HIV Action Plan: Annual Update 2022-23

Neil O'Brien Excerpts

Thursday 8th June 2023 Written Statements

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

I am pleased to update the House on the publication of the first annual update to Parliament on the HIV action plan. In January 2019, the Government committed to an ambition to end new HIV transmissions, AIDS diagnoses, and HIV-related deaths within England by 2030. Achievement of these ambitious commitments—including our interim commitment to an 80% reduction in transmissions by 2025—is within our grasp, and we should be encouraged by the progress already made. This progress is testament to the collective and ongoing efforts of many organisations across the UK Health Security Agency, local government, the NHS and wider health system, statutory agencies, and the voluntary and community sector.

As part of the plan, we committed to update Parliament each year on the progress made towards our ambition to end new HIV transmissions, AIDS, and HIV-related deaths within England by 2030. I am proud to present to Parliament a summary of the work undertaken towards these objectives in 2022-23.

Despite the challenging backdrop of the covid pandemic, England has seen a 33% fall in new HIV diagnoses since 2019. NHS England has committed £20 million in funding for 2022 to 2025 to expand HIV opt-out testing in emergency departments in areas with the highest HIV prevalence. This has helped diagnose 2,000 new cases of blood-borne viruses (hepatitis B and C as well as HIV) in the first year of the programme. During National HIV Testing Week 2023 almost 22,000 free HIV testing kits were ordered by the public—with self-testing kits that provide instant at-home results available for the first time. We have also established the HIV Action Plan Implementation Steering Group to oversee progress, as well as a Community Advisory Group and four task and finish groups to support PrEP access and equity; workforce; HIV control strategies in low prevalence areas; and retention and engagement in care, and I look forward to seeing the impact they will make.

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Mental Health Treatment and Support

Neil O'Brien Excerpts

Wednesday 7th June 2023 Commons Chamber

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

I beg to move an amendment, to leave out from “House” to the end of the Question and add:

“notes the increased burden on mental health following the pandemic, including on young people and those with severe mental illness; recognises the historic levels of investment being delivered by this Government into services, with an increase of £2.3 billion per year in front-line mental health funding over the past four years; notes that current NHS targets around access to talking therapies and intervention in psychosis are being met due to the efforts of NHS staff; and acknowledges the investment in mental health teams in schools, as well as the ongoing investment into open access mental health helplines in the 111 service and into the estate, including three new mental health hospitals to be opened in the next two years accompanied by a further £150 million in investment in new mental health ambulances and the development of better alternatives to accident and emergency services, including crisis houses, safe havens and step-down services.”

Improving mental health is a top priority for this Government. We can all agree that in the past it was not given the priority it deserves, and was seen as something to be ashamed of and not spoken about. Thankfully, we are changing that. We are working to achieve parity of esteem between physical health and mental health, with record amounts of investment going into NHS mental health services in England, and the stigma surrounding mental health is being reduced.

“The Five Year Forward View for Mental Health”, which was published in 2016, was a major step forward and secured an additional £1 billion in funding for mental health, so that an additional 1 million people could access high-quality services by 2020-21. It was followed by the NHS long-term plan in 2019, which committed an additional £2.3 billion a year for the expansion and transformation of mental health services in England by 2024, so that an additional 2 million people could get the NHS-funded mental health support that they need. It is also funding the increase in the frontline mental health workforce to meet the plan’s ambition for 27,000 additional mental health staff by 2023-24. There were 138,610 full-time equivalent mental health staff at the end of 2022, an increase of 8,900 on the previous year and of 20,700 on December 2010, so the mental health workforce in the NHS is radically bigger. In total, we spent around £3 billion more on mental health last year compared with four years ago. That is an increase of a quarter.

Backed by this huge investment, we are expanding access to NHS talking therapies for adults to meet the long-term plan’s ambition for an additional 1.9 million people to access National Institute for Health and Care Excellence-approved treatments for conditions such as anxiety and depression. From starting small in 2008, around 1.2 million people are now accessing NHS talking therapies every year, with 98% waiting less than 18 weeks for their treatment and 90% waiting less than six weeks. This means that we are delivering well over our national waiting time targets of 95% and 75% respectively.

Local mental health services are transforming community mental health care to give 370,000 adults and older adults with severe mental illnesses greater choice and control over their care and to support them to live well in their communities. We recognise that poor mental health is a major cause of sickness absence in the workplace and we are providing support to employees and employers on mental health in the workplace. We have announced additional measures to support workplace mental health, including a package to support the long-term sick and disabled to remain in or return to work. This includes £200 million for digital mental health to modernise NHS talking therapies, to provide free access to wellness and clinical mental health apps for the population, and to pilot cutting-edge digital therapeutics. There will be around £75 million to expand individual placement and support services to help more people with severe mental health illnesses into employment.

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

Will the Minister give way?

[Neil O’Brien]

I will make a little progress first.

We know that the number of children and young people experiencing mental ill health is rising, and that many of them will continue to experience mental health problems later in life. Spending on children and young people’s mental health continues to grow, from £841 million in 2019-20 to £995 million a year later, and now to £1.1 billion in 2022-23. This means that we are helping more children and young people than ever before. In 2021-22, there were over 743,000 new referrals to children’s and young people’s mental health services, which is 41% higher than the year before.

[Several hon. Members rose—]

[Neil O’Brien]

I will make a bit of progress before I give way.

The long-term plan will ensure that 345,000 more children and young people can get the mental health support they need when they need it.

We are committed to ensuring that children and young people can access mental health support in school, so that they can access help with anxiety and depression and other common mental health services before problems become more serious. In that way, we can prevent—in exactly the way we all agree on—the problems from becoming more serious. That includes continuing to roll out mental health support teams to schools and colleges in England.

[Fleur Anderson (Putney) (Lab)]

The picture that the Minister is painting does not quite tally with the experience that I am seeing in families, many of whom are watching with a feeling of helplessness as their children’s mental health deteriorates while they are on long waiting lists. In the NHS South West London ICB area, there are over 10,000 young people on waiting lists, and many have their cases closed without even getting the support they need. That leaves them with deteriorating mental health and it leaves their families in despair. How is it that the money the Minister is talking about does not seem to get through to the young people who need help?

[Neil O’Brien]

I will come to the point about waiting lists in a moment.

Let me complete my thoughts on prevention, which I think we all agree is important. There are 3.4 million pupils covered by mental health support teams in 2022-23, which equates to about 35% coverage of pupils in schools and learners in further education in England. We expect around 500 teams to be up and running by 2024, covering around 44% of pupils and learners, so it will be up from 35% to 44%. Over 10,000 schools and colleges now have a trained senior mental health lead, including more than six in 10 state-funded secondary schools in England. On prevention, the Government are also providing £150 million of capital investment in NHS mental health urgent and emergency care infrastructure over the next two years.

[Andy McDonald (Middlesbrough) (Lab)]

While the Minister is addressing the issue of young people, can I say that I have yet to hear any news from the Department as to whether there will be a public inquiry into the deaths of the three young women who died under the care of the Tees, Esk and Wear Valleys Foundation NHS Trust. Can he enlighten me on that?

[Neil O’Brien]

This is an extremely important issue that the hon. Gentleman is quite right to raise. We will be producing the results of the rapid review in the coming weeks, so he will not have to wait very long.

[Munira Wilson]

Like other colleagues, I see many children in my constituency waiting well over a year, sometimes two years, to access child and adolescent mental health services, so I was alarmed when NHS England recently told me that, on the latest modelling, the number of NHS-commissioned training posts in London for child and adolescent psychiatry will halve by 2031. I have no idea what is driving this modelling, but given that one in six seven to 16-year-olds have a probable mental health disorder, will the Minister at least look into these figures and undertake to write to me to explain why we are seeing such a drop in the number of training places?

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[Neil O’Brien]

Those are not figures that I am familiar with or recognise, but I will certainly take this up with the London commissioners because it sounds like an important issue. I have talked about the dramatic increase we have already seen in the mental health workforce, and we are setting out further steps in our long-term workforce plan, but I will take that away and look at it closely with other Ministers.

[Mr Toby Perkins]

One of the issues here is that the demand for mental health services has gone through the roof, from 3.6 million in 2020-21 to 4.5 million in 2021-22. My hon. Friend the Member for Tooting (Dr Allin-Khan) was clear in her view, which I share, that the policies of this Government have been a factor in driving up the mental health demand. Does the Minister accept that? If not, what does he put it down to?

[Neil O’Brien]

I was just coming to that, but on the point about prevention and the social origins of these things, we are in agreement about tackling the origins of these things. In terms of financial security, that is why we are providing financial help worth £3,300 per household, one of the most dramatically generous packages anywhere in Europe. The question of good housing was raised earlier. We have the Social Housing (Regulation) Bill and we are taking action to extend the decent homes standard to the private rented sector.

