHS has committed to ensuring that all smokers admitted to hospital are offered NHS-funded tobacco treatment services. Pregnant women are routinely offered a carbon monoxide test, which is used to identify smokers and to refer them to support to quit. National campaigns, such as Stoptober, have helped 2.1 million people to quit since their inception in 2012.

We have introduced a range of impactful smoke-free legislation, such as that referred to by the hon. Member for Denton and Reddish (Andrew Gwynne), including the ban on smoking in cars when children are present, plain packaging on cigarette packs and display bans, and raising the age for the sale of tobacco from 16 to 18. There are many more initiatives, and the legislation has been a cross-party effort. All those measures have contributed to reducing smoking rates overall, particularly among children. In 2021, just 1% of 11 to 15-year-olds were regular smokers, which is the lowest rate on record, although that is still, of course, much too high.

My hon. Friend the Member for Harrow East said that we have to go further and faster, and he is absolutely right. Smoking is still the leading preventable cause of health disparities, premature disability and death. There is an economic cost to smoking that puts a huge direct drain on household finances, as hon. Members have pointed out, and has a wider impact on productivity taxation and our wider economy. Tragically, two out of three smokers will die from smoking unless they quit.

Smokers are 36% more likely to be admitted to hospital, and the cost to the NHS is huge. The average smoker needs social care 10 years before a non-smoker, so the cost to social care is huge, too. That is why tackling smoking is central to our forthcoming major conditions strategy, which takes the place of the previous strategy mentioned by the hon. Member for Blaydon. Smoking and other causes of preventable ill health will be central to that strategy.

[Liz Twist]

Will the Minister clarify whether the tobacco control plan will come within the major conditions strategy?

[Neil O'Brien]

I will hopefully reassure the hon. Lady on that point shortly. I was saying that tobacco and tobacco control will be threaded through the major conditions strategy, but I will come to our specific plans to control smoking in a moment.

The major conditions strategy will look at cancers, cardiovascular disease, stroke and diabetes, chronic respiratory diseases, dementia—which has been mentioned several times today—and mental ill health. Smoking is a contributor to all those major conditions. Put simply, it makes all of them worse. It increases the risk of heart disease, heart attack and stroke, often disabling people for years. As my hon. Friend the Member for Harrow East mentioned, the theme for No Smoking Day this year is dementia and how stopping smoking protects brain health.

If smoking disappeared, the great majority of cancers would disappear for a large proportion of our population. More than 70% of lung cancer cases in the UK are linked to exposure to tobacco smoke. There is even a connection between smoking and diabetes. Cigarette smoking is one of the most important modifiable risk factors for type 2 diabetes. All these risks, across all these different conditions, can be changed by one lifestyle modification.

As many hon. Members have highlighted, last year the Government asked Dr Javed Khan to undertake an independent review to help to meet the smokefree 2030 ambition and reduce the devastation that smoking causes. My hon. Friend asked when we will set out our response. In the coming weeks, I will unveil a set of proposals to realise the smokefree 2030 ambition and to respond to the Khan review’s recommendations.

I thank hon. Members for their patience. Although I cannot divulge the specifics of the proposals at this time, I assure hon. Members that they are grounded in the best evidence on reducing tobacco use and its associated harms. They are bold, innovative and ambitious, and we have carefully considered the Khan review’s recommendations as part of the process. I look forward to the opportunity to share more details with hon. Members very soon and to set out more details of our road map to a smokefree 2030.

Prescription Charges: People Aged 60 or Over

Neil O'Brien Excerpts

Monday 6th March 2023 Westminster Hall

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

I am grateful to the hon. Member for Gower (Tonia Antoniazzi) for opening the debate so effectively on behalf of the Petitions Committee, and I thank all Members for their constructive contributions. I also thank the 46,000 members of the public who signed the petition.

The Government provided their initial response to the petition in January 2022, and I am pleased to be able to respond again today, having listened to hon. Members’ important and interesting contributions. The context, of course, is the Russian invasion of Ukraine and the high energy prices, inflation and cost of living pressures that it has unleashed. It is worth situating the debate in the context of some of the things we are doing to take action on that, some of which hon. Members have already referred to.

This winter, we are spending a total of £55 billion to help households and businesses with their energy bills—one of the largest support packages in Europe. A typical household will save about £900 this winter through the energy price guarantee, in addition to £400 through the energy bills support scheme. We are also spending £9.3 billion over the next five years on energy efficiency and clean heat, making homes cheaper to heat. Some of that is being paid for by the windfall tax; at 75%, it is one of the highest in any of the countries around the North sea, and it is enabling us to do more on the cost of living, such as the £900 cost of living payment for 8 million poorer households, and the largest ever increase to the national living wage, which will help 2 million workers. In total, we are spending £26 billion on cost of living support next year.

Turning specifically to prescription exemptions, I should start by trying to manage expectations about what I can say today, for reasons on which I will elaborate. It is clear that the outcome of the consultation on aligning the upper age exemption for prescription charges with the state pension age is very important to many Members’ constituents. However, I can only say at this point that no decision has been made yet to bring proposals forward.

We received over 170,000 responses to the consultation —a testament to the strength of feeling on the issue. We want to ensure that everyone across the country, especially those affected by the cost of living pressures caused by the Russian invasion, can afford their prescriptions. That is why we have thought long and hard about how best to balance the needs of those in the affected age group, many of whom will find that they have additional health needs compared with when they were younger, with the pressures facing the public finances. I can, however, assure Members that we will respond to the consultation in due course.

Hon. Members will be aware that the petition calls on the Government to protect free NHS prescriptions for all over-60s. We value our older members of society, and we recognise their social care and health needs. On the one hand, we recognise that families up and down the country are facing unprecedented pressures with the cost of living; on the other, we have to recognise that in the light of the covid pandemic, which has tested the NHS like never before, and the challenging economic landscape, we must ensure that public sector spending represents the best value for money for the taxpayer. As we look to the future in a post-pandemic world, there is no shortage of challenges ahead of us: an ageing population, an increasing number of people with multiple health conditions, and deep-rooted inequalities in health outcomes, which we are tackling. That is all in addition to the challenges of the pandemic and the elective backlog.

Charges have been around in the NHS for over 70 years, and prescription charges provide a valuable source of income for the NHS, contributing £652 million in 2021-22. That significant funding helps to maintain vital services for patients, and it is particularly important given the increasing demands on the NHS.

It is for those reasons that we consulted on aligning the upper age exemption for prescription charges with the state pension age. Historically, the initial exemption for prescriptions was for people aged 65 and over. The exemption was then extended to women aged 60 and over in 1974, and to men aged 60 or over in 1995, based on the state pension age for women at that time. The state pension age has subsequently increased to 66 for both men and women, with legislation already in place to increase it to 67, and then 68, in future years.

The Government have abolished the default retirement age, meaning that most people can continue to work for as long as they want and are able to. That means that many people in the 60 to 65 age range can remain in employment and be economically active, and therefore more able to meet the cost of their prescriptions. Indeed, more than half of people aged between 60 and 65 are economically active, with a further 20% receiving a private pension or some other income.

As increasing numbers of people live longer, work longer and so on, there are more people claiming free prescriptions on the basis of their age. It is projected that by 2066 there will be a further 8.6 million UK residents aged 65 and over, and that they will make up about a quarter of the total population.

It is important to know that over 1.1 billion prescription items are dispensed in the community each year, with nine out of 10 currently dispensed free of charge. The exemptions that allow that may be based on the patient’s age, certain medical conditions, or income. We estimate that if we were to make the proposed change, around 85% of 60 to 65-year-olds would be minimally affected by it. As I have just noted, more than half of them are in employment, with about another 20% retired with a private pension, so they have a higher income, while others would continue to qualify for free prescriptions on the basis of their particular conditions.

It is also worth noting that there are extensive arrangements in place to help those who are most in need of support with prescription charges. People who are on a low income but do not qualify on the basis of an automatic exemption, such as being on universal credit, can get help through the NHS low income scheme, which provides either full or partial help with health costs on an income-related basis. Anyone can apply for the scheme if they or their partner, or they jointly as a couple, do not have savings, investments or property totalling more than £16,000, not including the place where they live. A person will qualify for full help with their health costs, including free NHS prescriptions, if their income is less than or equal to their requirements.

To support those who do not qualify for an exemption due to one of the many other reasons, such as their age or their condition, or for the NHS low income scheme, prepayment prescription certificates, which were mentioned earlier in the debate, are available to help those who need frequent prescriptions to reduce the cost. The prescription charge is currently £9.35; a three-month PPC is £30.25; and a 12-month certificate is £180.10, which amounts to just over £2 a week. PPCs can offer significant savings, and an annual PPC can be paid for in 10 direct debit payments, to allow people to spread the cost over the year.

