Agenda for Change: NHS Pay Restraint

Philip Hollobone Excerpts

Monday 30th January 2017 Westminster Hall

[Catherine McKinnell]

My right hon. Friend makes an important point. There was a two-year pay freeze from 2011-12 and a 1% increase in 2013-14 and 2014-15, followed by confirmation in the Budget of summer 2015 that the Government would fund an average public sector pay award of only 1% for the four years from 2016-17. As has been pointed out, the Government decided to reject the independent NHS Pay Review Body’s recommendation of a further 1% uplift to all pay scales from 2014-15, stating that there would be an annual increase of at least 1% for Agenda for Change staff in England through either contractual incremental pay or a non-consolidated payment.

[Mr Philip Hollobone (Kettering) (Con)]

I congratulate the hon. Lady on her excellent speech, which I am following closely. Is there not very thin moral justification for the Government rejecting the review of an independent pay body when each of us as MPs has our pay independently assessed and awarded? I can see no justification for saying to hard-working nurses in Kettering, “You can’t have the pay rise that an independent pay body said you should have” when I, as an MP, automatically get a pay rise awarded by our independent body.

CQC: NHS Deaths Review

Philip Hollobone Excerpts

Tuesday 13th December 2016 Commons Chamber

[Mr Hunt]

It is a difficult one, because access to lawyers is a matter for the Ministry of Justice. I am not trying to duck the issue, but my responsibility, in what we are trying to do today, is to try to make sure that families do not feel as though they need to go to lawyers, because the NHS is open and transparent enough. With the values of people in the NHS, I think that ought to be achievable. I am happy to look at the case that she raises, and to bring it up with my colleague the Lord Chancellor.

[Mr Philip Hollobone (Kettering) (Con)]

Will the Secretary of State tell the House more about the healthcare safety investigation branch? How big will it be, who will head it up, where will it be based and how will it use its forensic detective work locally to get to the nitty gritty of the things that cause problems for hospitals?

[Mr Hunt]

I am happy to do that. The best way to understand what we are trying to achieve—this relates to what the right hon. Member for North Norfolk (Norman Lamb) said earlier about the speed of investigation—is to think about the tragedy of the recent Croydon tram crash. Within one week of the accident, the rail accident investigation branch produced and published a full investigation into exactly what happened, which made it possible to transmit that learning around the whole tram industry. That is what we are looking for. We have modelled the healthcare safety investigation branch on what happens in the transport industry. It has already been set up, and we are lucky that the person heading it up is Keith Conradi, who headed up the air accident investigation branch and knows exactly how these things should happen.

Oral Answers to Questions

Philip Hollobone Excerpts

Tuesday 15th November 2016 Commons Chamber

[Mr Philip Hollobone (Kettering) (Con)]

Kettering general hospital would be better able to deal with winter pressures were it given permission to develop its urgent care hub. The hospital tells me that its application has been with NHS Improvement for nine months now. Will the Minister prod NHS Improvement to get a move on in approving this application?

[Mr Dunne]

My hon. Friend held an Adjournment debate recently which I was pleased to respond to. We discussed the status of Kettering general hospital and the foundation trust that runs it. He is correct that it is discussing with NHS Improvement the development of a business case for an urgent care hub, and this is being considered in the context of the wider sustainability and transformation plan. Mr Speaker, I accept your admonishment in respect of my answer to the previous question. Of course, one of the primary solutions to winter excess deaths is the flu vaccination programme.

NHS Funding

Philip Hollobone Excerpts

Monday 31st October 2016 Commons Chamber

[Mr Speaker]

Order. Understandably, there is extensive interest in this subject. Accommodating anywhere near the number of would-be contributors will require brevity, to be exemplified—I hope and if he is true to form—by Mr Philip Hollobone.

[Mr Philip Hollobone (Kettering) (Con)]

People in Kettering appreciate plain speaking. Can the Health Secretary tell the House what the NHS budget was in 2014-15, what it will be in 2020-21 and what the difference is between the two numbers?

[Mr Hunt]

I want to get the exact figures in order to live up to my hon. Friend’s reputation for plain speaking, which is second to none. The NHS budget in 2014-15 will be £98.1 billion and in 2021 it will go up to £119.9 billion. In real terms, that is a £10 billion increase.