[Dr Luke Evans (Bosworth) (Con)]

Is it not the case that we have to be really careful about what we are talking about? There is a difference between mental wellbeing and mental health. We all suffer with our mental wellbeing but we do not all suffer with our mental health, and we therefore need to have the support that is appropriate. Social prescribing, for example, has a fundamental ability to help people who suffer with their mental wellbeing. Are the Government doing anything more to drive up social prescribing, so that GPs and allied professions can get the support from the third sector and other voluntary organisations that people so desperately need for their mental wellbeing?

[Neil O’Brien]

My hon. Friend, as an experienced clinician, makes an important and thoughtful point. This is exactly why we have so dramatically increased the number of social prescribers in primary care. An example in Britain is the parkrun practices initiative, which is connecting people to sporting and cultural activities that can improve mental wellbeing as well as mental health. My hon. Friend is completely right, and that is why this is a priority for us.

[Andrew Bridgen]

The suicide rate in North West Leicestershire increased by more than 300% during the lockdown. Does the Minister know what the increase was in his constituency?

[Neil O’Brien]

It is just not true there was an increase in suicides because of the lockdowns. There have been a whole series of careful studies of this and that is just not the case. I am afraid that my hon. Friend is not correct about this.

[Wera Hobhouse (Bath) (LD)]

Eating disorders are a national scandal and have reached epidemic proportions. Anorexia nervosa has the highest mortality rate of any mental health disorder and a third of people with binge eating disorders are at suicide risk. With at least 125 million people suffering from eating disorders and with soaring waiting lists, is it not time that the Government appointed something like an eating disorder prevention champion to tackle this incredibly difficult but rising crisis?

[Neil O’Brien]

I completely agree about its tremendous importance, and I take this opportunity to mention the incredible work on this hugely important issue by brilliant charities such as Beat. I will outline some of the general things we are doing to increase capacity further.

[Janet Daby]

Only a few weeks ago, I met a constituent who endured an awful kidnapping and rape. She had some initial counselling and therapy from specialist services, but she has now been on the waiting list for more than a year and a half. What would the Minister say to my constituent, who desperately needs therapy?

[Neil O’Brien]

I am terribly sorry to hear about the hon. Lady’s constituent’s case, which I will look at extremely closely. This is why we are putting in extra investment and tackling waiting lists.

[Several hon. Members rose—]

[Neil O’Brien]

I should make a little progress before taking further interventions.

The Government are providing £150 million of capital investment in the NHS’s urgent and emergency care infrastructure for mental health over the next two years. Those interventions include £7 million for 90 new mental health ambulances, with the remaining £143 million going to more than 160 capital projects with a preventive focus. These include new urgent assessment and care centres, crisis cafés and crisis houses, health-based places of safety for people detained by the police and improvements to the NHS 111 and urgent mental health helplines. The hon. Member for Tooting talked about creating such facilities in the community, and we are already doing that. We are also investing £400 million between 2020-21 and 2023-24 to eradicate mental health dormitory accommodation, improving safety and dignity for patients. Twenty-nine projects have already been completed since the programme commenced in 2020-21, eradicating over 500 dormitory beds.

[Dr Ben Spencer]

Will the Minister join me in welcoming the construction of the new Abraham Cowley unit, which will eradicate the dormitories that were in my constituency?

[Neil O’Brien]

I join my hon. Friend in celebrating that unit and his advocacy for people affected by mental health.

[Florence Eshalomi (Vauxhall) (Lab/Co-op)]

I thank the Minister for giving way, as I appreciate that he is trying to make progress. On the capital programme, one of the issues that my hon. Friend the Member for Tooting (Dr Allin-Khan) highlighted is Seni’s law, which will look at the treatment that patients receive in mental health units, where, sadly, restraint has led to deaths. The Minister talks about prevention, and we need to make sure that Seni’s law, which was enacted in November 2018, comes forward now. Does he agree?

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[Neil O’Brien]

The remaining provisions will be commenced as soon as possible.

We are working with the NHS towards implementing new waiting time standards for people requiring urgent and emergency mental healthcare, in both A&E and the community, to ensure timely access to the most appropriate high-quality support. We also recognise that there is much more to be done to improve people’s experience in in-patient mental health facilities. The Minister with responsibility for mental health, my hon. Friend the Member for Lewes (Maria Caulfield), has spoken to many Members following reports of abuse and care failings at a number of NHS and independent providers. We have been clear that anyone receiving treatment in an in-patient mental health facility deserves to receive safe, high-quality care and to be looked after with dignity and respect.

It is vital that, where care falls short, we learn from any mistakes to improve care across the NHS and to protect patients. That is why we have conducted a rapid review of mental health in-patient settings, with a specific focus on how we use data and evidence, including from complaints, feedback and whistleblowing reports, to identify risks to safety.

[Marsha De Cordova (Battersea) (Lab)]

The Minister wants to talk about data and evidence. We know that, within the mental health crisis, there are huge, long-established racial disparities, with young black men disproportionately being sectioned under the Mental Health Act 1983. The draft mental health Bill is still in train, and I would like to know exactly when the Government will table the Bill, which might stop these racial disparities and stop young black men dispro-portionately being sectioned.

[Neil O’Brien]

We are currently responding to pre-legislative scrutiny, so we are on the case. We are not just waiting, of course, and we are already doing things on these points, including through the culturally appropriate advocacy pilots for those at risk of detention and on the patient and carer race equality framework to avoid and prevent detention in the first place.

The rapid review’s report will be published very shortly. NHS England has also established a three-year quality transformation programme that seeks to tackle the root causes of unsafe, poor-quality in-patient care, including sexual safety, in mental health, learning disability and autism settings.

Our draft mental health Bill, which has been mentioned a few times in this debate, is intended to modernise the Mental Health Act so that it is fit for the 21st century and works better for people with serious mental illness. The draft Bill has completed its pre-legislative scrutiny, and we will respond to the Joint Committee’s recommendations very shortly.

In a world of increasing rates of multiple morbidity and diseases of increasing complexity, it is crucial that we continue our progress towards more person-centred, holistic care that considers a patient’s physical and mental health needs together. That is why we announced in January that we will be producing a major conditions strategy to tackle the conditions that contribute most to morbidity and mortality across the population of England, including mental health. The call for evidence is now open, and I encourage everyone to make their views known before it closes.

[Liz Twist (Blaydon) (Lab)]

The Minister is talking about the mental health strategy now being part of the major conditions strategy. Is he aware that many mental health organisations see it as a retrograde step that, having conducted an extensive consultation and invited views, the strategy will now be put back even further?

[Neil O’Brien]

I assure the hon. Lady that all contributions were fed into the major conditions strategy process. The reason why we are making the mental health strategy part of the major conditions strategy, and why we are looking at co-morbidities, is because, as the hon. Member for Tooting mentioned, people with mental health conditions have a shorter lifespan and, in general, the cause is typically a physical co-morbidity. It is essential that we look at these things together if we are to make progress on tackling disparities.

We have committed to publishing a new national suicide prevention strategy later this year, and we are engaging widely across the sector to understand what further action we can take to reduce cases of suicide. The new strategy will reflect new evidence and the national priority for preventing suicide across England, including action to tackle known risk factors and targeted action for groups of concern. We are also providing an extra £10 million over the next two years for a suicide prevention voluntary, community and social enterprise grant fund. This competitive grant fund will help to support the sector to deliver activity that can help to sustain services to help meet increased demand for support and to embed preventive activity that can help to prevent suicide and stem the flow into crisis services.

[Liz Twist]

Of course it is good that we will have a refreshed national suicide prevention strategy, and of course £10 million is welcome, but it is not out there yet. In the meantime, the £57 million that was earmarked for local work on suicide prevention has run out. Will the Minister consider making urgent interim arrangements to ensure that this vital work can continue until the strategy is published?

[Neil O’Brien]

I am conscious that we need to help the sector to maintain and grow its levels of service.

I finish by paying tribute to all those who do so much to support people’s mental health: frontline NHS staff, those working in the voluntary community and social enterprises, and all those who are quietly supporting a family member or loved one.

Tackling Obesity

Neil O'Brien Excerpts

Wednesday 7th June 2023 Written Statements

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

The Government are committed to helping people live healthier lives. The 2019 health survey for England estimated that over 12 million adults were living with obesity—28% of the population in England.

Tackling obesity, which increases the risk of a range of serious and chronic diseases such as cardiovascular disease and diabetes, remains a key priority.

The Government are announcing that up to £40 million of funding will be provided over two years to pilot ways to make the newest and most effective obesity drugs accessible to eligible patients living with obesity outside of hospital settings.

Earlier this year, the National Institute for Health and Care Excellence (NICE) recommended the use of semaglutide (Wegovy) when it launches for adults with a body mass index (BMI) of at least 35 and one weight-related health condition—such as diabetes or high blood pressure. There is evidence from clinical trials that, when prescribed alongside diet, physical activity and behavioural support, patients taking Wegovy can lose around 15% of their body weight after one year, reducing the risk of obesity-related illnesses. Some patients taking this weight-loss drug can begin to lose weight as quickly as within the first month of treatment. Another drug known as tirzepatide is expected to be assessed by NICE for weight loss. Losing weight can help to reduce the risk of obesity-related illness, which in turn can reduce pressure on the NHS, cut waiting times and realise wider economic benefits.

