Oral Answers

Philippa Whitford Excerpts

Tuesday 25th April 2023 Commons Chamber

[Neil O’Brien]

I am very happy to meet my hon. Friend, and we have already talked to some extent. The minimum UDA value that we introduced particularly helps rural and coastal areas of the kind he represents, and I am happy to talk further, and to go further, on all these things.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

As in the NHS, workforce is the biggest single issue. The Nuffield Trust has identified that, post-Brexit, dentists are among the key staff we are losing. On top of that, while Scotland and Wales have childhood dental health programmes, England does not. When will England have a national childhood dental health programme, and when will the contract in England be reformed to reward preventive work, rather than just dealing with emergencies?

[Neil O’Brien]

We passed legislation last month to make it easier for international dentists to come to the UK by reforming the General Dental Council to speed up the flow from abroad. The hon. Lady mentions an additional service that is available in Scotland. Of course, Scotland has 25% more funding per head than the rest of the UK, which is just one benefit of being in the UK, and it is one reason why people in Scotland voted to remain in the UK.

NHS Workforce Expansion

Philippa Whitford Excerpts

Tuesday 28th February 2023 Commons Chamber

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

May I start by expressing my thanks to all health and care staff across the UK? I pay tribute to them for the work they do year in, year out—especially during the pandemic, when they literally risked their lives to care for us and our loved ones. Sadly, some of them paid the ultimate price. Others who are suffering with long covid face losing their pay or their job, and we should be ashamed of that.

The covid pandemic had a massive impact on all four health services across the UK. The two biggest challenges are the backlog and the workforce we need to deal with it. However, there were underlying problems before covid. We had 10 years of Tory austerity: up to 2010, the annual average uplift in NHS funding was usually between 3.5% and 4%, but for most of the 2010s it was less than half that.

Scotland spends more than 6% more per head on health than England. That money covers things like free prescriptions. The shadow Health Secretary, the hon. Member for Ilford North (Wes Streeting), talked about not charging for GP appointments. Free prescriptions, in the same way, ensure that people take their medication, so that we do not let diseases get out of control and they do not end up costing more in hospital later.

We also spend a massive extra 43% on social care. That allowed us to provide free personal care, valued at £86,000, when we heard about the potential care cap in England. Providing free personal care, which in Scotland includes people younger than 65 if they have a need for it, allows people to live independent, high-quality lives in their own home for as long as possible. I am sure that there is not a person in this Chamber who will not want that when their turn comes.

Scotland has the highest number of nurses, care staff, GPs and consultants per head of population in any of the UK nations, but all the national health services are facing staff shortages in both NHS care and social care. Even where staff numbers appear to have increased, the problem is that demand is growing quicker. That is because we are an ageing population—and, sadly, we are not ageing well. From the age of about 50, we start collecting diseases. The NHS gets us through and helps us to manage, but many people, particularly in deprived communities, can spend 20 years or more in ill health. The NHS is struggling to cope. We need to invest in a wellbeing approach to every person who lives in the UK—every child born—so that they do not end up a bunch of old crocks like many of us in this Chamber.

Safe staffing is vital. It is not hospitals or machines, but people, who deliver treatment and care when we are ill. The staffing issues have multiple causes. The decade of austerity meant many public sector pay freezes and caps, which made jobs seem unattractive. Caps on public pay and benefits take money out of local economies—many of us know of dead high streets. It is a pointless approach, because less tax goes back to the Government and it strangles the economy. Giving people enough to live on, with decent benefits and decent public sector pay, injects money into local economies and stimulates growth, which we keep hearing is the big thing that this Government believe in.

Another cause is Brexit. There was a 90% fall in EU nurses coming to the UK after the vote in 2016—not even the loss of freedom of movement in 2021, but the vote. Since the formal loss of freedom of movement, care providers have suddenly had to deal with the Home Office. Many MPs in this Chamber will know just how difficult that is, with the cost of visas, the administrative burden and the general shortage of workers because of Brexit. Health and social care is having to compete with almost every other sector in the economy, so paying people badly simply will not wash.

Of course, there was also the pandemic. I was back in the NHS in the first wave in 2020, and I know that staff were incredible. They felt empowered. We were able to sit around a table, whether it was physical or virtual, work out what needed to be done, make a decision and move on in a way that staff on the frontline are rarely empowered to do. The problem is that this has gone on for three years now. Staff are suffering from exhaustion and burnout, but instead of having people clap for them, they get negative media complaining about staff and GPs and suggesting that GP practices are shut or that a phone appointment does not count.