Kettering General Hospital

Philip Hollobone Excerpts

Friday 21st October 2016 Commons Chamber

[Mr Philip Hollobone (Kettering) (Con)]

I wish to draw the Minister’s attention, on behalf of my constituents, to the good work that Kettering general hospital does for the local community, and to the challenges that will confront it in the years ahead. I am grateful to Mr Speaker for granting me permission to open the debate, and I am pleased to see the Minister in his place.

It is a huge privilege for me to be the Member of Parliament for Kettering. I regard Kettering general hospital as one of the pre-eminent issues for all local residents of the town, and I do not hesitate to use every possible parliamentary opportunity to draw the challenges that it faces of the attention of Her Majesty’s Government.

I want to address five main themes: the huge demographic challenge faced by Kettering and its hospital, the challenge posed by ambitious plans for an urgent care hub, which require Government support, the challenge of funding estate development on the hospital site, the problems caused by national IT roll-outs, and the workforce challenges.

People in Kettering are very proud of our local hospital, which has been on its present site for 119 years. Local people have been born there, have been repaired there, and have died there. Everyone is hugely proud of the doctors, nurses and ancillary staff, who do a fantastic job around the clock, day in day out, week in week out, to provide increasingly first-class healthcare for our local community. However, the size of the local community is growing at an unprecedented rate. Over the last census period, Kettering was sixth out of 348 local districts for household growth, and 31st for population growth. The local population is growing at a rate of about 1% a year, but within that, the number of elderly people is growing even faster. Thank goodness we are all living longer, but the number of people aged over 75 in the county of Northamptonshire is likely to rise from just short of 54,000 in 2017 to just short of 72,000 in 2023—and it is members of that cohort who require the most treatment at the hospital and present the biggest challenge.

The good news is that the hospital is raising its game, and is responding. The number of beds was 518 in 2010; it is now 561, having increased by 8%, and is set to increase further to 600 over the next year or so. However, the number of treatments being provided is increasing all the time. In 2004-05, there were 71,300 admitted-patient consultant episodes at the hospital; that rose to just under 91,000 in 2014-15, an increase of 27%. The number of out-patient attendances rose from 168,412 in 2004-05 to 274,614 in 2014-15, an increase of 63%. The accident and emergency figures show a 23% increase from 67,500 in 2010-11 to 83,000 now, in an A&E department that was built 20 years ago and designed to treat just 40,000 people. The pressures on the hospital are unprecedented. The funding provided by Her Majesty’s Government to the local clinical commissioning groups through NHS England is going up, but the Government have admitted that it is still short of the target amount.

[Mr Peter Bone (Wellingborough) (Con)]

I congratulate my hon. Friend on securing this important debate. Does he agree that one of the frustrations for the people of north Northamptonshire is that the Government have a formula for how much money we should get but they do not give us that amount because they overfund elsewhere? That frustration is felt across the whole of north Northamptonshire.

[Mr Hollobone]

You will know, Madam Deputy Speaker, that my hon. Friend has a great way of simplifying complex issues to make them readily understandable. His intervention is just another example of that.

NHS England has told Her Majesty’s Government that it is targeting the clinical commissioning groups that are more than 5% above or below the target funding, that both Nene and Corby CCGs are underfunded, and that the cash increase of 5.2% for Nene and 9.4% for Corby in 2016-17 will bring us within that 5% zone. This suggests that we are outside it at the moment. The fact that we are more than 5% away from the target funding and that we have one of the most rapidly increasing populations in the country illustrates the stiff challenge that Kettering general hospital faces.

[Tom Pursglove (Corby) (Con)]

Residents in Corby and elsewhere in east Northamptonshire are proud of their hospital, as are my hon. Friend’s constituents in Kettering. One of the challenges that goes with a growth agenda is the need for new infrastructure to support new homes. Does he agree that the new urgent care hub in north Northamptonshire, which we are all campaigning for, will be crucial not only for securing health services in our area, taking the pressure off A&E and meeting the growing needs of new residents moving into our area, but for meeting the Government’s agenda on the better integration of health services?

[Mr Hollobone]

One of the advantages of working closely with my fellow Members of Parliament is that we begin to read each other’s minds. My hon. Friend’s observation leads me seamlessly on to section 2 of my speech, which is entitled “Urgent care hub”.

In many ways, this is the most exciting challenge that the hospital faces. The idea of an urgent care hub is to have on one site, at Kettering general hospital, a one-stop shop for GP services and out-of-hours care, an on-site pharmacy, a minor injuries unit, facilities for social services and mental health care, access to community care services for the frail elderly and a replacement for the hospital’s A&E department, which, as I have said, is more than 20 years old.