NICE advises that weight-loss drugs are prescribed within a specialist weight management service. Currently, these services are mainly based in hospitals, which means that only around 35,000 people per annum have access to weight-loss drugs, when millions more could potentially benefit.

The £40 million pilots will explore how approved drugs can be made safely available to more people by expanding specialist weight management services outside of hospital settings. This includes looking at how GPs could safely prescribe these drugs and how the NHS can provide wraparound support in the community or digitally. This could increase dramatically the number of people who have the opportunity to benefit from these treatments and provide more equitable access.

The pilot will be delivered by NHS England working closely with the Office for Health Improvement and Disparities (OHID) and NICE. The pilots will be designed with input from primary and community care organisations and existing specialist weight management services. There will be a robust and independent evaluation led by the National Institute for Health and Care Research to ensure any wider roll-out is informed by the best possible evidence.

The pilot builds on the firm action the Government are already taking to tackle obesity. This includes introducing the soft drinks industry levy, which has seen the average sugar content of drinks decrease by 46% between 2015 and 2020, and investment of £350 million to boost school sport to help children and young people have an active start to life.

Last year the Government announced £20 million for the Office for Life Sciences’ obesity mission. This is in addition to the £40 million announced today and will explore innovative ways to best utilise promising medicines and digital technologies to help NHS patients achieve a healthy weight.

The Better Health: Rewards app is also being piloted in Wolverhampton. It is offering incentives such as vouchers for shops, gym discounts and cinema tickets for people who eat healthily and exercise more.

The Department for Health and Social Care launched a call for evidence in May to inform the major conditions strategy, including further work to tackle obesity.

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Oral Answers to Questions

Neil O'Brien Excerpts

Tuesday 6th June 2023 Commons Chamber

[Richard Thomson (Gordon) (SNP)]

4. If he will make an assessment with Cabinet colleagues of the potential impact of increasing the affordability of sun protection products on levels of skin cancer.

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

Last month was melanoma month and skin cancer month, and people are increasingly aware of the risks of excessive sun exposure without protection. Through the energy price guarantee and our direct support for vulnerable households, we have provided cost of living help worth, on average, £3,300 per household.

[Richard Thomson]

Since the early 1990s cases of skin cancer have doubled, with nearly 16,000 new cases diagnosed each year leading to 2,300 avoidable deaths annually. If some products were more affordable, more of our constituents might be able to use them and bring those numbers down. Will the ministerial team make representations to their Treasury colleagues about the Sun Protection Products (Value Added Tax) Bill, a private Member’s Bill promoted by my hon. Friend the Member for East Dunbartonshire (Amy Callaghan) which would remove VAT from some sun protection products, so that we can start to make an impact on those appalling figures?

[Neil O’Brien]

As the hon. Gentleman knows, tax matters are for the Treasury, but we are absolutely committed to providing cost of living support. By the end of June the Government will have covered nearly half a typical household’s energy bill since October, so we are providing one of the most generous packages in Europe.

[Mr Speaker]

I call the Scottish National party spokesperson.

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

The last time I asked Ministers whether they would support that Bill I was told that the issue of VAT and skin cancer was a matter for the Treasury, and we have just heard a similar answer. Surely this is a matter for joined-up government. What are Ministers doing—instead of imposing more pressure and costs on the NHS—to persuade their Treasury colleagues to consider more cost-effective cost preventive measures such as making skin protection products more affordable?

[Neil O’Brien]

The hon. Gentleman is campaigning for a reduction in the VAT on suncream, but let me put this into perspective. As I have said, our cost of living support is worth, on average, £3,300 per household. That is help on a huge scale. On cancer we are taking more action across the piece, and more people are being given life-saving checks, referrals and treatment than before.

[Kate Hollern (Blackburn) (Lab)]

5. What steps he is taking to improve cancer waiting times and outcomes.

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[Bill Esterson (Sefton Central) (Lab)]

9. Whether he plans to provide funding for a new primary health care facility in East Sefton.

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

The Government are providing record levels of capital to the NHS, with more than £24 billion allocated between 2022-23 and 2024-25, over £12 billion of which is allocated to integrated care boards themselves to invest in local priorities, including primary care facilities, of which just under £700 million has been allocated to NHS Cheshire and Merseyside integrated care board.

[Bill Esterson]

The Minister has just reminded us that the allocations are made by Government to integrated care boards. The problem is that, with a board the size of Cheshire and Merseyside, there are very many competing priorities. Sefton Council has secured more than £1 million from developers for a new health centre in East Sefton. The Health Secretary’s recent predecessors, of which there have been many, have agreed with me that a new health centre there is a priority. Will he and his colleagues match the priority accorded to this by their predecessors, match the ambition of my constituents and support the commitment by Sefton Council and award that additional funding, so that my constituents can get that much-needed health centre in East Sefton?

[Neil O’Brien]

The hon. Member has been campaigning doggedly for this for several years, and I am sure that his local ICB will be strongly seized of that and the strong arguments for it. He raised the issue of developer contributions. One thing that we have done in the most recent primary care recovery plan is set further steps to increase investment from developer contributions so that we match new housing with the much-needed infrastructure, such as primary care facilities.

[Gordon Henderson (Sittingbourne and Sheppey) (Con)]

10. What progress his Department has made on increasing the number of available GP appointments.

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

We are taking action to increase the workforce in general practice. We have managed to hit our target of recruiting 26,000 extra clinicians a year earlier. In fact, we have 29,000 extra clinicians in GP surgeries as well as nearly 2,000 more doctors. Of course, we will go further: as well as increasing the training of GPs to a record level—up from about 2,600 to 4,000 a year—we are also taking action to improve technology to take the burden of bureaucracy off GPs through our primary care recovery plan.

[Gordon Henderson]

Although I appreciate the Minister’s response, Sittingbourne and Sheppey still has one of the highest patient to GP ratios in the country. Without more GPs, no initiative to increase appointments will succeed. Our local integrated care board is doing its best to bring more doctors to our area. What help can my hon. Friend give to the ICBs so that they can provide my constituents with the GPs they need?

[Neil O’Brien]

My hon. Friend is quite right that we absolutely need to go further. That is why, through the primary care recovery plan, we are taking some of the pressure off general practice, investing £645 million in the new Pharmacy First service, which will free up about 10 million GP appointments a year. That is why we are investing about £60,000 per practice in new IT and modern online systems. None the less, he is totally right: we need those doctors in general practice. We have about 2,000 more now than we did in 2019, but we will go further. We have already increased GP training and we are looking at building on that further.

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

Can the Minister clarify when Oldham will receive its share of the 6,000 additional GPs that were promised in the Conservative 2019 general election manifesto? Today we are running with fewer GPs, and that is not helpful to anyone.

[Neil O’Brien]

I have already noted that we have increased the number of doctors in general practice by nearly 2,000 since 2019 alone. The number of direct patient-facing staff in general practice is 50% higher in total than in 2019, and that is up right across the country. However, of course we will go further and grow the number of clinicians in general practice, building on what we have already done.

[Matt Warman (Boston and Skegness) (Con)]

The primary care recovery plan includes excellent measures to extend visas for international medical graduates, but can my hon. Friend say whether that extension will be automatic, answering the concerns of the Royal College of General Practitioners, and whether it will be in place for the 1,000 or so graduates coming this June and August?

[Neil O’Brien]

My hon. Friend modestly does not mention his role in advocating for that important reform, which will help to increase the number of highly qualified GPs coming from other countries to work in the NHS. We will ensure that that extension is automatic, so that people have extra time to make sure they get the right placement in general practice.

[Tim Farron (Westmorland and Lonsdale) (LD)]

There was a net loss of 577 full-time equivalent GPs last year. A contributing factor in rural communities was the Government’s decision a few years ago to remove the minimum practice income guarantee, making it unsustainable for small surgeries—and many rural surgeries are necessarily small—to survive. Will the Minister consider whether it is time to reintroduce a strategic small surgeries fund, to allow smaller rural surgeries in communities such as mine to survive and thrive?

[Neil O’Brien]

The funding formula already takes account of rurality. I hear the hon. Gentleman’s argument, but it is worth noting that our GPs are doing more than ever before. In the year to April there were nearly 10% more appointments than before the pandemic, or 20 more appointments in every GP practice per working day. GPs are working incredibly hard, as well as putting in extra staff, and I pay tribute to them for the sheer amount of work they are doing.

[Paul Bristow (Peterborough) (Con)]

The Minister recently joined me at the Thistlemoor medical centre at the heart of my constituency. Led by the inspirational Modha family, the team prioritise making face-to-face appointments available for patients by having amazing admin and support staff who speak a variety of languages. That means that, by the time the patient sees the GP, all the relevant checks have been done and the GP has all the relevant information. How can we better use admin and support staff at GP surgeries so that doctors can maximise their time and operate at the very top of their licences?

