Cass Review

Paul Bristow Excerpts

Monday 15th April 2024 Commons Chamber

[Victoria Atkins]

I thank the hon. Lady, who has an exemplary record of campaigning on this issue. This comes down to the very careful review by Dr Cass. We have to get away from the idea that if a child presents with gender distress, that is the only part of their health that we should care about and look into. We have to look across the board to ensure that we look after every single part of them and do not assume that medical pathways are the only and inevitable pathways for them. One of the concerns raised in the report is that the terrible mental health issues that many children and young people were suffering from were not being looked after. People were just put on drugs and expected to get on with it. That is wrong, and we are determined to change it.

[Paul Bristow (Peterborough) (Con)]

What was the Secretary of State’s reaction to the news that almost all gender clinics refused to co-operate with the Cass review? Does she agree that this is too important an issue for a circle-the-wagons attitude? What can she do to ensure that Government guidance is followed to the letter, and in spirit, when we tackle a gender ideology that seems to be running rampant through our public institutions?

[Victoria Atkins]

This is not about my emotions, but I can tell my hon. Friend that I was disgusted and angry. What is more, this is about being able to have conversations in our public space. For example, if our public institutions—whether it is the NHS, schools or whatever—are asked to respond to a thoughtful and careful review such as the Cass report, they must do so, because this information does not belong to them; it belongs to their patients, to future patients—because we want to shape services to help them—and to us as a nation. I welcome such institutions’ about-turn in deciding that they will provide the data. I am pleased that has happened, but my goodness me, I wish they had done it earlier.

Oral Answers to Questions

Paul Bristow Excerpts

Tuesday 5th March 2024 Commons Chamber

[Paul Bristow (Peterborough) (Con)]

I remind Members of my entry in the Register of Members’ Financial Interests. The Medicines and Healthcare products Regulatory Agency’s international recognition procedure will ensure faster access to innovative treatments, but it will realise its full potential only if it is matched by the National Institute for Health and Care Excellence’s evaluation process. What is my right hon. Friend the Minister doing to ensure that the two processes are aligned?

[Andrew Stephenson]

My hon. Friend will be aware that there have been delays with approvals by the MHRA and NICE. We are keen to ensure that those delays are reduced, and I am delighted to tell the House that significant progress has been made in both organisations. I am happy to work with my hon. Friend and both organisations to ensure that progress continues to be made.

Health and Social Care

Paul Bristow Excerpts

Friday 23rd February 2024 Ministerial Corrections

The following is an extract from Health and Social Care Questions on Tuesday 23 January 2024.

[Paul Bristow (Peterborough) (Con)]

For new patients, accessing an NHS dentist in Peterborough is almost impossible. Should a new medical centre wish to establish a new NHS dental practice, doing so would require flexibility in units of dental activity rates and the ability to recruit dentists from overseas. Would the Minister give that effort her enthusiastic support and encourage NHS bosses to do the same?

[Dame Andrea Leadsom]

My hon. Friend is pushing against an open door. He may be aware that in 2023 we made some legislative changes to give the General Dental Council more flexibility to expand the registration options open to international dentists, tripling the capacity of three sittings of the overseas registration exam from August 2023 and increasing the number of sittings for the part 2 exam in 2024 from three to four.

[Official Report, 23 January 2024, Vol. 744, c. 133.]

Letter of correction from the Under-Secretary of State for Health and Social Care, the right hon. Member for South Northamptonshire (Dame Andrea Leadsom):

An error has been identified in my response to my hon. Friend the Member for Peterborough (Paul Bristow).

The correct information should have been:

NHS Dentistry: Recovery and Reform

Paul Bristow Excerpts

Wednesday 7th February 2024 Commons Chamber

[Victoria Atkins]

The dental recovery plan sets out immediate-term, medium-term and long-term plans. In the immediate term, we have the new patient premium that will be live from next month, the increase in UDA value to £28 and the golden hellos that I have described to under-served parts of the country. There is a batch of measures throughout the plan to address the concerns from colleagues across the House.

[Paul Bristow (Peterborough) (Con)]

I have a plan to open a brand-new NHS dentistry practice in Peterborough. New financial incentives, increased UDA rates and recruitment of overseas dentists to Peterborough are all part of that plan. Will my right hon. Friend meet me and those who want to open new NHS dental clinics in Peterborough, so that we can take advantage of every part of her excellent plan?

[Victoria Atkins]

I commend my hon. Friend for his excellent work as a constituency MP. It is exactly that sort of drive and ambition that will deliver results for his constituents. I would be delighted to meet him to discuss his plans, and I am pleased that our national dental recovery plan will fit well with his own local delivery plan.

Pharmacy First

Paul Bristow Excerpts

Wednesday 31st January 2024 Commons Chamber

[Dame Andrea Leadsom]

I am always happy to meet my hon. Friend. Just to let her know, 100 pharmacies in Cornwall are signed up to Pharmacy First.