[Andrew Gwynne]

I am a little concerned about the tone of what the Minister is communicating. He seems to be accepting that there will be a change on prescriptions for pensioners, but does he acknowledge the challenge with pension credit, whereby a large number of pensioners who are eligible for it do not apply for it, because they are fearful of the means test? What will he do to ensure that that does not happen when it comes to prescriptions?

[Neil O’Brien]

Perhaps I can set the hon. Member’s mind at ease. I said earlier that no decision had been made, and I reiterate that now. I have talked about the different measures that cause people either to be exempt from charges or to have the cost of their prescriptions cut, and I talked about PPCs as a final step, which can reduce the cost of prescriptions for those who do pay them.

It has been mentioned several times that prescription charges have been abolished entirely in the devolved Administrations. Health is of course a devolved matter, but it is worth noting that spending is £1.25 in Scotland and £1.20 in Wales for every £1 in England, so there is that additional budget. Those devolved Administrations, with the record increases in their spending settlements, have full discretion about how they choose to spend those budgets.

Several hon. Members asked me quite specific questions about the outcome of the consultation. I can only reiterate that we continue to consider, long and hard, the many responses that we received, trying to balance the cost of living pressures with the need for increasing funding for the NHS, and we will respond to the petition in due course. I thank hon. Members for their contributions today.

Hospice Sector: Fiscal Support and Cost of Living

Neil O'Brien Excerpts

Thursday 2nd March 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, Mr Paisley. I congratulate the hon. Member for North Ayrshire and Arran (Patricia Gibson) on securing this debate and thank her for the support that she gives to the palliative, end-of-life care and bereavement sectors. The Minister for Social Care, my hon. Friend the Member for Faversham and Mid Kent (Helen Whately), is unfortunately unable to be here today, so I am here to represent the Government. I extend my gratitude to all Members here today for their contributions, which I have heard and learned from. I pay tribute to my own local hospices in Leicestershire, LOROS—the Leicestershire and Rutland Organisation for the Relief of Suffering—and Rainbows, for the work that they do.

The Government are acutely aware of the pressures and challenges posed by the rising costs that have been mentioned in today’s debate. While they affect us all in every sector, the impact on the hospice sector has rightly been raised for debate. Everyone here recognises the incredible importance of palliative and end-of-life care services, and the invaluable work that hospices, charities and the people who support them do to ensure that dignity, care and compassion are present in our lives when we need them most.

The efforts of organisations such as Hospice UK and Together for Short Lives play a vital role in ensuring that we as a nation provide world-leading palliative and end-of-life care. Like pretty much everyone in the country, I thank them. I take this opportunity to say thank you for everything that they do.

The hospice sector supports more than 200,000 people with life-limiting conditions in the UK each year, as well as tens of thousands of family members with bereavement support. We know we have an ageing population presenting with more complex health needs for more years of life. On average, about 600,000 people die every year in the UK, and that number is expected to increase. With that expected increase, the number of people needing palliative care is also likely to rise. Health is of course a devolved policy area, so in terms of direct hospice policy, I can only speak to the English experience, although I will of course talk about some UK-wide areas that are highly relevant, such as energy policy.

While so much palliative and end-of-life care is provided by NHS staff and services, hospices also provide significant support to people at the end of their life and to those important to them. They are mainly independent charitable organisations that receive funding from a mix of public sources and charitable donations. The sense of purpose that is shared with the community—the community cares for the hospice and the hospice cares for the community—is something that we should cherish. I see that strongly in my constituency. It is emblematic of the incredible rallying of compassion and care that we see around hospices all over the country. We should also note the important role that hospices played at the height of the covid pandemic when considering their important place in their communities.

In England, integrated care boards are responsible for commissioning end-of-life and palliative care services to meet the reasonable needs of their local populations. In the Health and Care Act 2022, palliative care services were specifically added to the list of services that an ICB must commission. That will ensure a more consistent national approach and support commissioners in prioritising end-of-life and palliative care, as hon. Members have called for. In July 2022, NHS England published new statutory guidance on palliative and end-of-life care to support commissioners with that new duty. It includes specific reference to ensuring the sufficient provision of specialist palliative care services and hospice beds, and ensuring their future financial sustainability.

I recognise the importance of quality palliative and end-of-life care for children and young people. NHS England is investing £23 million via the children’s hospice grant by March 2023, rising to £25 million by 2023-24, in order to provide care close to home for seriously ill children when they need it.

On the question that the hon. Member for Twickenham (Munira Wilson) asked, although we only set out funding to date in the spending review, that does not mean that all funding will be cut off at that point. We are exploring exactly how that funding will be provided in the future. Furthermore, this financial year, NHS England has made £5 million of match funding available to ICBs for local children’s palliative and end-of-life care services. That will rise to £7 million in 2023-24, demonstrating the value of those services.

The funding of hospices and the sector is indicative of the Government’s commitment to their work and the vital societal role that they play. We recognise, however, that hospices, like every other organisation and household across the country, are having to contend with a range of budgetary pressures, including huge energy costs following the Russian invasion of Ukraine.

[Munira Wilson]

I thank the Minister for addressing one of my key questions about the children’s hospice grant. I am sure the sector will be grateful to hear that it is expected to continue. Although hospices will understand that he cannot commit to that at this stage, the problem is that if they do not know what they will get for the next three to four years, how can they make plans for their workforces and services? Will he say anything more than that something will continue? I do not know whether he is coming to this, but will he also say something about the ringfenced grant being administered directly, rather than via ICBs?

[Neil O’Brien]

Those are both really important points. The hon. Lady knows that it is not for me to set out the future of funding, but I hear the points she makes about ensuring that funding flows to hospices and that they are prioritised by ICBs, and about providing as much certainty as quickly as possible. Both those points have landed with me.

To meet the energy pressures, the UK Government’s energy bill relief scheme provides a price reduction in wholesale gas and electricity prices for all UK businesses and all other non-domestic customers. That means that they will pay wholesale energy costs below half of the expected prices this winter. A new scheme—the energy bills discount scheme, which has been mentioned— was announced in January, ahead of the current scheme ending in March. It is intended to help hospices’ budgetary planning into the future and provide certainty. That follows a Treasury-led review of the energy bill relief scheme some months ago.

The energy bills discount scheme will provide all eligible non-domestic energy users, such as hospices, with a discount on high energy bills until March 2024. It will apply to all UK domestic energy users in the voluntary and public sector, including hospices. We will invest up to £5.5 billion to support those non-domestic users. Furthermore, hospices may also be entitled to a reduction in VAT from 20% to 5% and exclusion from the main rates of the climate change levy on the energy they use for non-business purposes, as long as they meet the criteria in the scheme.

In addition to those two specifically energy-focused interventions, in 2022 NHS England released £1.5 billion in additional funding to ICBs to provide support for inflationary pressures, with local ICBs deciding how best to distribute that funding according to local need, including to palliative and end-of-life care providers such as hospices. I have previously mentioned the steps we have already taken in legislation and guidance to ensure that hospices are prioritised by ICBs.

A large part of hospice activity—probably the majority—actually takes place in people’s homes. That is why we are also taking action on domestic energy pressures. In fact, this winter we are spending a total of £55 billion to help households and businesses with their energy bills. That is among the largest support packages in Europe. A typical household will save about £900 this winter under the energy price guarantee, in addition to the £400 energy bill support scheme for households. On top of that, we are also spending £9.3 billion over the next five years on energy efficiency and clean heat, making people’s homes easier and cheaper to heat.

To help with some of the other cost of living pressures on households—which is the last thing people need when they are in need of hospice care—we are taking measures such as the extra £900 cost of living payment for 8 million poorer households, the largest ever increase to the national living wage for 2 million workers, and a total of £26 billion for cost of living support next year. I hope some of these supportive measures will reassure Members about the Government’s commitment to the sustainability of the hospice sector, particularly during this challenging fiscal period. I understand that the rising cost of living has caused all kinds of uncertainties, and we continue to engage proactively with the sector to try to understand the issues it faces.

[Munira Wilson]

Will the Minister give way?

[Neil O’Brien]

I will close my speech by again expressing my thanks to those who have attended the debate—including the hon. Lady, to whom I now give way.

[Munira Wilson]

I thank the Minister for giving way again. On his point about the energy bill relief scheme, will he at least acknowledge the absurdity of leaving hospices out of the energy-intensive grouping, while botanical gardens, zoos and museums, deserving though they are, have been included? Does he not recognise that that is utterly absurd, given the sort of services that hospices are delivering?