[Neil O’Brien]

It was an absolute pleasure to meet the Modha family and see the inspirational work happening in my hon. Friend’s constituency. In our primary care recovery plan we are learning some lessons from that work, particularly about focusing GPs’ time on the jobs only they can do—hence the investment in the extra 29,000 additional roles reimbursement scheme staff, the detailed plan in the primary care recovery plan to improve communication between hospitals and GPs, the cutting back of unnecessary bureaucracy, and the freeing up of resources by simplifying the investment and impact fund and the quality and outcomes framework. It is brilliant to learn from the inspirational work happening in his constituency.

[Patricia Gibson (North Ayrshire and Arran) (SNP)]

Recent research from the Nuffield Trust shows that Brexit—a Brexit supported by both the Government and the Labour party, it has to be said—has worsened the shortage of NHS staff across the UK. Indeed, it has led to more than 4,000 European doctors choosing not to work in the national health services across the UK, due to higher costs, increased bureaucracy and uncertainty over visas. Can the Minister tell me whether that is one of the success stories of Brexit that we keep hearing about?

[Neil O’Brien]

International recruitment is up. In fact, we have 38,000 more doctors and 54,000 more nurses in the NHS than in 2010. In England at least, we are taking every step we can to draw on that international talent and we are using it to grow staffing in the NHS.

[Mr Speaker]

I call the shadow Minister.

[Karin Smyth (Bristol South) (Lab)]

From Sittingbourne via Bristol and Oldham, people are fed up with not being able to speak with a GP when they need to. GPs are warning that rising demand and increased costs may lead to workforce cuts or even closures. They are fed up with the bamboozling of numbers—more of which we have heard this morning—whether on GPs, full-time trainees, locums and now appointments. Whatever the metric, can the Secretary of State or the Minister tell us how many more GPs or GP appointments they think are necessary for people to access the care that they need?

[Neil O’Brien]

We committed in our manifesto to increasing the number and availability of appointments by 50 million. We are well on our way to meeting that target, as I have mentioned—we had 10% more appointments in the year to April than in the year before the pandemic. That is the result of the additional staffing that we are putting in: the extra 29,000 other clinicians and the nearly 2,000 more doctors in general practice. We have made that investment, but the reason why GPs are doing more appointments is not just that we have provided a fifth more funding since 2017 up to 2021; it is also that GP teams are working incredibly hard, and I pay tribute to them for all they are doing.

[Luke Hall (Thornbury and Yate) (Con)]

11. What steps he is taking to provide funding for new hospitals and health centres.

--- Later in debate ---

[Anthony Mangnall (Totnes) (Con)]

12. When he plans to publish a dental recovery plan.

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

Our dental plan will be out shortly. We are already taking steps to reform the contract. We have created more bands for units of dental activity, to better reflect the fair cost of work and to incentivise NHS work. We have introduced a minimum UDA value to sustain practice where it is low, allowing dentists to deliver 110% of their UDAs. As a result, the amount of dental activity being delivered is up by about a fifth on a year ago, but we know that we must go further.

[Anthony Mangnall]

I welcome the Minister’s response and his comments in a recent Westminster Hall debate. It is clear that there is still a problem, and many of us are still asking for the recovery plan to come forward. I am afraid that “soon” is not good enough. Nearly every single one of the NHS dentists in my constituency is either not taking on new patients or leaving the area. “Soon” needs a date. Can we have this plan either immediately or sooner?

[Neil O’Brien]

I was seized by the thoughtful comments that my hon. Friend made in that Westminster Hall debate. We are working on all those ideas, and the plan will be out very shortly.

[Jim Shannon (Strangford) (DUP)]

I thank the Minister for his response. Would he consider encouraging more students to go into dental work by writing off student loans for those who go into NHS dental work for a five-year period—in other words, we get something back if we invest in them?

[Neil O’Brien]

At every stage, we are taking action to get more dentists doing NHS work. There are 6.5% more dentists doing NHS work than in 2010. The hon. Gentleman has an important idea. We are doing other things to retain NHS dentists, such as the important reforms that we made to pensions, which have helped both GPs and NHS dentists.

[Dr Luke Evans (Bosworth) (Con)]

13. What progress he has made on improving hospital facilities.

--- Later in debate ---

[Maggie Throup (Erewash) (Con)]

T4. Just a couple of weeks ago, the Obesity Health Alliance launched its manifesto to tackle the high levels of diet-related ill health and the impact that has on our economy and society. Can my hon. Friend update the House on the progress being made on implementing the measures in section 172 of and schedule 18 to the Health and Care Act 2022 on the advertising of less healthy food and drink?

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

We are still committed to reducing the advertising of unhealthy food, including the junk food watershed that will be implemented in 2025. Ahead of that, we are taking action on obesity across the board, including the sugar tax, which has cut the average sugar content of affected drinks by 46%, the calorie labelling that we have on out-of-home food in cafés and restaurants, and the location restrictions on less healthy food that are coming in from October.

[Mr Speaker]

I call the SNP spokesperson.

--- Later in debate ---

[Mr Speaker]

The question cannot go on forever; let us get an answer.

[Neil O’Brien]

I had a useful conversation with the Scottish public health Minister where we discussed many of these issues. We are providing huge cost of living support—some of the most generous in Europe, worth £3,300 a household—and taking action across the piece. Whether it is smoking or obesity, we are tackling the underlying causes of the health inequalities that the hon. Gentleman mentions.

[Sir Edward Leigh (Gainsborough) (Con)]

T8. Under the Human Rights Act, do the Government not have a duty of care to deal with the housing of illegal migrants? How can the Government ensure the health of 2,000 migrants cooped up in the former RAF Scampton? In particular, how will they ensure their health given the fact that the site is riddled with asbestos and contamination from 100 years of RAF usage? I see a case coming to the European Court of Human Rights.

--- Later in debate ---

[Anna Firth (Southend West) (Con)]

T9. Last week, not a single dentist across the city of Southend said that they were taking on new NHS patients, which is concerning for my constituents. Can my hon. Friend confirm again what steps he is taking to make sure that my constituents get the NHS dental treatment that they deserve?

[Neil O’Brien]

This is absolutely the top priority I am working on at the moment. I am totally seized of the challenge that my hon. Friend mentions. I have mentioned some of the reforms we are already making, which have increased dental activity by about a fifth in the year to March, but we know that we have to go further and we will do so shortly.

[Nadia Whittome (Nottingham East) (Lab)]

T6. More than one in 10 social care roles are vacant, and the biggest culprit in this recruitment and retention crisis is low pay. According to recent TUC analysis, a £15 an hour minimum wage for care workers would not only tackle staff shortages, but level up places such as the east midlands, introducing an £800 million economic boost. Will the Government introduce that?

--- Later in debate ---

[Simon Lightwood (Wakefield) (Lab/Co-op)]

In Wakefield, I am pleased to say that our campaign to save our city centre walk-in service has been successful, but every day people are still struggling to get a GP appointment. The latest NHS statistics show that, in April, 12,586 people waited more than 28 days. Quite simply, there are not enough fully qualified GPs. Labour has a workforce plan that is ambitious and costed. Where is the Government’s delayed and fully funded workforce plan?

[Neil O’Brien]

I have already mentioned that we have nearly 2,000 more doctors in primary care than we did in 2019, as well as the early delivery of the 26,000 extra clinicians we have brought into primary care. [Interruption.] The Opposition may not want to hear it, but the truth is that we have increased funding for general practice by about a fifth in real terms. We have more doctors and other clinicians, and GPs are doing 10% more appointments every month. We want to continue to build on that, which is why we have the primary care recovery plan and why we have invested a further £645 million in enabling people to get treatment from their pharmacists, freeing up 10 million more GP appointments. We know we must go further, but we are making progress.

[Aaron Bell (Newcastle-under-Lyme) (Con)]

I know the Minister is very keen to see the numbers of elective waits fall, and they have been falling. My constituents in Newcastle-under-Lyme share that aim. So will he welcome the local hospital trust opening not only a new modular theatre for specialised hand surgery, but a central treatment suite for day patients at the County Hospital in Stafford funded by NHS England’s elective recovery plan, which will help cut waits for planned procedures?

--- Later in debate ---

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

I refer Members to my entry in the Register of Members’ Financial Interests. Today Dr Mike McKean, a respiratory consultant and vice-president of the Royal College of Paediatrics and Child Health, said that vaping is “fast becoming an epidemic” among children. The Royal College of Paediatrics and Child Health said that we should ban disposable cigarettes—e-cigarettes—“without a doubt”. Will the Minister do all he can to prevent children from starting vaping, and will he back my ten-minute rule Bill, which was first introduced in this place in February, to ban disposable e-cigarettes?

[Neil O’Brien]

I pay tribute to my hon. Friend and her leadership on this issue. Many of the ideas that she has been putting forward are already in the plan that we set out to tackle youth vaping, including the creation of the “flying squad”, the ongoing call for evidence on youth vaping, and all the different things we could do to continue to drive it down.

[Stephanie Peacock (Barnsley East) (Lab)]

The non-surgical breast cancer service in South Yorkshire is facing a critical shortage of oncologists. The shortage is so severe that patients are being told to expect months between referral and appointment. What immediate steps are the Government taking to ensure that patients, no matter their postcode, see a specialist as soon as they need to do so?