The three local MPs are working hard on this issue but, frankly, we need more support from the Minister. The hospital has drawn up ambitious proposals to develop the urgent care hub, which could cost between £20 million and £30 million. It is exactly the sort of thing that NHS England has highlighted in its “Five Year Forward View” as the way forward, and it enjoyed the support of the previous Minister, my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter). In a debate in Westminster Hall on 24 March 2015, he said:

“The principle of the hub is absolutely the right way forward for the local NHS. It is the type of integrated care model that we need elsewhere in the country, particularly where the NHS is servicing a broad population. In this case, it is servicing not just Kettering, but a partially rural county and rural area. This is a model that I am sure hon. Members will continue to support and that I will continue to have a keen interest in supporting. I hope the plans will be successful at making the improvements that patients in my hon. Friend’s constituency and the area surrounding Kettering want. There are encouraging signs. The improvements envisaged are significant and would ensure that the local area had a resilient and high-quality health care system to deliver the highest-quality patient care.”—[Official Report, 24 March 2015; Vol. 594, c. 440WH.]

Would the Minister be kind enough to visit Kettering general hospital to look at the proposals for an urgent care hub? I am going to be pestering him at every Health questions this Parliament, and it would greatly assist the quality of his answers if he is able to visit the hospital and then speak from a position of knowledge. Kettering general hospital could lead a pioneering development for our country’s NHS.

That brings me to the wider issue of funding for the estate at Kettering general hospital. A small or medium district general hospital such as Kettering, which is on an ageing town-centre site, will inevitably have a great backlog of maintenance and equipment that needs to be replaced every year. The hospital spends something like £10 million to £15 million of capital each year through loans, unhelpfully swelling the balance sheet. The financial pressure on the hospital is clearly huge. The capital programme for next year is largely made up of three items: £5 million on a maintenance backlog; just over £1 million on IT infrastructure; and almost £1.5 million on medical equipment. The Minister needs to make the point to the Chancellor that there is currently no capital support for the strategic transformation plans.

Transforming district general hospitals up and down the country will be difficult. Nevertheless, Kettering general hospital is innovating. It has installed a new modular unit to try to upgrade the A&E, with 13 major bays for complex medical and surgical needs. I remind the Minister that Kettering’s A&E now treats 83,000 patients. It was designed to treat 40,000 and was built 20 years ago. Some £5 million has been spent on a new maternity unit, bringing state-of-the-art maternity services to the hospital, where 3,800 babies are delivered and 2,000 gynaecological and obstetric theatre procedures are carried out every year. Those developments are fantastic, but they are expensive and difficult for the Kettering General Hospital NHS Trust to afford.

My fourth point of five is about the national IT roll-out. Hospitals experience difficulties in complying with necessary advances in linking their IT systems to regional and national services. One example is the problem that local patients have experienced in getting their X-ray results. There is meant to be an integrated east midlands system for X-rays, but Kettering has experienced difficulties, and some delays in getting X-rays to patients have lasted three or four months, which the hospital admits is unacceptable. The Minister needs to be made aware of the IT challenge faced by district general hospitals.

On the workforce, Kettering is succeeding in recruiting staff, which is good news, but there are still vacancies. Of 1,200 nursing posts, 80 remain vacant as of today. Many of the nurses come from Europe and elsewhere. The hospital has recruited 72 European nurses and the good news is that 95% of them have stayed with the trust—the national average retention rate is 28%. On the Minister’s visit to the hospital, he will be able to learn from a good example of how to retain hard-working staff, and he may be able to apply that elsewhere. In Kettering, 61% of people voted to leave the European Union, a fact of which I am hugely proud, but when we negotiate our Brexit terms and conditions, we must make provision to retain key personnel from the EU who bring to our country the skills we need and are unable to find among our own people.

Kettering general is a very good hospital, but it is under a huge amount of pressure. There are things that the Government can do to make it succeed. Along with my hon. Friends the Members for Wellingborough (Mr Bone) and for Corby (Tom Pursglove), I will be on the Minister’s case for the rest of this Parliament to make sure that our hospital works properly and successfully, delivering the local patient care that people need and deserve.

--- Later in debate ---

[Mr Dunne]

My hon. Friend, from a sedentary position, extends an invitation, too. I am grateful to all three hon. Friends. I am relatively newly in post, and the demands at present are to visit hospitals that are in greater difficulty than any of these cases, but I will endeavour to see what I can do during next year possibly to visit Kettering.