[Neil O’Brien]

Although this is not my policy area, as I understand it, this applies to the energy-intensive and the traded sectors, so organisations need to pass through two different filters to qualify: they have to be very energy intensive and in the traded sector. That would explain the organisations that are chosen or not chosen, but as I said earlier, I absolutely hear the point that the hon. Lady is making.

I pay tribute to all those working in and supporting the palliative and end-of-life care sector and providing essential support to those who need it. I hope I have reassured Members of the Government’s commitment to supporting these invaluable services.

Future of the NHS

Neil O'Brien Excerpts

Thursday 23rd February 2023 Commons Chamber

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

I am grateful to the hon. Member for Jarrow (Kate Osborne) for securing this very important debate. We have had a very large number of interesting and important speeches this afternoon—there are too many to list every single one of them. We had an important contribution from the former Health and Social Care Secretary, my right hon. Friend the Member for West Suffolk (Matt Hancock), about the importance of technology and building on the lessons of the vaccination campaign, which we are certainly doing. We had a very interesting intervention from the right hon. Member for Islington North (Jeremy Corbyn) who stressed the importance of housing for health. He is absolutely right about that, which is why we are taking forward the extension of the decent homes standard to the private sector and taking through the Social Housing (Regulation) Bill to fix some of those issues. My hon. Friend the Member for The Cotswolds (Sir Geoffrey Clifton-Brown) talked fascinatingly about the digital revolution in Denmark and the standardisation of new hospital builds there, which is something that we are in fact doing through Health 2.0. We are also looking at the discharge figures in his local area that he mentioned.

The hon. Member for Bolton South East (Yasmin Qureshi) talked about the dental reforms and said that they were only a starting point. I absolutely agree and will come on to that matter in a moment. My hon. Friend the Member for Delyn (Rob Roberts) talked about the challenges facing the NHS in Wales, reminding us that this is a common challenge across the UK. I can reassure my hon. Friend the Member for Christchurch (Sir Christopher Chope) that we are very interested in driving forward apprenticeship and non-degree routes into healthcare. We are extremely enthusiastic about that and I am happy to pursue that conversation with him after this debate.

Before I begin, I wish to pay tribute to our NHS and care workforce. Our staff work tirelessly to provide excellent care for patients, and our country is rightly very proud of them. The covid pandemic tested the NHS like never before, and all the NHS staff rose to meet those tests in extraordinary new ways. As we look to the future, we can take pride in the NHS’s response to covid-19, and take inspiration from the new and innovative ways of working that were born from the most difficult of times.

The NHS has certain foundation stones that we will never change, including being free at the point of use, regardless of income, and comprehensive services provided solely on the basis of need. It will never be for sale to the private sector. Of course we cannot just preserve the NHS; we need to make it fit for the future. The challenges we face are changing, including an ageing population and the backlog created by covid, and the NHS needs to change with them.

Today I will talk about: finance and the workforce; supporting urgent care; cutting backlogs; and improving social care and primary care. Those are some of the issues raised by hon. Members this afternoon.

The spending review provided a record settlement to the Department over this Parliament, increasing core resource spending by £46.9 billion to £180.4 billion in 2024-25, to ensure long-term sustainable funding is available to support the NHS of the future. In addition, the Chancellor’s autumn statement made up to £14 billion extra available for the NHS and adult social care.

According to the King’s Fund, real-terms spending will have increased by about 42% between 2010 and the end of this Parliament. That funding, a record both in real terms and as a share of the economy, will enable us to ensure that the NHS has the long-term resources and workforce it needs, because our NHS would be nothing without our fantastic health and social care workers. That is why we are on track to recruit an extra 50,000 nurses by March 2024, and it is why we have already expanded medical training places by 1,500 a year, or 25%. We now have 35,000 more doctors and 47,000 more nurses working in the NHS than in 2010.

Alongside recruitment, training our existing workforce is hugely important. Ensuring the NHS is a workplace that provides the environment and flexibility to support long-term careers is a key priority, which is why there are now 900 more medical specialty training posts in 2023, including 500 in mental health and cancer treatment, in addition to the 700 additional specialty training posts that we funded in 2022 and the increase in GP training posts from 2,400 a year to a record 4,000 a year.

We are committed to further supporting our NHS staff to develop their skills and to deliver excellence to patients, which is why the Government have committed to publishing a long-term NHS workforce plan this year.

[Liz Kendall]

Will that long-term workforce plan include social care staff?

[Neil O’Brien]

It will be right across the piece. We have already set out some of our plans for social care, and the full details will hopefully be with the hon. Lady in the not-too-distant future.

The NHS recently published a delivery plan for recovering urgent and emergency care services. It is backed by record investment, including a £1 billion dedicated fund for hospital capacity over 2023-24. We will achieve these improvements by delivering 800 new ambulances and 5,000 more sustainable, fully staffed hospital beds, as well as an ambition to scale up innovative virtual wards, which are already making huge improvements, to support 50,000 people a month in their own home.

The number of ambulance and ambulance support staff is up by 40% since 2010. As well as having those extra staff, we are putting in an extra £50 million in capital funding to upgrade and expand hospitals, including with ambulance hubs and facilities for patients who are about to be discharged. That will free up hospital beds and address handover delays, helping to get those extra ambulances swiftly back on the road.

As well as getting people to hospital, we must further prevent the need for urgent care. That is why we extended vaccinations and are rolling out fall services across the country. We also need to improve the flow through hospitals, as the hon. Member for Leicester West (Liz Kendall) said, by investing in social care. I will say more about that in a moment.

Members know only too well the pressure that the pandemic put on the NHS. The number of people waiting more than 52 weeks for elective care rose from 1,468 in August 2019 to 436,000 in March 2021. In February 2022, the NHS published a delivery plan for tackling the covid-19 backlog, which set out a series of public commitments and initiatives to reduce the backlog. We met our first target by virtually eliminating waits of two years or more by July 2022—that is from a peak of 23,800 at the start of January 2022. To support that elective recovery and to cut backlogs, one of our top five priorities is to spend more than £8 billion from 2022-23 to 2024-25, in addition to the £2 billion elective recovery fund and the £700 million targeted investment fund made available last year. As well as having 4,800 more doctors and 10,900 more nurses than this time just last year, we have 89 new surgical hubs and 92 community diagnostic centres already up and running—the hon. Member for Stockton North (Alex Cunningham) talked about the one in his local area.

As part of this elective recovery, we continue to deliver the huge investment in mental health that was set out in the long-term plan for the NHS, with £2.3 billion extra by next year, supporting an extra 2 million people to get the treatment they need each year. Taken together, that elective funding could deliver the equivalent of about 9 million more checks and procedures, and means that the NHS in England is aiming to deliver about 30% more elective activity by 2024-25 than it was delivering before the pandemic—that is a huge increase. We are aiming to end 18-month waits by April and the NHS is making good progress towards that.

Turning to general practice and primary care, I know that GPs are under huge pressure, and I am incredibly grateful to them and their teams for their hard work. We are investing an extra £1.5 billion to create an additional 50 million general practice appointments a year by 2024. We are doing that by increasing and diversifying the workforce and we are well on our way to hitting that target. In December and indeed January, there were, on average, 1.34 million general practice appointments per working day, excluding the covid vaccinations that GPs are doing. That is about a 10% increase on pre-pandemic levels. GPs are doing more than ever before and a wider range of things than ever before, and they are really working hard.

Since 2019, we have recruited more than 2,000 more doctors into general practice and more than 25,000 additional clinical staff into general practice. So we are well on the way to hitting the 26,000 extra commitment that we made ahead of schedule. They are covering a wide range of extra roles, from pharmacists to physios, mental health specialists and more. So GPs are now effectively leading a diverse team with many different specialist skills. We also had a record-breaking number starting training as GPs last year—it is up from about 2,400 a year to 4,000 a year now. As we committed to do in our plan for patients, we have amended funding rules to bolster general practice teams with new roles. We have increased the clinical services available from community pharmacies already and we are looking at how we can go further. We have introduced new digital tools and improved IT systems, where, again, we are looking to go further.

Of course, we know we need to do more. In the autumn statement, we committed to creating a recovery plan for primary care that addresses the challenges facing general practice. That plan will aim to make it easier for the public to contact their practice and easier for practices to see their patients sooner. That is due to be published in the coming weeks.

[Kate Osborne]

Can the Minister clarify something for me? He talks about the workforce plan. Can he tell us whether it is fully funded and whether it includes social care?

[Neil O’Brien]

It will be about both what is needed over time—some of the time horizons might be longer—and what we are going to do about it.

Let me complete the thought about primary care—

[Kate Osborne]

Will the Minister give way again?

[Neil O’Brien]

I want to make a bit of progress. I am sorry, but I will perhaps come back to the hon. Lady in a bit.