[Jack Brereton (Stoke-on-Trent South) (Con)]

A number of dentists across north Staffordshire are stopping NHS treatment, which is extremely concerning. Some of my constituents have reported that they are being told they will have to pay either £120 a year or £14 a month to stay on the books. Will my hon. Friend look into those serious concerns and meet me to discuss the matter further?

[Neil O’Brien]

I am happy to meet my hon. Friend to discuss those important issues further.

Healthcare Facilities: Royston

Neil O'Brien Excerpts

Monday 5th June 2023 Commons Chamber

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

I congratulate my right hon. and learned Friend the Member for North East Hertfordshire (Sir Oliver Heald) on securing this important debate and I thank him for his work advocating for health services for his constituents. If there were any danger of Royston being forgotten, my right hon. and learned Friend and his activities are ensuring that that does not happen. It was genuinely a huge pleasure to meet him, his local ICB, Addenbrooke’s and in particular his local GPs, who I thought were a particularly impressive and thoughtful bunch with many interesting ideas that he is helping to catalyse. I also congratulate him on his imaginative and thoughtful advocacy on behalf of Royston Hospital and the opportunities presented by that site, which he has explained further in this debate.

We absolutely recognise the importance of suitable and well-functioning premises for healthcare facilities, expanding our NHS workforce further, and accommodating and enabling good-quality healthcare services for growing populations, particularly in areas such as Royston that are expanding so rapidly. We are taking action to support ICBs in that aim, and we are aware that many areas, including Royston, are set to experience further increases in population, which of course puts pressure on local health services.

We announced in the delivery plan for recovering access to primary care, which is part of the wider review going on of the national planning policy framework—the subject of the most recent debate, in fact—that we would be better considering how primary care infrastructure can be supported and how we can get more of the profits of development flowing into our primary care facilities. So we will be updating guidance to encourage our local planning authorities to engage with ICBs, particularly on large sites where there is opportunity and the need for extra primary care capacity.

NHS England is currently undertaking a formal assessment of all general practice premises through a primary care data collection programme, and this will provide an overview of the current capacity, suitability and ownership of all premises, with the information made available to local commissioners to inform their planning. But the activity of my right hon. and learned Friend in pointing out the opportunities and the challenges will be very clearly in the minds of his local ICB as it thinks about its future plans.

From 2023, a substantial proportion of primary care business-as-usual estates and GP capital is included within overall integrated care system capital funding envelopes. That allows local systems to take a more cohesive and coherent approach to how they spend capital across that system, and to prioritise the primary care investment needs in their own local strategies.

As well as funding from specific national programmes, Cambridgeshire and Peterborough ICB—as we now know, it is responsible for commissioning health services in Royston; my right hon. and learned Friend was quite right about that—received £77 million in operational capital funding in 2022-23, totalling over £205 million during this spending review period. Cambridgeshire and Peterborough integrated care system has worked in partnership with NHS Property Services to develop the first estates strategy for the region. This was consulted on earlier in 2023 and approved by the ICB on 10 March.

The ICB has been working closely with primary care providers to try to stabilise primary care provision locally, and is now reviewing estates and local health care provision to make sure that they are also fit for the future. I know that the ICB is in conversation with the Hertfordshire Community NHS Trust, Granta Medical Services, and NHS Property Services—my right hon. and learned Friend has mentioned some of this—to review all the sites and consider options for a potential healthcare centre, co-located with primary care and diagnostic facilities.

In its decision-making capacity for estates and healthcare service commissioning, it is essential that the ICB is able to fully assesses capital and revenue costs, and service implications, that would arise from any decision. The ICB has noted that, while it recognises the community hospital is not currently functioning as it should, it is important that any future decisions on its use are not taken until it has fully considered and appraised all options, as my right hon. and learned Friend has quite rightly insisted on. That is why the ICB is about to begin a comprehensive listening and engagement exercise for an initial six weeks, encouraging local communities to take part in that conversation through a range of routes. The ICB will share more details in the coming weeks, on its website, on social media channels and through updates to key stakeholders, as well as via the printed materials in the community so that everyone knows that this conversation is ongoing.

Another approach and consideration that integrated care boards may take when they are shaping healthcare estates locally is the reconfiguration of services. This is a clinically-led local decision following appropriate engagement with patients and stakeholders. Responsibility for the delivery, implementation and funding decisions for services ultimately rests with the appropriate NHS commissioner. All substantial planned service change is subject to a full public consultation, and must meet Government and NHS England’s tests to ensure good decision making. As my right hon. and learned Friend has sometimes pointed out, community diagnostic centres are an important development to allow patients to access planned diagnostic care nearer to home, without the need to attend acute sites. That is only one of the ways we are doing that, including through virtual wards and a closer tie-up between primary and secondary care. Funding for community diagnostic centres has been allocated so that areas with unmet need receive more funding. That will help to tackle health inequalities.

My right hon. and learned Friend rightly raised the Priors Field surgery closure at Sutton. NHS Cambridgeshire and Peterborough ICB is pleased to conform that from 1 April, Malling Health took on an interim contract to provide primary care services to the patients of Priors Field surgery. While that interim solution is being secured, the ICB continues to work with key stakeholders in the local community to ensure that communities in Sutton and the surrounding areas continue to have access to primary care services that meet their needs, both now and in the future. Knowing my right hon. and learned Friend well, I know that he will not be backward in coming forward to make the case strongly for investment in his local community and constituency, and we will continue the useful and helpful conversation that we have been having.

[Sir Oliver Heald]

I am grateful to the Minister for the help he has given us. Would he be prepared to continue to take an interest in Royston and its future plans, because I think that has been very helpful so far?

[Neil O’Brien]

I am happy to conclude as I started, by saying that I would love to continue that conversation with my right hon. and learned Friend, his constituents and local clinicians. I thought it was extremely interesting, and they had some powerful ideas. I look forward to continuing that with my right hon. and learned Friend and local clinicians.

Question put and agreed to.

Dental Care: Durham

Neil O'Brien Excerpts

Wednesday 24th May 2023 Commons Chamber

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

Let me come directly to the questions asked by the hon. Member for City of Durham (Mary Kelly Foy). She called for a comprehensive dental reform plan. Yes, we will do that, and we will do it soon. She called for an overhaul of the 2006 contract. Yes, we will do that. Will we work with those at the BDA? Yes. In fact, I met them yesterday. We are keen to draw on their expertise.

I congratulate the hon. Lady on securing the time for this important debate. It is absolutely my top priority right now to work at pace to try to address the significant problems in dentistry. I am not here to say that there is no problem; I am here to try to fix the problem as quickly as possible. We could debate the figure on dental activity all day, but the bottom line is that it is not high enough and we need to get it higher. To come directly to her point about correcting the record and so on, the latest published figures show that there are 1,473 more dentists than there were in 2010—about 6.5% more.

[Mary Kelly Foy]

NHS dentists?

[Neil O’Brien]

NHS dentists, yes. Activity is definitely going up—about a fifth more patients were seen in the year ending March than in the year before that—but it is still too low. That is a point on which we absolutely agree.

We have started—only started—to reform the contract. We have introduced more bands for units of dental activity to better reflect the fair cost of work so that there is fairness for dentists, and to incentivise more NHS work. We introduced the first ever minimum UDA value to help sustain practices where UDA values are low. That has implications for under-delivery in some bits of the country.

We are for the first time allowing dentists to do 110% delivery of their UDAs so that those who want to do more NHS dentistry can do more, with a requirement to update their availability on the NHS website. We have also started the process of making it easier for dentists to come to work in the UK. Last month, we brought into force legislation enabling the General Dental Council to increase the capacity of the overseas registration exam. We are also working with local partners around the country who have various ideas about creating new centres for dental development so that, in areas that do not have a dental school, we can get more people to train and remain, and dentists flow to the bits of the country where there the need is most acute.

Some of those reforms are starting to have effects. It is good that the reforms to split band 2 have been reasonably well received, as has the 110% option. The splitting of band 2 is being used and the proportion of band 2bs is going up. As I say, activity is going up, which is encouraging, but it is not high enough and needs to be higher still. The reforms that we have talked about so far have just been a start. I am under no illusions about the significant challenges to address, not just in Durham but across the whole country.

The forthcoming dental plan will build on those initial steps to go further on improving the payment model and those initial banding changes, especially focusing on improving access for new patients, which is a particular problem. We want to consider how we address historical UDA valuations—they are stuck in time in 2006 and are, in some cases, unfair—and look fundamentally at how we make NHS work more attractive.

[Peter Gibson]

I thank the Minister for his engagement with me on dentistry in my constituency, and I welcome the reforms that he is talking about, but as he has just mentioned UDAs, could he say something about the disparity of UDA rates across a region? That disparity means that a large practice can concentrate its efforts in areas with higher UDA rates rather than in areas with lower UDA rates.