[Mr Hollobone]

One visit to all three of us would kill three birds with one stone.

[Mr Dunne]

I have responsibility for the acute sector, not the community sector, so initially my visit would be focused on Kettering hospital. I will certainly do what I can, but I think that it will have to be some time next year. My hon. Friend has previously met my predecessors to discuss health services in his constituency. He has raised a number of issues today, and I will attempt to address most, if not all, of them in the time that I have.

I wish to start with my hon. Friend’s concerns about the underfunding of his local clinical commissioning groups. That was a point also raised by my hon. Friend the Member for Wellingborough. NHS England is working to move CCGs towards their target fair share of funding, but this has to take place at a pace that maintains stability in the system across the country at a time of significant financial challenge. I feel that quite acutely as a local Member of Parliament representing a rural constituency that has been consistently underfunded. We are taking steps, as I mentioned to the House in a debate earlier this week, to look at introducing a fairer share of funding for rural areas and addressing other issues such as social deprivation. A consequence of that has been to try to bring those CCG areas that are recognised to be underfunded closer to the target.

The point was made that Nene and Corby CCGs have been beyond 5% of the target. I am pleased to confirm the figures that were mentioned earlier by my hon. Friend the Member for Kettering: Nene and Corby CCGs received cash increases of 5.2% and 9.4% respectively in the current year. Those increases are significantly above the average for English CCGs and bring them both within 5% of their target allocation in this year. I think that 9.4% is one of the highest increases in allocation that we have seen this year across the country, so I hope that he recognises that we are moving to right that historic challenge. This year, more than £757 million will go into my hon. Friend’s local area, and allocations over the next few years should bring both Nene and Corby CCGs even closer to their funding target.

I will take a moment to touch on the national pressures that are affecting the NHS. The NHS is very busy, but hospitals are generally performing well. The latest figures for August 2016 show that more than nine out of 10 people were seen in A&E within four hours. During 2015-16, nearly 2,500 more people were seen in A&E each day within four hours compared with 2009-10.

Paramedics respond to the majority of life-threatening cases in under eight minutes. More than 567,000 emergency calls received a face-to-face response from the ambulance services across England in August 2016 alone—an average of 18,300 a day. Ambulance services are busy, which is why we are increasing paramedic training places by more than 60% in this year alone, on top of the 2,300 extra paramedics who have joined the NHS since 2010. That allows more than 200 additional ambulances to be deployed by the NHS compared with 2010.

[Mr Dunne]

I would agree with my hon. Friend in the event that the hospital in Wellingborough were able to cope with the condition, but many of the most serious conditions need to go to the best place to deliver the service, even if it takes a bit longer to get there. The quality of treatment in our ambulances now, with the skills of the paramedics who are on board in almost all cases, is such that very few people die while in transit. They are kept stable, and they need to go to the best place for treatment.

Going back to the national picture, the NHS last year treated, on average, 21,000 more outpatients a day and performed more than 4,400 operations a day compared with 2010. There is substantially more activity across the NHS, which is one reason why we have recruited so many more clinicians to help cope with this activity. We now have over 8,500 more doctors and over 2,700 more nurses, paid for in part by having nearly 7,000 fewer managers. Ultimately, we want to reduce pressure on services by reforming the urgent care system and caring for people better in the community, and that is where I think some of the things being done and being planned for the Kettering area are so interesting. It is clear that the NHS in the constituency understands the scale of the challenge and is taking action to address it.

[Mr Hollobone]

We understand the scale of the challenge. The problem is that the urgent care hub proposals, which are really exciting and could be rolled out across the country, are now with NHS Improvement, and its say-so is required to go to the consultancy phase.

[Mr Dunne]

Indeed, and our plans for improvement and integration among collaborative NHS areas across the country, including the Kettering area, through the sustainability and transformation plans are being delivered for each area today. NHS England will review those plans and decide to prioritise those that meet the national objectives and are best thought out.

In the past three years, including the current year, the Department has provided just over £37 million of interim revenue support and over £15 million of emergency capital to the trust. Since May 2010, capital expenditure on the hospital has amounted to £68.7 million, so it is receiving quite substantial support from the Department. The intention of the transformation work is to move to a position where the ability to cope with the remaining additional pressures on A&E and across the patient flow in the hospital is built in.