Let me complete the thought on primary care. We will also be saying more about dentistry, which was an issue raised by the hon. Member for Bolton South East. She mentioned some of the reforms that we made. We are trying to make dental practice more attractive. We started reforming the contract and creating more unit of dental activity bands to better reflect the fair cost of NHS work and so incentivise it. We have introduced the minimum UDA value to help where it is particularly low. We are letting dentists deliver 110% of their contracted UDAs to encourage more activity. We have changed the law to make it easier for overseas dentists to do NHS work here, which someone mentioned earlier. Plans are advancing for centres for dental development in Ipswich and places such as Cumbria. But there is much more to do, as the hon. Lady said, and we will be saying more about that soon.

On adult social care, we are taking decisive action, with record investment, making available up to £7.5 billion over the next two years to support adult social care and discharge. That historic funding boost—that record investment in adult social care—will put the system on a much stronger financial footing and help local authorities to address pressures in the sector.

[Liz Kendall]

The Minister has repeatedly used this £7.5 billion extra for social care figure, but will he confirm that £3.15 billion of that is from the Government’s failure to implement the cap on care costs and postponing the right of self-funders to have their care funded at local authority level, and that £1.75 billion of it is from the social care precept? In other words, this is a tax on ordinary people—it is not coming from the Government as new money.

[Neil O’Brien]

Is that not a revealing comment from the Opposition? The Government do not have any money. All this spending comes from hard-working taxpayers, and the Conservative party wants to keep the burden of tax down. On the hon. Lady’s point about the other pot of spending, we chose to prioritise funding through the frontline. That is our choice and it is one we will defend because we know we urgently need to improve social care—[Interruption.] It is tax, yes. All Government spending comes from tax, that is correct, and the idea that that is in some way a revelation speaks volumes about where the Opposition are.

In December 2021, “People at the Heart of Care: adult social care reform” was published, setting out a 10-year vision for reforming adult social care. We have made good progress over the last year on some of the commitments in that White Paper. We invested £100 million to begin implementing reforms on digitisation and technology, local authority oversight and new data collections and surveys, so that people working in the NHS and adult social care have improved access to the information they need to ensure personalised, high-quality care. The Carer’s Leave Bill, currently going through Parliament, will introduce a new leave entitlement as a day 1 right, available to all employees who are providing care for a dependant with a long-term care need. We will set out our next steps on social care soon.

We are committed to supporting our NHS by putting in place the investment and reform to secure its future and we will bring forward a workforce plan later in the year. We are building back better from the pandemic.

[Alex Cunningham]

I got the impression the Minister was winding up; I just ask him to commit to looking at the issues I raised in my speech about the secret report into the activities of North Tees and Hartlepool NHS foundation trust.

[Neil O’Brien]

I am happy to make that commitment.

[Sir Christopher Chope]

The Minister has not covered the issue of productivity. He has mentioned, quite rightly, that the Government do not have any money. It is our money, taxpayers’ money, so why are the taxpayers not allowed to have access to these issues in the NHS with lack of productivity?

[Neil O’Brien]

I am as keen as my hon. Friend to explore all those different things and I am happy to take them up with him following this debate. Many things I have been talking about in this speech, the new technology we are putting in for GPs and the new ways of working, are crucial not just to getting taxpayers better value for money, but to protecting the NHS in the long term by enabling people to do more. The NHS is an enormous source of pride in this country. It is free at the point of delivery and it always will be, giving high-quality care for all. That remains our enduring commitment to our national health service.

[Mr Deputy Speaker (Mr Nigel Evans)]

The final word goes to Kate Osborne.

Performance-enhancing Drugs and Body Image

Neil O'Brien Excerpts

Tuesday 21st February 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, Mr Mundell, and to listen to my hon. Friend the Member for Bosworth (Dr Evans). I knew as soon as he secured the debate that he would bring us something special, and he did not disappoint—it was a fascinating speech. Without wishing to spoil the impact of my response, there were so many good questions and important ideas in it that I will not be able to bottom all of them out this afternoon, but we should see this as the start of a conversation that I am keen to pursue with him. Likewise, there were many important and interesting observations from other hon. Members, including about the issue of roid rage, which was raised by the hon. Member for Rutherglen and Hamilton West (Margaret Ferrier), and about the position of young men in society, which was raised by my hon. Friend the Member for Don Valley (Nick Fletcher). I was sorry to hear about the tragic case of Matt, which was raised by my hon. Friend the Member for Rochford and Southend East (Sir James Duddridge), and I am sure our hearts go out to his parents and family.

I will touch on the positive steps we took last week in the substance misuse and recovery strategy—the 10-year drugs strategy. My hon. Friend the Member for Bosworth mentioned that the strategy has a heavy focus on alcohol, heroin and crack, and the reasons for that are obvious. Indeed, as part of the launch, I met my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter), who will appreciate that there is a big focus on those drugs because they drive about half of all acquisitive crime. Alcohol is one of the big killers and addictions that causes so many problems. As part of that 10-year drugs strategy, we have created a ministerial working group across Departments of exactly the kind that my hon. Friend the Member for Bosworth talked about creating. There is every reason to look, through that group, at what we can collectively do, particularly on the illegal sale of some of these drugs.

To mention a bit about the strategy, this is a £421 million investment over the next two years to improve the number of recovery and treatment places. Perhaps I can cheekily use this opportunity to thank everyone working in the drug and alcohol treatment sector for all the fantastic work they are already doing, and there are many other things we want to extend out to, which my hon. Friend the Member for Bosworth has raised today.

[Dr Dan Poulter (Central Suffolk and North Ipswich) (Con)]

I draw Members’ attention to my declaration in the Register of Members’ Financial Interests—I am a practising addiction psychiatrist. I thank the Minister for the focus he is bringing to bear on this area and for the fact that the Government have put in place a comprehensive strategy for the next 10 years that focuses on alcohol, crack cocaine and opiate use, which is absolutely the right focus. I also thank him for the fact that the strategy is backed up with substantial investment, which is very much needed and which I am sure will make a big difference over time.

However, we do not have good data collection for steroid misuse. A good way of collecting data about drug use in the general population is through the crime survey for England and Wales. I wonder whether the Minister might be able to take that away from the debate and collect some more robust data to ensure that steroid use is properly captured in that crime survey. Perhaps he might have conversations with colleagues in other Departments because that will give us a much stronger basis to work from, and an evidence base is important in drug and alcohol treatment.

[Neil O’Brien]

My hon. Friend brings huge expertise to the debate. He and my hon. Friend the Member for Bosworth are right that we need better data. Perhaps one route is through the CSEW, as he says. It may be that there are other routes for getting better data on prevalence. There are limits to how much people will report some of these crimes when it is something they are taking, rather than a case of stealing to fund that, but there may be different ways we can get the right data.

In terms of what we know, a small cohort of people—only 0.2% of people aged between 16 and 59—use steroids. However, these individuals, as my hon. Friend and other Members have pointed out, may not be fully aware of the health risks associated with the drug or the impact it can have on their mental or physical health. As Members present certainly know, anabolic steroids are prescription-only medicines that help patients gain weight and rebuild tissues that have become weak because of serious injury or illness—that is their clinical use. These drugs are sometimes taken without medical advice to try to improve muscle mass or athletic performance. Anabolic steroids are a class C drug under the Misuse of Drugs Act 1971. Although it is not illegal to possess them for personal use, possession, importation and exportation are illegal if deemed to be with the intent to supply others. So people who are involved in these issues need to be extremely careful.

Lots of work is under way across multiple Departments on this important issue, and I want to talk about just some of the actions the Government are taking, notwithstanding the need to do more on a range of fronts. The Government are committed to stopping the illegal trade in human medicines. The majority of IPEDs are sold online through illegal trading websites based overseas. The Medicines and Healthcare products Regulatory Agency works with private sector partners to try to reduce the presence of such websites and, with the Home Office Border Force, to intercept and seize medicines entering the UK.

We are also taking action in the Online Safety Bill to prevent criminal activity, including the illegal sale of steroids. The intention is that companies that fail to comply with the Bill when it has been enacted will face stiff financial penalties or, in the most serious cases, have their sites blocked by the independent regulator, Ofcom. I hope that that addresses some of the concerns about the frightening-sounding websites that the hon. Member for Croydon Central (Sarah Jones) mentioned.

Of course, we know that preventing the trade in steroids is not enough to tackle the problem. As my hon. Friend the Member for Bosworth rightly said, the wider issue lies with the increased prevalence of body dysmorphia and the societal preference for young men to look a particular way. The rise of social media has undoubtedly increased this pressure in recent years, as young people have greater access to platforms promoting often unrealistic and digitally altered body images.