[Neil O’Brien]

My hon. Friend is quite right. Some of those disparities, which can occur from one end of the street to the other, are extremely hard to justify, hence the introduction of the minimum UDA rate and why we are looking at going further. He is completely correct. Funnily enough, as well as coming to improving access to treatment, I was just about to respond to his earlier point about prevention and his rather brilliant idea about what more we could do in schools. We are, following the conversations we have had, actively considering that.

I thank the hon. Member for City of Durham for her important work in securing this important debate.

[Mary Kelly Foy]

It feels as if the Minister is coming to the end of his speech, but I would really like him to correct the record. In my point of order yesterday, I said that the Prime Minister has on seven occasions said that there are 500 more NHS dentists, when there are in fact 700 fewer dentists. If the Minister has met the British Dental Association, it will have pointed that fact out to him. Could he please correct the record, or may I ask you, Madam Deputy Speaker, for advice on how we can encourage the Prime Minister to correct the record before the House rises tomorrow?

[Neil O’Brien]

I have already read out the statistics. I will not read them out again, and I do not think there is a need to correct the record. The statistics that the hon. Lady is drawing on are incomplete, because there is effectively a two-month lag between activity and the need to report that activity. Drawing on such incomplete information does not give the full picture, so I caution her against doing so.

First, I encourage the hon. Lady to wait for the official data in the usual way. Secondly, we are looking to improve that official data by, indeed, working with and responding to concerns raised by the BDA. I do not think that headcount is a sensible measure with the workforce. There are more people doing NHS work than there were in 2010. What we are really interested in is the total amount of activity, which is best measured by the total number of UDAs being delivered. As I have said, that total amount of activity is going up. In the last month for which we have data, it had gone up from 85% in March 2022 to about 101% in March 2023, but it is still not high enough. Although the trend is positive and dentists are doing more NHS work, the point of agreement here is that that needs to improve further.

[Mr Kevan Jones]

I am sorry, but the Minister cannot have it both ways. First, the population of this country has increased since 2010 and we need to measure the number of dentists against the size of the population. The other thing is that he can talk about UDAs, but if people are in an NHS dentist desert, as is the case in Durham, it does not matter if the number has gone up elsewhere. If people do not have access to a dentist, they do not have access to a dentist and therefore cannot be treated.

[Neil O’Brien]

That point is clearly correct, but that is not to disagree with anything that I have just said.

Rather than getting into the weeds—I have already read out the official statistics—let me try to end on a note of agreement. We absolutely want to take further steps to ensure that we increase access to NHS dentistry where it is lowest and, as well as improving the service for patients right across the country and improving preventive activity, we want to see particularly rapid improvement in those areas, perhaps including that of the hon. Member for City of Durham, that have not had the level of access that we would want over recent times.

Question put and agreed to.

NHS Dentists: South-West England

Neil O'Brien Excerpts

Wednesday 24th May 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, Ms Elliott. I congratulate my hon. Friend the Member for West Dorset (Chris Loder) on securing this incredibly important debate. Dentistry is the No. 1 issue that I am working on, and I reassure hon. Members that we are doing so at pace. We know that there are serious challenges across the country; hon. Friends and hon. Members are quite right about the scale of those challenges, which are particularly acute in the south-west.

I met the commissioners for dentistry in the south-west earlier this week. I met the professions separately, and I had further meetings about our dental plan earlier today. This is absolutely top-priority. I have been talking for some time to hon. Friends present and to south-west Members and others to generate the ideas that will go into the plan. They are the first in my mind when I think about those who are contributing important ideas to our dentistry plan, not just in their speeches today but in our conversations.

We have already started the process of reform, but it is only a start. We have created more UDA bands to reflect the fair cost of work and to incentivise NHS work. We introduced the first ever minimum UDA value to help to sustain practices where they are low, and—to address the point raised by my hon. Friend the Member for South Dorset (Richard Drax)—we have allowed dentists, for the first time, to deliver 110% of their UDAs, to encourage more activity from those who want to do more NHS dentistry. We have also started the process of making it easier for dentists to come and work in the UK. Just last month, legislation came into force that enables the General Dental Council to increase capacity for the overseas registration exam. I have also met the council to discuss how we can bust the backlog that built up during covid.

Plans for the centres for dental development are emerging around the country, which is very exciting and will address the issue that colleagues have mentioned about how to encourage dentists to train and then remain in the south-west and in other areas that find it more difficult to attract dentists. We have started to empower hygienists and therapists as well, exactly as my hon. Friend the Member for St Ives (Derek Thomas) proposes. We stand ready to go further. The reforms to split band 2 and the 110% option have been well received by the profession. They are being used: the proportion of the new band 2b that is being used is going up, which is already having some effect on delivery, although of course that effect is not high enough.

In data published by NHS England this week, the proportion of contracted units of dental activity delivered went up from 85% last March to 101% this March, and the number of NHS patients seen has gone up by about a fifth over the last year, so there is progress, but there is much more to do. We will go further in the forthcoming dental plan, which I hope will be out relatively shortly.

The reforms that I have talked about and the forthcoming dental plan draw on the ideas that Members across the House have put forward today. They will build on those initial banding changes, further improve that payment model and start to take us away from the 2006 contract, which everyone agrees is broken. Exactly as my hon. Friend the Member for West Dorset pointed out, that is the core of what we need to do.

We will also ensure further measures to improve access, particularly for new patients, look at how we address historical UDA variations that are not justified, improve transparency—I think my hon. Friend the Member for Torbay (Kevin Foster) made that point—and take further steps to grow the workforce, not least through the workforce plan, which we will publish very shortly. Fundamentally, we will do everything we can to make doing work for the NHS and NHS patients more attractive to dentists. At the same time—to answer the question that the Opposition Front Bencher, the hon. Member for Denton and Reddish (Andrew Gwynne), quite rightly asked—we will do more to encourage prevention as well.

The devolution of dentistry from the NHS regions to the individual integrated care boards at a more local level is an important improvement that we want to build on. It provides an opportunity for much closer integration with other local care services and much more accountability about what is being commissioned and delivered at the local level. People and MPs can go and see the person responsible for delivery in their area much more easily, and our dentistry plan will build on just that.

[Chris Loder]

I very much appreciate what the Minister is saying about the plan for dentistry going forward. The last time I brought up the issue was in July 2022, almost a year ago. We had these problems then, and we have them much worse now. Will the Minister share with us how some of these great initiatives, which I am pleased to hear about, will be expedited so that they can have the maximum effect as soon as possible for those who are most affected in the south-west?

[Neil O’Brien]

I feel the exact same sense of burning urgency that my hon. Friend feels. I hope our plan will be out very shortly.

[Richard Drax]

The Minister may be coming to this point, but can I ask him about the disincentives—the cap beyond which dentists do not get paid, and the money that is taken off them if they underspend? Is that issue going to be resolved?

[Neil O’Brien]

Absolutely. I mentioned that in the last financial year we brought in the 110% flexibility so that those who do want to go further and deliver more NHS care were able to do so. We are looking at continuing that and also making some further changes to make the system more flexible and give local commissioners more power, so we do not have these rigidities in the system leading to the absurd situation where there is both under-delivery and underspend, which is completely maddening to everyone.

Once again, I thank my hon. Friend the Member for West Dorset for raising this hugely important subject. I am sure all hon. Members will want to see the dentistry plan out as shortly as possible.

[Luke Pollard]

Could the Minister return to the question I raised about additional training places for dentists? We have a really good dental school in Plymouth that wants to take on more dental students. That could deliver a big impact for our region. Is that something that he is minded to look favourably on?

[Neil O’Brien]

We will set out our plans extremely shortly on the future of the workforce and on growing training places. I am sure we will look closely and with great interest at individual proposals such as the one that the hon. Member has just made.

Not just in the south-west, but in the entirety of England, we are looking to improve and build on the NHS service that is so vital to all of our constituents. It is a personal passion of mine, and we are working at pace on it. We know it needs to improve. We have had good ideas coming from Members across the House this afternoon, and we will try to put them in place as soon as we can.

Healthcare Services: Carshalton and Wallington

Neil O'Brien Excerpts

Tuesday 23rd May 2023 Westminster Hall

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

I thank my hon. Friend the Member for Carshalton and Wallington (Elliot Colburn) for securing this important debate, and I pay tribute to him for his incredible campaigning work over the years. He has been relentless, like an unstoppable force. I hope that we will reach an announcement in the near future, so that all the Ministers’ phones can recover and all my hon. Friend’s hard work in campaigning for the hospital he was born in will pay off. I know how important the issue is to him on many different levels.

Today’s debate is well timed in one sense, and badly timed in another, in so far as we are hopefully coming towards a decision and an announcement in the very near future. It might be slightly frustrating for my hon. Friend that I cannot say more today, but I will set the scene on where we are with the new hospital programme. As he knows, we are working closely with the Epsom and St Helier University Hospitals NHS Trust on its plans for a new specialist emergency care hospital in Sutton. Acute services are to remain at the current Epsom and St Helier Hospitals, which is a key point that my hon. Friend has called for.