I became quite ill and ended up in the hospital across the road in autumn 2021. When I finally got back to where I live, I had three GP consultations, two specialist consultations and just one day in a hospital, going through tests, before my medication was organised. Frankly, with my lifestyle, that suited me down to the ground. I did not need to hang around in a clinic, risking infection with covid. The job got done. Let us stop denigrating phone appointments. GPs are not stupid. If they speak to a patient on the phone and need to examine them, they will arrange that.

We have to realise that it is not just about the media; as politicians we have a duty, too. I have to gently point out to the shadow Health Secretary—particularly as my own husband was a GP—that GPs are not just gatekeepers for the NHS. They provide long-term continuity of care, they examine the patient, they are advocates and they guide the patient to the right service. Imagine someone with back pain. Were they digging the garden? Do they need to see a physio? Do they have a slipped disc, do they have a kidney stone, do they have a leaking aneurysm—or do they have metastatic cancer? How is a patient meant to disentangle that without a GP?

[Wes Streeting]

Let us be clear about this: I have never disputed GPs’ expertise or the important role that they play in diagnosis. But if the hon. Member thinks GPs are so fantastic, why are there so many fewer now under the SNP in Scotland?

[Dr Whitford]

That is not true—and 99% of our trainee posts last year have already been filled. Perhaps the hon. Gentleman should look at the statistics. We have more GPs per head of population than any of the other nations in the UK, including Wales, which his party runs.

So what do we need to do about this? Clearly we need to train more staff, but we must also not only increase the number of both nursing and medical student places, but look at the cost of studying and the student debt that those people will be left with. We do not have tuition fees in Scotland and our nurses receive a bursary of £10,000 a year, which means that we are investing £20,000 in every student nurse in Scotland.

[Karin Smyth]

The hon. Lady talks a great deal about the inputs of the SNP Government in Scotland, but very little about the outcomes there. Does she not agree that, rather than carping about the contrast between how good things are in the rosy land of Scotland that she portrays—which is not a true picture, as we know from what is happening with the SNP leadership election—and how bad they are in Wales, England and indeed Northern Ireland, we should start learning from the different ways in which the different Governments are providing services and working people? We need to stop carping about those differences, learn from each other and recognise that outcomes are different, rather than just talking about the inputs. Is that something on which she might want to work with other people?

[Dr Whitford]

I think I have spent the last eight years demonstrating the different approaches that Scotland takes. The Minister talked about community pharmacies, which have been providing minor ailment care in Scotland since 2005. Our optometrists are allowed to refer people with cataracts directly to hospital, whereas in England, they are often made to go through a GP. So I am sharing and have shared ideas in that way. However, there has been a 5.8% increase in the uptake of nursing jobs in Scotland, so we also have more nurses per head of population.

[Wes Streeting]

rose—

[Dr Whitford]

I should like to make some progress. The hon. Gentleman had a very long time at the Dispatch Box and I think there should be more than just the three of us.

It is important to recognise the impact of the loss of the nursing bursary in 2016. The number of nursing student applications fell in England after the bursary was cut, so perhaps this is one of the ideas that I am sharing. The numbers recovered to some extent in 2019, when the bursary was brought back, but it is only £5,000, and tuition fees are more than £9,000 a year. Nurses in England are graduating with debt of about £50,000, and they need to begin paying it back immediately, which means that the money is coming out of their salaries. Perhaps that could be looked into.

If the number of medical students is increased, it is necessary not only to ensure that there are places on the ward where they can learn—this was mentioned by the hon. Member for Bosworth (Dr Evans), who is no longer in the Chamber—but to expand and fund the training places in hospital they will occupy after they graduate. There was a real problem last year when the extra medical students who were graduating could not find foundation jobs until the last minute. If graduates do not go through the foundation scheme, they cannot practise as doctors. We also need to invest in middle-grade specialist training in order to create consultants.

We need to recruit more from overseas, because progressing from student to consultant or GP takes nine or 10 years, while progressing from student to consultant surgeon takes about 15 or 16 years. Adding more student places will not solve the problem in the short term. We must, however, avoid recruiting from low and middle- income countries on the World Health Organisation red list. That is simply unethical, and is being reported as direct recruitment from trusts in England. We should be ruling that out. It should not be allowed and I think the Government could tackle the matter.

We have, unfortunately, lost freedom of movement, and it is clear from what Labour is saying that it will not return. That is a challenge for us in Scotland, because we need people: we are facing a huge demographic challenge. The Government should put all health and social care roles on the shortage occupation list, and reduce visa costs and hassle. Forty-nine per cent. of overseas GP trainees in the UK report these issues, and 17% of those say that they may leave. The obstructive process of dealing with the Home Office is driving doctors away. The Government should perhaps also waive the NHS charge for staff who work in health and social care.