Schools play a really important role in helping young people to make positive choices about their wellbeing through their compulsory relationships, sex and health education curriculum. The Office for Health Improvement and Disparities has worked with the Department for Education to create quality teaching resources for teachers in order to help prevent substance abuse and to address some of the issues with young people feeling that they should look a certain, completely unrealistic. To pick up on some of the horrifying stories that the hon. Member for Croydon Central shared about the young Scouts she met who were all fans of Andrew Tate, that is also something that we need to address in education in schools.

As well as informing students about the risks associated with harmful substances—this goes to the point that my hon. Friend the Member for Bosworth made about harm reduction as well as prevalence reduction—schools have an important duty to protect pupils from harm and to provide mental and physical health support. Through statutory health education, secondary school pupils are taught about the similarities and differences between the online world and the physical world, including how people may curate a particular image of their life online, how information is targeted at them, and how to be a discerning consumer of information online. I am always interested in how we can improve what is taught in schools, because the world facing young people is so different from the world that the generation of people represented here experienced when they were young.

I am proud to highlight that the Government have committed to offer all state schools and colleges a grant to train a senior mental health lead by 2025. That will enable schools to introduce effective, whole-school approaches to mental health and wellbeing. Backed by £10 million in 2022-23, over 8,000 schools and colleges have taken up the offer so far.

We are also taking significant steps to tackle body image issues. On 2 February, the Government responded to the Health and Social Care Committee’s important report on the impact of body image on mental and physical health. We welcomed the Committee’s report and recommendations, and we agree with the Committee that image and performance-enhancing drugs are a significant public health issue. However, we know that prevention is better than cure, and when it comes to harmful substances, it is crucial that we ensure the public have access to sufficient information to inform them of the harms associated with substances such as steroids. The Government-commissioned website Talk to FRANK provides detailed information on the mental and physical health risks of taking steroids, and it is updated on a regular basis.

Additionally, UK Anti-Doping already has an outreach and communication programme that is run in partnership with ukactive, which has been live since 2018. The partnership aims to improve education and awareness around image and performance-enhancing drugs in gyms and leisure centres because, as my hon. Friend the Member for Bosworth rightly pointed out, such places are a focus for these issues. They are the right places to target, and we need to work with sporting bodies, gyms and the like to try to tackle the problems where they are most concentrated.

I draw Members’ attention to the investment that we are making in mental health services. The Government will have invested £2.3 billion a year by 2024 in expanding the services available in England, including for people with body dysmorphic disorder. An additional £54 million is being invested in children and young people’s community eating disorder services in 2022-23. That investment is alongside the development of a major conditions strategy, which will address prevention and treatment for mental ill health, with an aim of producing an interim report in the summer.

I once again thank my hon. Friend for securing this debate on an important issue, and for his many, many ideas. He set out a whole suite of things that we need to be doing. It was a fascinating speech. I commend his work in this area, including his image campaign last year, which achieved national media coverage and will no doubt have had a beneficial impact.

The Government are taking significant steps to protect the mental health of the nation, and particularly young people, and we are ensuring that the right support is in place for those suffering or at risk of body dysmorphic issues. Although a review is not currently planned, the Department of Health and Social Care, the Department for Education and the Department for Digital, Culture, Media and Sport will continue to work closely on tackling the use of anabolic steroids, educating the public on the risks associated with them and ensuring that mental health support is available for all those who need it.

Organ Utilisation Group Report

Neil O'Brien Excerpts

Tuesday 21st February 2023 Written Statements

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

The House will remember that, under this Government, Max and Keira’s law was introduced—a law that garnered all-party support—changing the legal basis of consent for organ donation to one of deemed consent, commonly referred to as “opt out”. At that time the Government committed to 700 additional transplants per year which reflected the overwhelming support of the population in helping others, after death, through the gift of organ donation. Following this legislation, the Government set up the Organ Utilisation Group (OUG) under the expert chairmanship of Professor Sir Steve Powis to deliver improvements in the number of organs that are accepted and utilised for successful transplant in adult and paediatric patients.

The House can be justly proud of the role that British clinicians and scientists have played in the history of successful transplantation. But not many realise that this leadership continues today, particularly in the field of new methods of organ preservation and perfusion. The OUG heard evidence that described the importance of continued support to maintain that leadership status both for patients in the United Kingdom and across the globe.

The Government also wish to pay tribute to patient groups, individual patients and their carers who gave time and consideration to significant engagement with the work of the OUG. It is clear the output of the report has benefited from this engagement to a significant extent.

The Government welcome the 12 recommendations in the report and note that many of these do not require extra resource; they simply need a different way of working, with increased collaboration across organisations that deliver the service. I am confident that the recommendations will give benefits to those in need of a transplant with the aim that all patients should have fair and equitable access to transplant services regardless of their background or heritage or where they live in the country.

I also wish to recognise the donation and transplant teams across the country for their hard work during the pandemic. Their use of new collaborative processes has enabled people at the end of life who wished to donate to have these wishes honoured, and those patients who desperately needed a transplant to have that procedure performed, often through night-time surgery. Recommendations in the report also address the need for a robust and sustainable service that acknowledges this round-the-clock vital activity.

The OUG heard evidence from national and international stakeholders, which led to the following themes and recommendations. Each recommendation is accompanied by supporting actions to inform implementation.

Theme 1: Placing the patient at the heart of the service

Recommendation 1: Patients who are being considered for transplantation, referral or listing must be supported and have equal access to services irrespective of their personal circumstances including ethnic, geographical, socio-economic status or sex.

Recommendation 2: Transplant services must be run with reference to patient feedback, including frequent opportunities to listen and act on views from less heard voices.

Theme 2: An operational infrastructure that maximises transplant potential

Recommendation 3: Standardised patient pathways must be developed and made available for each organ type, with well-defined timescales for each stage of the pathway. Data available for each stage of the pathway informs monitoring against best practice. Clinical leads for utilisation support the review of the data, to identify and drive local improvement initiatives.

Recommendation 4: Transplant units must build on the lessons learned during the covid-19 pandemic and increase further the collaborative effort across units.

Recommendation 5: NHS England must undertake a comprehensive review of cardiothoracic services to ensure that services in place are sufficiently sustainable and resilient and are able to provide the best possible outcome for patients.

Theme 3: Creating a sustainable workforce that is fit for the future

Recommendation 6: A national transplant workforce template must be developed to provide definitions of the skill mix for an effective, safe and resilient transplant workforce that is fit for current and future demands.

Theme 4: Data provision that informs decisions and drives improvements

Recommendation 7: The provision of data must be transformed, using digital approaches to provide access to complete, accurate and standardised data and information to everyone who needs it at critical decision points throughout the donation to transplantation pathway.

Theme 5: Driving and supporting innovation

Recommendation 8: National multi-organ centres for organ assessment and repair prior to transplantation must be established to provide the optimum practical steps to bring new techniques into everyday clinical therapy as rapidly as possible, to maximise the number and quality of organs available for transplant and support logistics at transplant units.

Recommendation 9: A national oversight system must be established that makes the best use of the UK’s world leading innovation in assessment, perfusion and preservation of donated organs.

Theme 6: Delivering improvements through new strategic and commissioning frameworks

Recommendation 10: All NHS trusts with a transplant programme must have a transplant utilisation strategy to maximise organ utilisation.

Recommendation 11: National measurable outcomes must be defined and agreed in order to prioritise, monitor and evaluate the success of key strategies, tools and processes.

Recommendation 12: Robust commissioning frameworks must be in place, with well-defined roles and responsibilities of the various agencies involved in organ transplantation, particularly focusing on the relationship between NHS Blood and Transport and commissioners. Memorandums of understanding (MoUs) across the agencies must be created to formalise the process for the joint commissioning of transplant services.

The Government are grateful to Professor Sir Steve Powis and all the members and observers of the OUG. We have committed to an implementation oversight group that will be led by the Department of Health and Social Care, working with expert stakeholders in organ utilisation to drive forward implementation of the recommendations.

The House will remember many heartfelt and emotional interventions from members across all parties at the time when Max and Keira’s law was passed. The recommendations in this report follow up on that important change in our legislation and, once properly implemented, will increase transplants for patients in desperate need of donated organs and tissues wherever it is safe to do so.

[HCWS569]

Government Support for Breastfeeding and the 2023 Lancet Series

Neil O'Brien Excerpts

Monday 20th February 2023 Commons Chamber

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

I congratulate the hon. Member for Glasgow Central (Alison Thewliss) on securing this timely debate. I know that she has a keen interest in this important matter and shows great leadership in ensuring that infant feeding remains a priority Government policy, perhaps most notably as chair of the all-party parliamentary group on infant feeding and inequalities. I welcome the publication of the 2023 Lancet series and the information it provides to add to the debate on promoting breastfeeding.