The plan is part of our wider programme to build 40 new hospitals. All the schemes within that programme are being grouped into cohorts, based on their readiness to progress and the extent to which they can realise the benefits of the national programme approach. The Epsom and St Helier scheme is a cohort 3 pathfinder scheme, which means it will be one of the very first of the larger and more complex schemes to be taken forward in line with the national programme approach.

The programme has developed an integrated systems approach known as Hospital 2.0, which spans the whole hospital lifecycle from business case and design through to construction, commission and handover. The use of Hospital 2.0 is the vehicle through which the national programme approach can ensure that we get the maximum value for taxpayers’ money and deliver more efficient and effective designs for hospitals. Our Hospital 2.0 process will drive efficiencies of about 25% when compared with traditional means of delivering infrastructure. The trust is at the outline business case stage, and we are working very closely with it to incorporate that national, standardised approach.

To date, the trust has received £20.5 million in public dividend capital to progress its scheme. That includes fees for design works and a contribution towards the costs of a new electronic patient record system. Further allocations for the scheme, including the total individual allocation, will be decided through the proper business case process. That will ensure that it is deliverable, is aligned with the national programme and delivers value for money for taxpayers in my hon. Friend’s constituency.

We are planning a range of events and communication about the decisions that we will make on this matter in the near future. I am sure that my hon. Friend will be the first to engage with us on those. It is perhaps frustrating that I cannot say more today, but I pay tribute to my hon. Friend’s incredible work in making the case and, in fairness, helping his local NHS to make the case for the investment that he is calling for.

My hon. Friend touched on general practice, and I absolutely recognise the pressures that on general practice during and after the pandemic. That is why, on 9 May, we launched our primary care recovery plan. It is designed to tackle, as my hon. Friend said, the “8 am rush” for appointments, which is not good enough. Just this week, we delivered, ahead of schedule, on our manifesto commitment to put 26,000 additional staff into general practice. We said that we would get 26,000 by next March; in fact, we have now delivered 29,000—well ahead of schedule. Of course, as well as those extra clinicians, such as physiotherapists, pharmacists and paramedics—all those extra people in the wider team that we now have in general practice—we are taking action to retain our invaluable experienced GPs. That is why we have made significant reforms to GPs’ pensions, lifting 8,900 GPs out of annual tax charges and helping to retain invaluable GPs.

As part of the primary care recovery plan, and as my hon. Friend noted, we are investing £240 million in new technologies for general practice—both up-to-date phones, so that no one ever calls and gets an engaged tone, and good, high-quality online systems, so that people, particularly those who are older or who find it more difficult to use the internet, can always navigate their way through it simply. What we find when the systems have been deployed well is that a very large number of people start to use them—they are very convenient and well designed—and that takes the pressure off the phones so that it is much easier, for those who do want to use the phone, to get through. That is another significant investment.

Of course, on top of that, we are investing £645 million over the next two years in the new NHS service, Pharmacy First, which will also take pressure off GPs, because it will enable people to go to their community pharmacy—often, in a very convenient place on the high street or in people’s neighbourhoods—to get treatment for a range of common conditions. For the first time, a pharmacist will be able to supply a range of antibiotics and directly take pressure off GPs by enabling people to get the treatment that they need in a convenient way.

My hon. Friend also touched on dentistry, where we have started to take action but we know we have to do more. Our dentistry plan will follow, I hope, hot on the heels of the primary care recovery plan. We have already started to reform the problematic 2006 contract that the last Labour Government put in. We have allowed dentists to go to 110% of their normal delivery, so that those who want to do more NHS work can. We have started to make NHS work more attractive by better matching the payments that dentists get to the costs of the work that they are doing. We have brought in minimum UDA rates, minimum rates of payment to support dentists where their rates, historically set, have been very low. That is starting to have an effect. In the year to March, dentists saw about a fifth more NHS patients than they had in the year before, but we know that we have to go further—it is not good enough at the moment—and we will produce a radical dentistry plan in the very near future.

I again thank my hon. Friend the Member for Carshalton and Wallington for bringing all these issues to my attention and to the attention of every other Minister in the DHSC. I hope that he will feel that his hard work over a very long period on behalf of his local NHS and the hospital that he was born in will be rewarded, and I hope that we will be able to say more about that very shortly.

Question put and agreed to.

Cost of Living: Healthy Start Scheme

Neil O'Brien Excerpts

Tuesday 23rd May 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 Twigg. I am grateful to the hon. Member for Stretford and Urmston (Andrew Western) for securing this debate and to the other Members who have participated. The hon. Member for Strangford (Jim Shannon) made a typically compassionate speech.

The Russian invasion of Ukraine has had a global impact. We have seen a rise in inflation, with increased food costs and higher energy prices, and that has impacted on the cost of living. The challenge of the increase in the cost of living is felt by everyone across the country. The Government understand and recognise the challenges that many face as a result of the huge increase in inflation.

The Government have taken, and will continue to take, decisive action to support people with the cost of living. In response to higher food costs, the Department for Environment, Food and Rural Affairs continues to work with food retailers and producers on ways to ensure the availability of affordable food—for example, by maintaining value ranges, price matching and price freezing measures.

In response to higher energy prices, the Department for Business, Energy and Industrial Strategy put in place the energy price guarantee to shield households from the unprecedented rises in energy prices. The guarantee will run until April 2024, and the Government are working with consumer groups and industry to explore the best approach to consumer protections from April 2024 onwards, as part of wider retail market reforms. As set out in the energy security plan, we intend to consult on those options this summer.

In response to the higher cost of living more generally, the Department for Work and Pensions is providing up to £900 in three lump sums for households on eligible means-tested benefits, a separate £300 payment for pensioner households and a £150 payment for individuals in receipt of eligible disability benefits. From this April, the Government have uprated benefit rates and state pensions by 10.1%. In order to increase the number of households who can benefit from those uprating decisions, the benefit cap levels were also increased by the same amount.

Also from this April, the national living wage that this Government introduced increased by 9.7% to £10.42 an hour for workers aged 23 and over. That is the largest ever cash increase for the national living wage. For those who require extra support, the Government are providing an additional £1 billion of funding, including Barnett impact, to enable the extension of the household support fund in England this financial year. That is on top of what we have provided since October 2021, bringing the total funding up to £2.6 billion. This is used by local authorities to help households with the cost of essentials.

[Alison Thewliss]

It is interesting to hear about all the things that were uprated with inflation. Will the Minister explain why Healthy Start was excluded from that?

[Neil O'Brien]

If I can just complete the thought, the total cost of living support that the Government have provided is worth more than £94 billion across 2022-23 and 2023-24. That is, on average, more than £3,300 per UK household. It is one of the most generous support packages for the cost of living anywhere in Europe.

I turn to the critical role that the Healthy Start scheme plays in supporting hundreds of thousands of lower-income families across the country. Eating a healthy, balanced diet, in line with “The Eatwell Guide”, can help to prevent diet-related disease. It ensures that we get the right energy and nutrients needed for good health and to maintain a healthy weight throughout life. The Healthy Start scheme is one way that the Government continue to target nutritional support at the families who need it most, which is increasingly important in view of the cost of living.

Healthy Start is a passported benefit, one of a range of additional sources of help and support that the Government provide to families on benefits and tax credits. It is a statutory scheme that helps to encourage a healthy diet for pregnant women, babies and young children under four from lower-income households. Women who are at least 10 weeks pregnant and families with a child under four years old are eligible for the scheme if they claim: income support; income-based jobseeker’s allowance; child tax credit, if they have an annual family income of £16,190 or less; universal credit, if they have a family take-home pay of £408 or less a month; or pension credit. Pregnant women on income-related employment and support allowance are also eligible for the scheme.

Anyone under 18 who is pregnant is eligible for Healthy Start, regardless of whether they receive benefits. Following the birth of their child, they must meet the benefit criteria to continue receiving Healthy Start. The scheme offers financial support towards buying fresh, frozen or tinned fruit and vegetables, fresh, dried and tinned pulses, plain cow’s milk and infant formula. Beneficiaries are also eligible for free Healthy Start vitamins.

In April 2021, as has been mentioned, we increased the value of Healthy Start by 37%, from £3.10 per week to £4.25 per week. Unlike the Scottish Government’s scheme, which is for the under-threes, Healthy Start is for the under-fours. Pregnant women and children aged over one and under four each receive £4.25 a week, and children aged under one each receive £8.50 a week—twice as much. For a family with a six-month-old and a three-year-old, that is £12.75 a week to help towards buying nutritious foods. That comes on top of the benefits and all the other measures, such as the increase in the national living wage, that I mentioned.

[Andrew Gwynne]

I am grateful to the Minister for rattling off the sums. To go back to the point that the hon. Member for Glasgow Central (Alison Thewliss) made about the Healthy Start grant and why the Government chose not to uprate it, will he share with the House what the cost to the Exchequer would have been to uprate it? That must have been part of their deliberations as to why not to do it. What is the cost?