However, I agree with all the Opposition Members who have said that what is most important is retaining staff, because otherwise we will lose experience. Some decent pay would be a start, and after the pay freezes and after covid, those staff certainly deserve it. The Government are keen to rave about the independent pay review body when it suits them, but to ignore it when it does not. Nurses in Scotland were already being paid between £1,300 and £2,500 more than those in the rest of the UK, and to catch up with what is being paid to Agenda for Change staff in Scotland, the UK Government will need to provide a 14% pay rise for the coming year. If they did give a decent pay rise to the incredible staff who work in the NHS, devolved nations would also be able to fund a decent pay rise for their staff. Both Scotland and Wales are limited by having no real borrowing powers.

We need a review of the pay, terms and conditions and support for junior doctors, of how their rotas are managed and of their quality of life, because we need to understand why they are leaving the UK—part of that is wanting the adventure and experience of working overseas, so perhaps we should consider building that into our training schemes, giving junior doctors a flexible year in which to do research, work as a volunteer or work in another country—and, of course, we need reform of the mess that is the NHS pension. The lifetime and annual tax allowance system is penalising senior staff who do extra work. Many are refusing extra roles such as that of clinical director or educational supervisor. They are turning down the overtime that is critical to clearing the backlog, going part time, or even retiring earlier.

The Scottish Government and, I am sure, the Welsh Government are offering pension recycling and “retire and return”, but that is all the devolved Governments can do. The problem lies in the Treasury. This system was introduced in 2015, supposedly to deal with tax evasion and avoidance. It is nonsensical to apply it to a public sector defined benefit scheme. Pensions cannot be played with that way. The problem is that increases in the pension pot are being counted as income. Staff have no way to predict that, and end up being faced with vast bills simply for being able to work some extra weekends.

We also need to maintain the wellbeing projects that were started during the pandemic. All NHS staff are still facing a huge amount of stress this winter, which is made worse by the staff shortages and the increased demand resulting from covid, influenza and other respiratory infections. The covid data from 2022 shows that there was no respite. Unlike in 2020 and 2021, hospital admissions stayed relatively high, even between the peaks, which means that staff have literally been running non-stop for nearly a year and a half. As has been said, staff are willing to work hard—they have always worked hard—but the problem is that when they go home at night feeling they did not do a good job and when they feel that their ward is not safe, that undermines both their commitment and their ability to do the job. The General Medical Council reports that burnout and dissatisfaction are the two main factors driving senior staff out of the NHS.

However, we must not forget social care staff. I was surprised that they were not mentioned in Labour’s motion. The standard measure of NHS performance in all four health services is the four-hour A&E target because it assesses the flow through a hospital from admission to discharge. It started to deteriorate in England in 2013, following the changes introduced in the Health and Social Care Act 2012, but it fell in all four health services in the later phases of the pandemic as hospitals tried to restart elective work. NHS Scotland is also struggling after covid, but let me gently point out, notwithstanding the snide comments from Tory and Labour Members, that Scotland is still the best-performing of the four nations in this regard.

Struggling A&E performance is driven not by A&E issues but by the back-pressure of patients who are waiting for beds—in other words, by delayed discharges. The lack of care workers to deliver home care is what is actually driving the A&E issue, and this should be the thermometer to test the temperature of the entire acute system. There are currently more than 160,000 vacancies for social care in the UK. We cannot fix the NHS without fixing social care, so we need a workforce plan for NHS and social care. As in Scotland, we need to respect care staff: pay them a minimum of the real living wage, not the pretendy living wage; pay sleepovers when they carry them out; and pay travel time. To have them doing all these things unpaid is undermining their take-home pay.

In Scotland, care staff are now registered and getting access to professional training and development. This is part of our plan for a national care system, but care staff need decent pay. They also need recognition and respect for the very tough job of looking after our loved ones. I cannot imagine anyone in this Chamber who could do the job. They need a career path so that good staff who enjoy delivering care can remain in the care sector and not just use it as a stopgap until they can get a better paid job on the till in a supermarket.

[Several hon. Members rose—]

Vaccine Damage Payment Scheme: Covid-19

Philippa Whitford Excerpts

Tuesday 6th September 2022 Westminster Hall

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

We are here to discuss the vaccine damage payment scheme of 1979. My interest is as chair of the all-party parliamentary group on vaccinations for all, so it is clear that I am absolutely and utterly pro-vaccination.

We can be grateful for just how rare significant side effects or damage are when it comes to vaccines as a whole. However, as the right hon. and learned Member for Kenilworth and Southam (Sir Jeremy Wright) has said, if we are to maintain confidence not only in vaccination in principle but in further covid-19 vaccines, it is important that people feel secure and supported and that they are not hearing horror stories of people who have been hurt in some way by the vaccine and then just left stranded. It is vital that we do that, or we will see a rise in vaccine scepticism and vaccine hesitancy, and that will be manipulated exactly as we have seen over the last couple of years.