Breastfeeding is a crucial aspect of infant health and nutrition, and this Government are committed to promoting and supporting breastfeeding policy to ensure that all infants have the best start in life. The Government understand the many health benefits that come with breastfeeding for both the mother and the child, and it is our priority to encourage, support and empower women to breastfeed. We recognise that for some women, breastfeeding may not always be a viable option—for some, it may simply not be what they want to do—but the Government continue to create a supportive environment that informs and supports families when starting the infant feeding journey, ensuring that they are able to make informed decisions about how best to feed their babies. This includes providing breastfeeding advice and guidance through a range of approaches, including paid-for social media activity, personalised email programmes and the NHS Start for Life website.

In line with these commitments, we have taken a number of steps to improve support for infant feeding. From 2022-23 we are investing around £300 million in family hubs and Start for Life services, targeting the three years of funding at 75 local authorities in England that have high levels of deprivation and disproportionately poor health and educational outcomes. These 75 participating local authorities have already received at least half their year 1 allocation. As part of this, 14 local authorities have been identified to become trailblazers to lead the way and support other local authorities to improve the services offered to families. This funding package includes £50 million to invest in infant feeding services, which will enable participating local authorities to design and deliver a blended offer of advice and support for families in line with local needs to help all families to meet their breastfeeding goals. Services will enable parents to access face-to-face, virtual, and digital infant feeding support when and where they need it.

The Government also recognise the importance of creating a breastfeeding-friendly work environment, and we recommend that employers take steps to enable women to breastfeed as a matter of best practice. For example, the Health and Safety Executive has published comprehensive guidance on how employers can meet their legal requirements to support new mothers, and it advises employers that it is good practice to provide a private, healthy and safe environment for breastfeeding mothers to express and store their milk. The Advisory, Conciliation and Arbitration Service has also published guidance to support employers in accommodating employees who return to work while breastfeeding or expressing milk.

As is recognised in The Lancet series, it is critical that Governments gather reliable data on rates of breastfeeding to ensure that policies are having their desired effect and to better target our interventions. Therefore, work is currently under way on the delivery of a new infant feeding survey, commissioned for England by the Department of Health and Social Care’s Office for Health Improvement and Disparities. The new survey, which last ran in 2010, will provide valuable information on infant feeding behaviours and other related factors. Data collection is expected to commence this year and we anticipate that the results of the survey will be available in 2024.

These investments and strategies all build on existing measures that this Government continue to uphold. This includes legislation that governs the marketing, composition and labelling of infant formula and follow-on formula. The legislation reflects the latest scientific advice on the essential composition of infant formula and follow-on formula. This legislation upholds the Government’s commitment to the general principles and ambitions of the World Health Organisation’s international code of marketing of breast milk substitutes by prohibiting the promotion, marketing and advertising of infant formula to ensure that breastfeeding is not discouraged. The legislation mandates that the labelling of infant formula and follow-on formula includes information stating the advantages of breastfeeding, includes the necessary information on the appropriate use of the products and does not include pictures or text that idealise the use of the product.

I understand that there have been calls to strengthen this legislation or even go further than is specified in the WHO code, as is suggested in The Lancet series that prompted this debate. The Government of course welcome challenges to our existing ways of doing things and we are committed to ensuring that our legislation continues to be based on comprehensive evidence and sound analysis.

[Alison Thewliss]

The UK Government’s current legislation falls far short of the code’s recommendations, and it is not enforced in any meaningful way. Many tins found in shops do not comply with the legislation as it exists, never mind the code’s stronger recommendations. These tins of formula have idealised images, such as cartoon bears and animals, on their labels, which would not happen if the Government enforced even their current legislation.

[Neil O’Brien]

I will come to the hon. Lady’s point about legislation in a moment, but I will first complete my thought.

We must not forget that there are non-legislative routes by which we can achieve many of the same goals. For example, as part of the NHS’s ongoing vision to improve post-natal care, the long-term plan includes a commitment that all maternity services that do not deliver an accredited, evidence-based infant feeding programme, such as the UNICEF UK baby-friendly initiative, will begin the accreditation process with a view to all services achieving full accreditation by March 2024. Local maternity systems in England are responsible for ensuring that all maternity services are on track to achieve this commitment, which will help to improve standards and reduce variation in the care that women and families receive. Targeted support is now available for local services to fulfil the commitment.

I recognise there is always room for improvement, and we continually work to enhance our efforts and to ensure our legislation and policies reflect the latest scientific advice and evidence. The UK has strict legislation in place that gives effect to the aims and principles of the WHO international code of marketing of breast-milk substitutes, which is governed in Great Britain through retained EU legislation. There are currently no differences in GB legislation on the areas covered by the code. The protocol on Ireland/ Northern Ireland provides that EU legislation relating to nutrition continues to be directly applicable in Northern Ireland, and this includes Commission delegated regulation 2016/127 on infant formula and follow-on formula, so we have precisely the same rules in place as the European Union. I know that, in general, the SNP is always keen on that.

The Government have demonstrated, through our continued significant policy development and ongoing investment, a steadfast commitment to promoting and supporting breastfeeding, where appropriate, to ensure that all children have the best start in life. We remain committed to protecting our children, and we will continue to take the necessary steps to ensure that all mothers and families have the information and support they need to make informed decisions about how to feed their babies.

Question put and agreed to.

Sudden Cardiac Death: Young People

Neil O'Brien Excerpts

Wednesday 1st February 2023 Commons Chamber

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

I am grateful to my hon. Friend the Member for Scunthorpe (Holly Mumby-Croft) for securing this debate on such an important issue. I am extremely sorry to hear about Nathan and about Stephen and Gill and, indeed, about the constituents of the hon. Member for Merthyr Tydfil and Rhymney (Gerald Jones). I would very much welcome the meeting that my hon. Friend described with her constituents, and we will set that up.

We recognise, though it is hard to understand, the devastation caused to families by the sudden cardiac death of a young person. Sudden cardiac death is an unexpected and sudden death that is thought to be caused by a heart condition.

The implementation of genomic laboratory hubs across England provides an opportunity to explore the systematic introduction of post-mortem genetic testing for SCD. Seven NHS genomic medicine service alliances play an important role in the support of genomic medicine. Those NHS GMS alliances are supporting several transformation projects, including a national project with the NHS inherited cardiac conditions services, the British Heart Foundation and the country’s coroners.

The project will test the DNA of people who died suddenly and unexpectedly at a young age from a cardiac arrest, and their surviving family can also be offered genetic testing to see if they carry the same gene changes. In addition, a pilot project based in the NHS South East Genomic Medicine Service Alliance is aimed at people who have had an unexpected cardiac arrest and survived. They will be offered a genomic test to enable access to treatment, and further genomic testing will be offered to identify immediate family members at risk if a gene change associated with a heart condition is found.

As my hon. Friend the Member for Scunthorpe mentioned, screening programmes in England are set up on the advice of the UK National Screening Committee. These are not political decisions; they are decisions based on the best currently available evidence, and they determine whether the introduction of a screening programme would offer more good than harm. As my hon. Friend said, in 2019 the National Screening Committee reviewed the evidence to provide general screening, and concluded at that time that there was not enough evidence to support the introduction of a national screening programme.

Research showed that the current tests were not accurate enough to use in young people without symptoms, because incorrect test results can cause harm by giving false reassurance to individuals with the condition who may have been missed by the screening test, while individuals without the condition may receive a false positive test result that could lead to unnecessary treatments. The review found that most studies for SCD were in professional athletes, whose hearts of course have different characteristics from those of the general population. Tests can work in different ways in different groups of people. That is why it is very important that research is gathered in a general population setting, as to base it on athletes would not provide a good indication of what would happen if we tested all young people under the age of 39.

The UK NSC was due to review SCD in 2022-23, as my hon. Friend mentioned, but has been unable to do so for a variety of reasons to do with covid and competing priorities. I am unable to confirm this evening when the regular review of SCD will take place, but I am assured that it will take place as soon as constraints allow. I will write to my hon. Friend setting out more details very shortly, because I know how urgent it is to understand when that will happen.

In 2022, the NSC’s remit was expanded to set up a research sub-group to keep abreast of ongoing research related to screening, and to identify research requirements and advice on mechanisms to address them. The committee has encouraged stakeholders to submit any peer-reviewed evidence it may have on incidence for review by the NSC via its early update process, but so far it has not received anything. My hon. Friend asked a series of detailed questions and made a series of very helpful suggestions about how we change the process. The NSC will doubtless have heard the issues that she has raised in this House, but I also undertake to raise directly with the NSC all her very constructive points.