My hon. Friend the Member for Kettering said that the trust’s emergency department was too small and too limited in scope, and he touched on the new construction completed this year to extend the scope of the A&E department. It was originally built 20 years ago for 40,000 attendances a year, but is now dealing with more than 82,000. But the trust has had some success in reducing A&E attendances; there are more than 3,000 fewer than six years ago. The measures to integrate with the surrounding area are therefore having an effect on reducing attendances, despite the growing demand overall.

The trust has recruited and trained additional medical staff. Since 2010, the trust has increased its doctors by 77, or 24%, to 394. That is one of the most significant increases I have seen thus far. Some of this has come from the recruitment of staff through the certificate of eligibility for specialist registration scheme, involving doctors who have, for example, completed their specialist training overseas and chosen to practice in this country.

My hon. Friend and my hon. Friend the Member for Corby referred to proposals to develop the urgent care hub at the hospital. The aim is to develop a one-stop shop, which will enable patients to use primary care facilities, rather than A&E, by having these services co-located on the Kettering general hospital site. These services would enable rapid assessment, diagnosis and treatment by appropriate health and social care professionals. Patients would be streamed into appropriate treatment areas to minimise delays and reduce the need for admissions. This is an example of best practice across the NHS; it is what we are trying to introduce to relieve pressure on clinicians in the A&E department.

My hon. Friend the Member for Kettering raised the possibility of capital investment to develop this hub. The Department’s position has not changed. We are looking to the trust to take responsibility for developing and taking forward its own capital investment proposals. Foundation trusts, such as Kettering, can apply to the Department’s independent trust financing facility for a capital investment loan. They need to work closely with local planning authorities to ensure that developer infrastructure contributions can be taken into account as a source of funding.

I hope that these plans will be successful as they emerge through the STP, and as I have said, I hope that I will find an opportunity to visit Kettering on one of my visits north if I am allowed to do so on a suitable day when not required here in the Chamber.

Question put and agreed to.

Community Pharmacies

Philip Hollobone Excerpts

Monday 17th October 2016 Commons Chamber

[David Mowat]

I can only repeat that we value and can see the value in community pharmacies. We do not believe that any reductions will be skewed towards the independent sector; nor do we believe that the sector’s position overrides our duty to look at clustering and to make sure that the money we spend in this sector—£2.8 billion—is spent most effectively and cannot be spent better on other parts of the NHS.

[Mr Philip Hollobone (Kettering) (Con)]

As far as residents in the Kettering constituency are concerned, community pharmacies are a good thing. They relieve the pressure on the overburdened A&E at Kettering general hospital, and they are the only place to go when people cannot get an appointment at their local GP surgery. Can we please make more use of the community pharmacies that we have? If the Minister is right, and he suspects that not many community pharmacies will close, let me tell him in all candour that the process he is going through is completely cack-handed, because it is spreading fear among the community pharmacy community up and down the country?

[David Mowat]

The current process began in December last year, and will be brought to an end shortly. I do not know about the specifies of the pharmacy scene in Kettering, but I repeat that we regard pharmacies as vitally important to the NHS. One of the proposals that we shall announce shortly is a proposal for an integration fund of £300 million, which will be used entirely to provide services and pay for pharmacies to provide them. It will be informed by the review that is being conducted by Richard Murray of the King’s Fund, and Kettering will benefit from those services in just the same way as other parts of the country.

Oral Answers to Questions

Philip Hollobone Excerpts

Tuesday 11th October 2016 Commons Chamber

[Mr Hunt]

The extra money we are putting in to the NHS is going to better cancer care, better mental health care and better GP provision—it is going to all the things that Members on both sides of the House know matter. It will also mean that we can support our hospitals better. With our ageing population, we will continue to have great demand for hospital care, but the best way to relieve pressure on those hospitals is to invest in better out-of-hospital care, which has not been done for many years.

[Mr Philip Hollobone (Kettering) (Con)]

Kettering general hospital is treating a record number of patients with increasingly world-class treatments, yet despite being located in an area of rapid population growth, due to an historic anomaly, the funding for the local clinical commissioning groups is among the worst in the country in relative terms. What can Her Majesty’s Government do to correct that?

[Mr Hunt]

I am happy to look at that particular funding issue for my hon. Friend. I know that Kettering hospital is under a great deal of pressure. The one thing that it could do to relieve its financial pressures is to look at the number of agency and locum staff that it employs. As with many hospitals, there are big savings to be made in that respect in ways that improve rather than decrease the quality of clinical care.