[Neil O'Brien]

We have chosen to spend over £3,300 per UK household, on average, on the cost of living support. Putting that into the schemes that are available and targeted at people with low incomes, and indeed at the entire population, is the choice that we have made. To reiterate my earlier point, and since the hon. Member says that I am rattling off the figures, it is worth stressing that we have invested £3,300 per household—a colossal sum of money. That is unprecedented. There has never been a cost of living intervention anywhere of that magnitude, so that must be an important part of the discussion about Healthy Start.

[Alison Thewliss]

Will the Minister give way?

[Neil O'Brien]

I will continue with my points and perhaps come back to the hon. Lady in a moment.

Healthy Start is delivered by the NHS Business Services Authority on behalf of the Department. Following user research and testing by the Department and NHSBSA, the scheme, as various Members have mentioned, was switched from being paper-based to a digitised service to increase uptake and usability. We have introduced an online application to replace the previous paper-based application form and a prepaid card to replace paper vouchers. The digitised scheme opened to the public for the first time in September 2021. The online application provides an instant decision for many families. The prepaid card can be used in any retailer that sells Healthy Start foods and accepts Mastercard.

I am pleased to see that the number of new families joining the scheme continues to grow following the introduction of the prepaid card. Since September 2021, there have been more than 500,000 successful applications, with 48% coming from new families. The scheme now supports more than 375,000 families on lower incomes, and that continues to grow month on month. The current uptake is 64.6%, which is higher than the paper scheme, which had a 59.9% uptake in August 2021.

The hon. Member for Stretford and Urmston asked whether we published the figures on eligibility. Yes, the total number of eligible and entitled beneficiaries are published on the NHS Healthy Start website and are broken down by local authority.

[Alison Thewliss]

Will the Minister give way?

[Neil O'Brien]

If this is on the point about data.

[Alison Thewliss]

The Minister is making an interesting point about the uptake, but can he account for why things are so much better in Scotland, where the uptake of Best Start Foods sits at 88%?

[Neil O'Brien]

The schemes are not completely comparable because the Healthy Start scheme covers a wider base of people, as I mentioned. It goes up to age four rather than age three, so it has a wider field of benefit than the Scottish scheme. That may be part of the story, but there could be other reasons, and there may be important things that we can learn from the Scottish scheme. I am always keen to have those discussions.

To increase take-up, NHSBSA actively promotes Healthy Start through its digital channels and has created free toolkits to support stakeholders to do so. NHSBSA uses a range of communications activities to engage parents, pregnant women and healthcare professionals to help to raise awareness of the scheme. NHSBSA has attended Maternity & Midwifery Forum events and placed advertisements in the Bounty packs, which many people receive when they have children, and the “You and your pregnancy” magazine, which is given to pregnant women in the first trimester.

We constantly review the materials produced for the Healthy Start scheme to ensure that communications reach those who need support the most. That is why, following user research by NHSBSA, promotional material was translated into the top five languages spoken by Healthy Start families, to reach a wider demographic. NHSBSA continues to engage with national and local stakeholders to improve the delivery of the scheme and increase the uptake.

Healthy Start is an important part of the support provided by the Government, but it is only one aspect of the support available for families. We are funding 75 English local authorities with high levels of deprivation to ensure that parents and carers can access Start for Life services locally. The healthy child programme is a universal offer across all 150 local authority areas—led by health visitors and school nurses—that supports families from the antenatal period up to school entry. The nursery milk scheme provides reimbursement to childcare providers for a daily third of a pint portion of milk to children and babies. The school fruit and vegetable scheme provides around 2.2 million children in key stage 1 with a portion of fresh fruit or vegetables each day at school, and 419 million pieces of fruit and vegetables were distributed to children in 2022-23.

The Government have extended free school meals eligibility several times and to more groups of children than any other Government over the past half a century, including the introduction of universal infant free school meals and further education free meals. Under the benefits-based criteria, 1.9 million of the most disadvantaged pupils are eligible for and are claiming a free school meal. That saves families around £400 per year. To make it easier for families to find support, the Government also created an online resource so that families can easily check what help is available to them.

At a time when families need support, and with the cost of living increasing, the Government are committed to helping as many families as possible to access the Healthy Start scheme, as well as all those other schemes, to help those most in need.

Health Services: Wantage and Didcot

Neil O'Brien Excerpts

Thursday 18th May 2023 Commons Chamber

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

I congratulate my hon. Friend the Member for Wantage (David Johnston) on securing this important debate. He mentioned in his remarks that there are limits on what he is allowed to say in this Chamber about certain aspects, particularly about how we marry up new housing with new GP surgeries, but none of us in Government are in any way strangers to his very strong views on the subject. The amount of work and campaigning that he has done on this issue is formidable, and I pay tribute to him for that.

I recognise the struggles that my hon. Friend’s constituents have reported in his survey in getting an appointment with their GP or dentist. Despite the efforts of general practice teams, who are now delivering something in the order of 10% more appointments every month than they were pre-pandemic—that is the equivalent of about 20 more appointments per working day, per surgery—demand is rising. We have about 30% more people over the age of 70 than we did in 2010. Those people tend to have about five times more appointments than younger people. Therefore, because of the ageing society and the effects of the pandemic, demand is rising. That is why we have listened and why we have taken action, including just last week publishing our primary care recovery plan to address some of these concerns.

Our plan is ambitious and it will modernise access to general practice—effectively the front door of our NHS. We want to end the 8 am rush for appointments and ensure that patients know how their requests will be handled the first time they contact their practice. To achieve that, we are investing the equivalent of £6,000 per practice to provide new technology, including modern digital phone systems so that people do not get engaged tones, and easier digital access so that many more issues can be dealt with online at a convenient time for the patient, which will free up phone lines for those who do need to call so that they always get through easily.

As my hon. Friend mentioned, we are expanding the role of community pharmacies in delivering primary care and investing up to £645 million to enable pharmacists to provide treatment for common conditions. Pharmacists will be able to supply prescription-only medicines and start courses of oral contraception for the first time. That will provide more choice for patients and be a convenient way of getting treated. It will also reduce the pressure on general practices, freeing up something in the order of 10 million appointments a year, again making it easier for my hon. Friend’s constituents to get through. We have started consulting the Pharmaceutical Services Negotiating Committee, with a view to introducing the new service by the end of the year.

We are continuing to cut bureaucracy to reduce the time that GPs have to spend on work that is not work that they need to be doing. The plan frees up approximately £37,000 per practice by cutting back targets and improving communication between GPs and hospitals—something that has been raised with me many times by GPs. Of course, we still need to deliver more appointments and, to do that, we need more staff. I am pleased to say that today, we have managed to deliver, ahead of schedule, our manifesto commitment to recruit 26,000 additional staff into general practice. Those extra staff are helping to deliver the 50 million extra appointments that we promised by March 2024. It is through both the additional staff that we have invested in and the very hard work of general practice teams, to whom I pay tribute, that they are already delivering 10% more appointments compared with 2019.

The recruitment and retention of general practitioners remains a big priority for us, including the retention of our wonderful experienced general practitioners. That is why we are helping to retain senior GPs by reforming pension rules—the No. 1 thing that the profession was asking us for—and lifting about 8,900 GPs out of annual tax charges.

My hon. Friend quite rightly raised some specific concerns about the provision of adequate services to meet the needs of new housing developments—something that is an issue in particularly desirable and fast-growing areas like that of my hon. Friend. I am very seized of this crucial issue, and we are working on it in real time.

Last week we announced that, as part of the GP plan, we would be making a series of reforms through the national planning policy framework and planning guidance changes to ensure that new housing always comes with the GP surgeries that are needed. That means changing the NPPF and planning guidance and, even before that, updating the planning obligations guidance to ensure that local planning authorities address primary care infrastructure, just as they do other infra- structure demands such as education.

On top of that, the Government will update guidance to encourage local planning authorities to engage with the local NHS—the local integrated care boards—on large sites that might create the need for extra primary care capacity. My hope is that a bigger chunk of the £7 billion a year that we are raising from housing developers will flow into new primary care facilities.

As my hon. Friend mentioned, local authorities have an unavoidable and crucial role in enforcing the delivery of the commitments that developers make and in ensuring, as they make and enforce their local plans, that what was promised is delivered. Wherever new development is planned, they must plan for the infrastructure that is needed alongside it. That is something local authorities absolutely must deliver for their constituents, and I am sorry to hear that there seems to be some trouble with that in his constituency.

My hon. Friend also mentioned challenges with dentistry; we are working on that very actively and will be publishing our plan for dentistry shortly. The reforms we made some months ago to enable dentists to do more—about 110% of their contracted work—and to split up the bands so that they are paid more fairly for the NHS work they do have been received well by the profession. About a fifth more people were seen by NHS dentists in the year to March compared with a year earlier, so we are starting to make progress, but we know there is more to do. To answer his question, I want to reassure him that we will be publishing our dentistry plan very shortly.

I thank my hon. Friend not just for his thoughtful speech today, but for all the work he has done to campaign on this issue ever since he was elected. He always makes a powerful case, both in the Chamber and behind the scenes, and he has many thoughtful ideas that are already influencing Government policy. I pay tribute to him for his work and I hope his constituents will soon see positive changes as part of our recovery plan.

Question put and agreed to.