[Paul Bristow (Peterborough) (Con)]

This brilliant announcement has the potential to free up many thousands of GP places in areas such as Peterborough, but the initiative will be the success that we need it to be only if more people know about. My right hon. Friend touched on an awareness campaign, but what efforts will she make to ensure that it reaches difficult-to-reach communities, such as those for whom English is an additional language?

[Dame Andrea Leadsom]

There will be a big communications plan, which I am happy to share with my hon. Friend. Well over 100 community pharmacies in his area have signed up to Pharmacy First, which is brilliant news. It is incumbent on us all—and the purpose of the statement—to ensure that our constituents know about this excellent new service.

Oral Answers to Questions

Paul Bristow Excerpts

Tuesday 23rd January 2024 Commons Chamber

[Dame Andrea Leadsom]

As I said to the hon. Member for Oxford West and Abingdon (Layla Moran), I absolutely understand the challenge for some people. The situation has improved over the last year. Since the covid pandemic, where almost every dentist had to stop working altogether, we have not seen the recovery we want. We are putting in plans—not a paper ambition like the one Labour has put forward, but significant reforms that will enable many more people to be seen by NHS dentists. I say gently to the hon. Member for York Central (Rachael Maskell) that a recent Health Service Journal article states that Humber and North Yorkshire ICB

“have indicated in board papers that dentistry funding will be squeezed to help them balance their books.”

I encourage her to talk to her ICB about that too.

[Paul Bristow (Peterborough) (Con)]

For new patients, accessing an NHS dentist in Peterborough is almost impossible. Should a new medical centre wish to establish a new NHS dental practice, doing so would require flexibility in units of dental activity rates and the ability to recruit dentists from overseas. Would the Minister give that effort her enthusiastic support and encourage NHS bosses to do the same?

[Dame Andrea Leadsom]

My hon. Friend is pushing against an open door. He may be aware that in 2023 we made some legislative changes to give the General Dental Council more flexibility to expand the registration options open to international dentists, tripling the capacity of three sittings of the overseas registration exam from August 2023 and increasing the number of sittings for the part 2 exam in 2024 from three to four. That will create an additional 1,300 places overall for overseas dentists aiming to work in the UK. We will also be bringing forward measures to enable dental therapists to work at the top of their training, which will expand the capacity. He is right that reform of the UDA is also required and we will be bringing forward our plans shortly.

Building an NHS Fit for the Future

Paul Bristow Excerpts

Monday 13th November 2023 Commons Chamber

[Paul Bristow (Peterborough) (Con)]

It is a great pleasure to speak in this debate following the first King’s Speech in more than 70 years. I refer the House to my entry in the Register of Members’ Financial Interests.

The debate is entitled, “Building an NHS fit for the future”. In my view, we face no bigger public policy challenge. To build an NHS fit for the future and make the right financial choices, we need to get a grip on how much we spend. Money alone does not provide improved outcomes for patients; the investment we make—or, in other words, our spending—needs to deliver value. The NHS is not cheap, and it is certainly not free: it costs around £180 billion, or £2,700 per person, a year. The NHS is not underfunded, but workforce challenges, escalating costs and an increasing level of non-clinical activities are putting a strain on it. We need to debate how that money is spent, and I want to contribute by highlighting three areas.

First, I will address procurement. “Value-based procurement” is a term that has been used in the NHS for many years—it is not new. Whether or not we use that term, it is clear that the tariff, and other systems and culture, need to change to embed value into the system. What do I mean? Well, we need a transactional relationship in our NHS that goes way beyond the simple purchase of a commodity or a technology. We need long-term relationships between suppliers and our NHS that deliver better outcomes for patients and good value for money for the taxpayer. That requires a cultural change among procurement leads, yes, but for others as well.

As well as that partnership approach, savings need to be made across the whole treatment pathway—from referral to discharge—rather than just on the acquisition of an individual commodity or therapy. Pathway change is required, and “We have always done it this way” can no longer be the answer. Trust leaders should be told what is expected of them in that regard, and then they can flow that cultural change throughout the entire organisation. That should be exciting and rewarding for NHS staff, managers and teams. We need mechanisms and systems that not only incentivise that, but insist on payment and tariff systems focused on reducing expensive overnight hospital stays, prioritising day cases, early diagnosis and referral, and putting patient outcomes at the centre of things.

Secondly, I will address innovation. Recently, I accompanied Health and Social Care Committee colleagues on a trip to Singapore, where we saw how digital technology and artificial intelligence can transform efforts to tackle cancer. The Committee is conducting a future cancer inquiry. There was a rather amusing moment—I found it amusing, anyway; others might not—when I asked a couple of questions about the inspiration for that approach and about the regulatory and reimbursement models for technology. It was clear to us all that the inspiration for the approach was actually the UK, especially the 100,000 Genomes Project and the Galleri test from Grail. On regulatory and reimbursement models, we were given a presentation that looked almost exactly like NICE—I have sat through numerous presentations on NICE, reimbursement and all that, so one more would not make any difference. Obviously, Singapore has different funding models for its healthcare system, but how it judges whether something is cost effective looks remarkably similar to NICE.