The consensus at present has been to focus on rapid identification of sudden cardiac death and automated external defibrillator use in people who suffer a cardiac arrest, in line with the NHS long-term plan. The Government continue to encourage communities and organisations across England to consider purchasing a defibrillator as part of their first aid equipment, particularly in densely populated areas. My hon. Friend the Member for Brigg and Goole (Andrew Percy) mentioned some of the excellent work that has been done in his local area on this front. At the end of last summer, the Government announced that all state-funded schools across England will receive at least one AED on site, with more devices delivered to bigger schools, boosting their numbers in communities across the country. In December, we also announced the community defibrillator fund, which gives communities matched funding and aims to install about 1,000 more defibrillators across the country. I know that many hon. Members in this House will want to take up that offer and are spearheading work to get more AEDs out into the community.

To conclude the debate and start the process that we will be going through, I again thank my hon. Friend the Member for Scunthorpe for raising this hugely important issue. We have heard some truly heartrending stories this evening, and I thank all those involved in The Beat Goes On and other similar organisations for their hugely important work. I promise that this issue will continue to get our utmost attention as a Government.

Question put and agreed to.

Essex Mental Health Independent Inquiry

Neil O'Brien Excerpts

Tuesday 31st January 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, Mr Davies. I thank my right hon. Friend the Member for Chelmsford (Vicky Ford) for securing this important debate, and I thank her and all the local MPs—my right hon. Friend the Member for Witham (Priti Patel), my hon. Friend the Member for Rochford and Southend East (Sir James Duddridge) and my right hon. Friend the Member for Maldon (Sir John Whittingdale)—for their dogged work over a long period in trying to get justice both for those in the Public Gallery and for all the others who are unable to be present this morning.

I know that Members have raised a lot of concerns about the progress of the inquiry, and I want to take this opportunity to make clear our strong commitment to this absolutely vital work. The speech made by my right hon. Friend the Member for Chelmsford was stark, and I know that some of the victims, survivors, and friends and families of people who have been affected are in the Public Gallery. It is a powerful reminder of why the inquiry is so important: it has to get to the truth.

The Government are committed to improving mental health services across the country, which is why we launched the independent inquiry in January 2021, covering a 20-year period from 2000 to 2020. Obviously, it is a complex inquiry. Like Members present, I am pleased with the hard work of Dr Geraldine Strathdee, the inquiry chair, since the inquiry started its work. However, I am concerned about the level of co-operation that the inquiry has received, which was set out clearly by my right hon. Friend the Member for Chelmsford. It is not good enough, and Dr Strathdee has recently raised concerns about this. She met the Secretary of State and has since published an open letter in which she stated that

“in the event that staff engagement remains very poor, it is my view that the inquiry will not be able to meets its terms of reference with a non-statutory status.”

We take those concerns very seriously.

Dr Strathdee has raised two particular concerns. The first is about the participation of current and former staff, and the second is about the availability of documents for the inquiry. As a result of Dr Strathdee’s concerns, the Secretary of State met Paul Scott, the chief executive of Essex Partnership University NHS Foundation Trust, to better understand how the trust will support the inquiry. The Secretary of State sought assurance on two key issues. The first is what actions the trust will take to encourage more staff engagement with the inquiry, and the second is assurance that the trust will provide all the evidence and information requested by the inquiry, to enable it to fulfil its terms of reference. I know that Mr Scott has also written to local MPs setting out the steps that he thinks necessary to improve engagement, and he feels confident that progress can be made.

On staff participation, I remind the House that it is incumbent on all holders of public office and all health professionals to demonstrate their fitness for office by voluntarily co-operating with independent inquiries. In their guidance on the duty of candour, professional regulators advise that health and care professionals must be open and honest with their colleagues, employers and relevant organisations, and take part in reviews and investigations when requested. Similarly, they must support and encourage each other to be open and honest. I therefore hope that anybody who is asked to contribute evidence will co-operate fully with the inquiry in the public interest and in fulfilment of their professional obligations. The Department is also working closely with the inquiry and NHS England to look at what more can be done.

Dr Strathdee has expressed her concern that an additional 600 cases were recently sent to the inquiry. The trust has advised that they were identified during a validation process. I appreciate that this is not ideal, but I understand that the trust has allocated appropriate staffing and resource to ensure the thoroughness of the searches requested by the inquiry.

As Members have mentioned, the participation of families is equally important to the work of the inquiry, and I am grateful to all who have provided evidence to date. I am disappointed that a number of families who have tragically lost loved ones have chosen not to participate and get their voices heard. I urge them to reconsider, so that the inquiry can be as thorough as possible.

Our view is that a non-statutory inquiry, if it is possible, remains the most effective way to get to the truth of what happens. It is quicker, and potentially involves not having to drag clinicians through the public processes of a statutory inquiry. When my right hon. Friend the Member for Witham was Home Secretary, she used the non-statutory process to protect those who did not want to be named and dragged through a statutory process. It is faster and more flexible, which is why it was chosen in the first place. Although statutory inquiries can compel witnesses to give evidence under oath, that does not necessarily mean that it will be easier to obtain the evidence we want. However, all that turns on people co-operating with a non-statutory inquiry, and we now need to see a quantum leap in the level of co-operation. We will not hesitate to move to a statutory inquiry if we do not see a dramatic increase in the level of co-operation. Given how long this has gone on, we cannot wait for a long period for a transformation in the level of engagement. While the approach remains non-statutory for now, we will not hesitate to change that approach if we do not see the change we need rapidly.

[Sir James Duddridge]

I have visited Essex Partnership University NHS Foundation Trust in Rochford a number of times and have been incredibly impressed with its work, notwithstanding its very real problems. What I cannot get over is why people have not come forward to give evidence in a non-statutory environment, because these are caring individuals who want to improve the service. I do not understand why only 11 people have come forward.

[Neil O’Brien]

That is a vital question. There is an excellent chair, and many publicly spirited individuals are already co-operating to get to the truth and improve services for the long-term. We are currently in this environment of the non-statutory inquiry, which allows an informal approach. People do not have to give evidence in the way they would if we went to a statutory approach. There is an opportunity for people to co-operate more with the inquiry, exactly as my hon. Friend says.

[Vicky Ford]

I understand that the Minister is asking for a quantum leap—that is a good phrase to describe the massive change we need—rapidly. Does he agree that rapidly should mean no more than one month?

[Neil O’Brien]

It is not for me to put a date on that in this setting. I have had conversations with a number of the hon. Members here, but my hon. Friend can rest assured from the tone of what I am saying that this will not be a long period of time. We are not kicking this into the long grass; we urgently need this change because, as numerous Members have pointed out, this has been going on for a long time and families who have been through the mill are waiting for justice.

[Sir John Whittingdale]

One of the problems with a non-statutory inquiry is people’s reluctance to come forward. If it becomes statutory, certain consequences obviously follow, including the publication of the names of those who are summoned to appear. Will my hon. Friend the Minister think about making his requirement that the co-operation be achieved in a short space of time more public, so that people understand exactly what will follow if they continue to fail to co-operate?

[Neil O'Brien]

This debate goes some way to achieving exactly that. My right hon. Friend is exactly right that the current non-statutory approach has the benefit that those who give evidence do not have to be named. That is why it would clearly be more desirable if we could make the non-statutory approach work, but that has not been the case to date and, unless that changes, something else will have to change too.

To continue making progress in how we address issues with mental health services, Members will be aware that we have recently announced a rapid review into patient safety in mental health settings across England. The review will focus on what data and evidence is available to healthcare services. I am pleased that Dr Strathdee will be leading the rapid review over the next couple of weeks, given her knowledge and experience. However, I assure hon. Members that the work of the inquiry in Essex will continue at the same time.

I firmly believe in the importance of transparency and accountability to improve patient safety, and I wish to take all action necessary to assist the inquiry in its work. This is absolutely the last chance to make progress. If staff engagement and access to documents remain unsatisfactory despite these actions, we will consider whether the inquiry should remain on a non-statutory footing. We simply cannot go on as we have, with inadequate co-ordination and documents not being forthcoming. Everyone in the inquiry knows the situation and that there is not a long period of time for things to change.

I thank hon. Members for bringing forward the debate, because it allows us to set out the situation clearly for the public. I thank all who are here today, all who have co-operated with the inquiry, and all who have lost loved ones or been personally affected by this matter and have had the bravery and grit to come forward and talk about their experiences. We are extremely grateful to them.

Question put and agreed to.