Junior Doctors: Industrial Action

Philip Hollobone Excerpts

Monday 5th September 2016 Commons Chamber

[Mr Hunt]

I completely agree. I am afraid that this is where I am very, very disappointed with the Labour party. Thrilled though it might be to have so many supporters of the leader in the more extreme ranks of the BMA, it helps no one to try to use the NHS as a political pawn and to weaponise the NHS as it tried so destructively to do before the last election.

[Mr Philip Hollobone (Kettering) (Con)]

Kettering general hospital is under pressure on a number of fronts. Even if the industrial action does not take place, the threat of it diverts key personnel from their normal difficult task of contingency planning, filling rotas and making sure that patients stay as safe as possible. Does my right hon. Friend agree that even the threat of industrial action does huge harm to our hospitals and the NHS?

[Mr Hunt]

I am more than happy to agree with my hon. Friend. The staff at Kettering general hospital work extremely hard. I have been there, as he knows. It is a very busy hospital. One shudders to think what the impact would be if we removed a third of the doctor workforce in a hospital such as that.

Oral Answers to Questions

Philip Hollobone Excerpts

Tuesday 5th July 2016 Commons Chamber

[Mr Hunt]

The health surcharge that this Government have instituted for people on long-term visas to come and work and live in the UK is the right thing to do, because it is important that everyone makes a fair contribution to the cost of NHS services. In terms of future arrangements for EU nationals in the UK, that would obviously be subject to the negotiations that now happen, and a very important part of those negotiations will be access to the EU health systems for British citizens currently living in EU countries.

[Mr Philip Hollobone (Kettering) (Con)]

Will the Secretary of State tell the House how many EU nationals work in the national health service and how many EU nationals use the national health service? Is it not the case that the number of eastern Europeans, especially, coming to this country has simply overwhelmed GP practices and A&E centres up and down the country, and now we have got a chance to redress the balance?

[Mr Hunt]

Without wanting to reopen the debate that concluded on 23 June, the overwhelming view in the NHS is that we are very lucky to have the incredible support of 110,000 EU nationals working in the health and social care system. I want to put on record to this House what a fantastic job they do and how much we are all in their debt.

NHS Commissioning (Pre-Exposure Prophylaxis)

Philip Hollobone Excerpts

Tuesday 7th June 2016 Commons Chamber

[Jane Ellison]

The NHS England position is based on a legal argument, and as the matter is likely to go before the courts, it is not really appropriate for me to comment further. There was a little discussion this morning on this subject in the Health Committee, for which some Members were present. I have laid out a process by which we will work out how and where this is commissioned. Clearly, we need to identify the commissioner.

I do not accept the right hon. Gentleman’s challenge about fragmentation, simply because if we look around the world at a series of very different health systems, we see that they are all going through broadly the same process of understanding where PrEP sits. There are a number of options, but first we need to go through this work. On his latter point about stigma, he is right to identify that it is a significant concern, but I do not accept that that is what this represents. He knows my personal commitment to tackling stigma, and we could not have made it clearer that addressing rising HIV rates, addressing STIs in the MSM community and looking at the challenges surrounding things such as chemsex are all very much front of mind, and we have given considerable time and thought to them. We must challenge stigma wherever it rears its head.

[Mr Philip Hollobone (Kettering) (Con)]

Given the challenges of HIV, I think that my constituents would be excited by the prospects that PrEP offers. They would, however, be a little disturbed by the fact that every country in the world seems to be going through the same process, and duplicating, replicating and holding up what could be a very exciting development to combat the spread of HIV across Africa. Many countries are suffering from this far worse than we are, and they would be horrified by the thought that the process could get bogged down in a court when this treatment, if it were available, could do very real good.

[Jane Ellison]

My hon. Friend is right to recognise that PrEP has potential. It is, in fact, being used in some places internationally. The point I was making was that there is no simple, one-size-fits-all solution. Different countries have different challenges. For example, the level of HIV prevalence and the services available to manage that prevalence, and to manage testing, are very different in different countries. That forms different landscapes into which PrEP might fit. To give an example from Africa, PrEP was licensed last year, and it will be available for sex workers in selected sites. HIV prevalence among female sex workers is estimated to be just under 60% in South Africa. There are different contexts in which PrEP is being taken forward, and that is just one of them.