Although some of our systems, and our clinical research, are admired around the world—about which we can rightly be proud—we need to be flexible to allow those innovations to be effectively reimbursed. There is still no specific tariff for digital technologies, but one is vital if we are to adopt such technology at pace and scale. We must not lose the advances and potential that AI could have for patient outcomes and diagnosis simply because there is no effective way of assessing, reimbursing and embedding the technology in the NHS. The technology can and should make it easier for the NHS to save money, and we must learn how to pay for it.

Finally, we need to end the one-year NHS funding cycle. Muti-year financial settlements—or funding arrangements that reward outcomes rather than activity—need to be embedded across the whole system, including at trust and ICB level. That will save money, and we must move it forward. In-year savings incentivise only short-term cost gains. The drastic change needed to embed innovation and new pathways that focus on patient outcomes, and to generate savings by doing things differently, is possible only by changing single-year funding models.

We want those innovations to be a must-have, not a nice-to-have. Time and again, innovation has dried up when the one-off funding pot has ended. I could bore the House with countless examples of that—hon. Members will be pleased to hear that I will not, but they will be familiar with what I am saying. It is the same in any big bureaucracy, be it the NHS or local government: short-term decision making, cost escalation, cultural resistance to change, and innovation treated as a nice-to-have. We cannot go on like this; we must move on from that system. We cannot have a situation in which other countries take inspiration from us in research and technology but do it much better, while we remain in an analogue age not because of a lack of ambition, but because our system does not embrace ways to spread those things at pace and scale.

Oral Answers to Questions

Paul Bristow Excerpts

Tuesday 11th July 2023 Commons Chamber

[Will Quince]

I thank the hon. Lady for her question, and I am sorry to hear of the experience of her three constituents. There certainly is hope within the long-term workforce plan. As she rightly alludes to, we are reliant on researchers to submit high-quality research proposals, and that requires clinicians specialising in this area. It is something I take very seriously, and I would be very happy to work with her on it.

[Paul Bristow (Peterborough) (Con)]

I refer Members to my entry in the Register of Members’ Financial Interests.

My father, the late Alan Bristow, died of a brain tumour in April 2020. He was 77, and that was incredibly sad, but when a child dies of a brain tumour, it is unbelievably wicked. Brain tumours are still the biggest killer of young people. What can the Minister do to ensure that appropriate funding is being put into research into brain tumours, especially for younger people, and when will the Government respond to the O’Shaughnessy review into clinical trials in the UK, which would help the brain tumour community?

[Will Quince]

I thank my hon. Friend for his question, and I am sorry to hear of his own personal experience. He is absolutely right that, in relation to children, I am very keen to find a way forward. The Government are committed to finding high-quality brain cancer research, and we expect to spend more as new research progresses. The £40 million of funding announced will remain available, and if we can spend more on the best-quality science, we will do so. We worked really closely with Lord O’Shaughnessy on his review, we have accepted his recommendations and we have put in £121 million to support it.

Oral Answers to Questions

Paul Bristow Excerpts

Tuesday 6th June 2023 Commons Chamber

[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.

Recovering Access to Primary Care

Paul Bristow Excerpts

Tuesday 9th May 2023 Commons Chamber

[Steve Barclay]

There is funding in other parts of the Department’s budget, not least for tech innovation and the work we are doing on artificial intelligence. There is further scope to use AI in demand management, for example to relieve pressure on GPs by looking at changes in the behaviour of frail or elderly patients and picking up changes early. The use of AI presents a significant opportunity. There are questions about how we can use data better; indeed, there are challenges for those across the House in how we can use data better to manage pressure within primary care. So there is funding elsewhere in the Department’s budget, in addition to what I have announced here.

[Paul Bristow (Peterborough) (Con)]

I am pleased to inform the House that my mother has moved in with my wife and me, from the Secretary of State’s constituency. One of the joys of living with my mother is helping her with Tesco orders and Amazon deliveries and with surfing what she calls the interweb, and I am looking forward to helping her with the new NHS app. Does my right hon. Friend agree with me that enabling many more people to use the NHS app, including Mrs Bristow, and having many more services available on the NHS app is more convenient for patients and will free up GP time, so that GPs can do what they should be doing?

[Steve Barclay]

I am happy to recognise the scope for Mrs Bristow and many others to make more use of the NHS app. That app is all about empowering the patient and enabling them to get the right care, in the right place, at the right time, whether from a pharmacist, one of the additional primary care roles we are creating or a GP where applicable. The NHS app can free primary care practices from many of the tasks that are currently placed on them, such as people phoning for their records or repeat prescriptions. It is a key part of streamlining such tasks.