Oral Answers to Questions

Neil O'Brien Excerpts

Tuesday 24th January 2023 Commons Chamber

[Gill Furniss (Sheffield, Brightside and Hillsborough) (Lab)]

20. What recent assessment he has made of the adequacy of access to NHS dentistry.

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

The Government are working to improve access. We have made initial reforms to the contract and created more unit of dental activity bands to better reflect the fair cost of work and to incentivise NHS work. We have introduced a new minimum UDA value to help sustain practices where they are low, and we are allowing dentists to deliver 110% of their UDAs for the first time to deliver more activity. Those are just the first steps; we are planning wider reforms.

[Peter Aldous]

On 20 October, the House passed a motion highlighting the continuing crisis in NHS dentistry and calling on the Government to report to the House in three months’ time on their progress in addressing this crisis. That time has now elapsed. I am grateful to the Minister for that update, but can he confirm that the Government will be producing a comprehensive strategy for the future of NHS dentistry, and can he inform the House when it will be published?

[Neil O’Brien]

It was very useful to meet my hon. Friend the other day, who is a great expert on this issue. As he knows, we are working at pace on our plans for dentistry. As well as improving the incentives to do NHS work, we are working on the workforce to make it easier for dentists to come to the UK. We laid draft secondary legislation in October to help the General Dental Council with that. We are working on our plans for a centre for dental development in Ipswich and elsewhere in the east of England, as he knows. Although we have not yet set a date to set out the next phase of our plans, my hon. Friend knows from our meeting that this is a high priority area for us and that we are working on it at pace.

[Gill Furniss]

I was contacted recently by my constituent Helen, who said:

“I don’t know what to do. I have phoned 25 dental practices today and been told the same thing each time: all we can do is put you on a 3 year waiting list.”

What does the Minister say to Helen and the thousands who, like her, cannot access an NHS dentist? When will he get a grip on this crisis?

[Neil O’Brien]

We are the first to say that the current situation is not satisfactory. That is why we invested an extra £50 million in the last quarter of last year, and it is why we are working at pace. Let us be clear: dentistry has not been right since Labour’s 2006 contract, and until we fix the fundamentals of that and the problems set up by the Opposition, we will not tackle the underlying problem.

[Rachel Maclean (Redditch) (Con)]

7. What steps his Department is taking to increase the number of NHS beds available in the Alexandra Hospital in Redditch.

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[Mr Toby Perkins (Chesterfield) (Lab)]

11. If he will make an assessment of the adequacy of GP appointment availability in (a) Chesterfield constituency, (b) Derbyshire and (c) England.

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

In November, there were 13.9% more appointments in general practice across England as a whole than in the same month before the pandemic. In Derby and Derbyshire, there were 16.6% more appointments. Our GPs are doing more than ever, and, compared with 2015-16, we are investing a fifth more in real terms. But we know that demand is unprecedented, and we are working to further support our hard-working GPs.

[Mr Perkins]

I thank the Minister for that answer. We know that there are GP appointment difficulties everywhere, but we also know that it is much more difficult in more deprived communities. Social Market Foundation research shows that GPs in more deprived communities have twice as many patients on their books than those in more affluent areas. This means that, in addition to the greater health inequalities in those communities, people are finding it very difficult to get appointments, including at the Royal Primary Care practice in Staveley. Why should patients in more deprived communities be expected to tolerate far greater difficulties in getting GP appointments than those in more affluent areas?

[Neil O’Brien]

In Derby and Derbyshire, for example, there are 495 more doctors and other patient-facing staff than in 2019. Step 1 is to have more clinicians, which we are doing through that investment. The hon. Member raises a point about Carr-Hill and the funding formula underlying general practice. There is actually heavy weighting for deprivation, and the point he raises is partly driven by the fact that older people tend not to live in the most deprived areas, and younger people tend to live in high IMD—index of multiple deprivation—areas. That is the reason for the statistic he used. Funding is rightly driven by health need, which is also heavily driven by age. We are looking at this issue, but the interpretation he is putting on it—that there is not a large weighting for deprivation—is not quite right.

[Maggie Throup (Erewash) (Con)]

In south Derbyshire there are now 133 more full-time equivalent clinical staff in general practice than in 2015. That includes nurses, physios and clinical pharmacists. What more is my hon. Friend doing to encourage more people to book an appointment with the most appropriate healthcare professional, rather than simply defaulting to booking a GP appointment?

[Neil O’Brien]

That is an excellent question. As well as having an extra 495 staff across Derby and Derbyshire, it is crucial that we use them effectively by having good triage. That is why we are getting NHS England to financially support GPs to move over to better appointment systems. That is not just better phone systems, but better triage.

[Justin Madders (Ellesmere Port and Neston) (Lab)]

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

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[Paul Holmes (Eastleigh) (Con)]

Eastleigh, Hedge End and the villages have many vibrant pharmacies, but it is disappointing that Lloyds has closed two branches in my constituency. I welcome the additional £100 million that this Government are investing in community pharmacies, but can my right hon. Friend confirm how that funding will cut NHS waiting times and, more importantly, reverse the trend of closures?

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

My hon. Friend is right. Although pharmacies are private businesses, we invest £2.5 billion in the clinical services they provide. We put in another £100 million in September so that they can provide more services. The number of community pharmacists is up by 18% since 2017, and we have introduced the pharmacy access scheme to ensure that we support pharmacies in areas where there are fewer of them. Clearly, the solution is for pharmacies to do more clinical work, take the burden off GPs and provide accessible services. That is exactly what we will keep growing.

[Mr Speaker]

I call the Scottish National party spokesperson.

--- Later in debate ---

[Dr Luke Evans (Bosworth) (Con)]

I declare an interest as a GP and the immediate family of a GP and doctors. GPs are working incredibly hard in tough times. It is true that supply has gone up, but so too has demand. Change needs to happen in primary care, but one of the bedrocks is the GP partnership model. Does this Government agree?

[Neil O’Brien]

Unlike the Opposition, we do not regard GPs’ finances as murky and we do not want to go back to Labour’s policy of 1934 by trying to finish off the business that even Nye Bevan thought was too left-wing. We do not believe in nationalising GPs; we believe in the current model. [Interruption.] We do not believe that people with a problem should immediately go to hospital, driving up costs and undoing the good work of cross-party consensus in the last 30 years. A plan that was supposed to cause a splash has belly-flopped.

[Mr Speaker]

Mr O’Brien, when I move on, I expect you to move on with me. I have all these Back Benchers to get in. I do not need the rhetoric; I want to get Members in—I want to hear them, not you.

[David Linden (Glasgow East) (SNP)]

T2. The UK has the sixth largest and richest economy in the world, yet data from the Food Foundation shows that in September 2022, 9.7 million people on these islands lived in food insecurity. That kind of malnutrition does not have a good impact on the health service. When will Ministers pick up the phone or nip along the corridor to the Department for Work and Pensions and tell it to drop its punitive sanctions regime, which pushes so many people into poverty and so many problems on to the NHS?

[Neil O’Brien]

We are concerned about the exact same issues. The £900 cost of living payment for 8 million households is how we are trying to address this. It is also why we are bringing in the largest ever increase in the national living wage for 2 million workers.

[Priti Patel (Witham) (Con)]

The Secretary of State is well aware of the challenges facing Essex mental health care and the independent inquiry there into so many patients who have died. Can he tell the House and my constituents what steps he is taking to make this a statutory inquiry?

--- Later in debate ---

[Anna Firth (Southend West) (Con)]

“The Future of Pharmacy” report was published yesterday and highlighted again the funding pressures on the sector, including for the brilliant Belfairs Pharmacy in Leigh-on-Sea, which asks whether the Minister will urgently consider writing off the £370 million of covid loans given to pharmacies during covid-19.

[Neil O’Brien]

We are working to increase the amount of funding going into pharmacies so that they can do more clinical services. I will look closely at the issue that my hon. Friend raises.

[Matt Western (Warwick and Leamington) (Lab)]

T7. Last week, the Government decided to mothball the covid-19 testing facility in Leamington, which will leave up to 670 people without a job. The lab reputedly cost more than £1 billion—perhaps the Minister could confirm—and when the investment was made, I was promised that it would be used for other purposes, such as pathological testing and other diagnostics. Why is that not happening?

--- Later in debate ---

[Neil O’Brien]

Absolutely; we are looking at that issue. We have already brought in a new minimum UDA value, and we would like to deliver more. We will look at measures to encourage people to work in areas with the greatest shortages.

[Jim Shannon (Strangford) (DUP)]

T8.   On World Cancer Day 2022, the then Secretary of State for Health and Social Care, the right hon. Member for Bromsgrove (Sajid Javid), announced a 10-year cancer plan to make us a world leader. Today, cancer services are buckling under immense pressure. Can the Minister confirm that the strategy will be fully resourced and will she commit to working with cancer charities to ensure that it is delivered?