[Alicia Kearns]

As a former civil servant, I believe that the case load is so small that it is not unfair to expect Ministers to look at each case individually. They have the capacity and are capable. The purpose of vaccination is to protect not just ourselves but others around us, and many who have had negative consequences acted in the national interest and to protect their loved ones. They deserve the bare minimum of a Minister looking individually, case by case, to see what support they need and whether they deserve the vaccine payment or some exceptional support. Does the hon. Lady agree?

[Dr Whitford]

I totally agree. The Government’s response to the petition talks of 174 cases. When I was a breast cancer surgeon and there was the scandal about PIP implants, which I knew we had never used, I still had to go through every single breast reconstruction I had done in a period of 17 years in order to absolutely verify that that was not the implant. It is absolutely possible with such numbers.

At the moment, only 11 cases have been settled. Only 2% in recent years have been successful. Whenever any kind of scheme has only that kind of return, it has to be looked at. As has been said, it is a long wait and people are left not able to work or they have family pressures and receive no support. Who is deciding the 60% disablement? As has been said, it is an absolute cut-off. Even the maximum payment has not been reviewed since 2010 and it would not cover anyone for 20 or 25 years of lost earnings and ability.

The Government say it is not compensation. I think that a no-fault scheme is absolutely right. I raised this issue with the right hon. Member for Stratford-on-Avon (Nadhim Zahawi) when he was Minister for Covid Vaccine Deployment, in December 2020, and said that if the Government were removing liability from pharmaceutical firms, they had to step in and replace them. I would like to see the VDPS improved for all vaccine users, but the covid-19 vaccine is a specific case where urgent action is needed and where it is even more important to get financial support.

We heard about cerebral venous sinus thrombosis and how catastrophic, but thankfully rare, it is. People have also had micro-thrombosis and an array of autoimmune responses to the vaccines. My constituent, who does not want to be named, suffered from Guillain-Barré syndrome, which is now recognised and mentioned in association with the vaccines. It is a neurological condition that has caused him to have partial facial paralysis and problems with balance. That may sound minor, but he worked at heights in a majorly physical job and has not been able to work since spring 2020. He, and people like him, are terrified of the 60% disablement. He imagines that when he walks into a room, regardless of his facial appearance or his balance, people will think, “Well, you’re not really that bad”, but he cannot do the job he was doing before.

It is vital that we take these cases out of the VDPS, deal with them quickly to ensure confidence in the covid-19 vaccine, and take the time to change the VDPS to make it responsive, quick and something that the public believe in. In total, there are currently only just over 2,000 cases, which is not an overwhelming number to work through if it means that we maintain confidence in vaccines and the benefits they bring to all age groups, throughout our lives, against multiple diseases.

--- Later in debate ---

[Jim Shannon]

It certainly is. Things are never straightforward and there are complex issues. However, today our request is quite simply on behalf of those who have contacted the hon. Member for Central Ayrshire and each and every one of us. We have them in Northern Ireland as well; some of my constituents have been impacted. I think it is really important that we do that.

[Dr Whitford]

It is not just a matter of who they sue—whether it is a pharmaceutical company or the Government. As with contaminated blood, is the point not that people injured by vaccines—or damaged in some way through healthcare—should not struggle with some long court battle? Look at how long the contaminated blood scandal has been running—surely we do not want to put people through litigation if it can be settled more fairly.

[Jim Shannon]

As always the hon. Lady gives us a focused way forward. Since I was elected as an MP in 2010, the contaminated blood scandal has been at forefront of my mind, as it has been for the right hon. Member for Kingston upon Hull North (Dame Diana Johnson), who is the Opposition spokesperson for that issue. People have waited all that time for compensation, but there is some hope now of it coming.

However, many people in the compensation chain for the contaminated blood scandal have not yet got satisfaction. The hon. Member for Central Ayrshire is absolutely right: litigation, by its nature, is traumatic and it adds to the problems for those who are already distressed because of their physical health, and experience anxiety, depression and all sorts of other issues. If there is a way of doing it—and the right hon. and learned Member for Kenilworth and Southam has referred to what that is—then let us do it.

The Second Reading of the Covid-19 Vaccine Damage Bill is scheduled for the end of October. I would like to hear that we must do well by our constituents across the whole of the United Kingdom of Great Britain and Northern Ireland who fell victim to this particular problem. We know that the 1979 Act does not apply to many other vaccines, and we have heard so much anti-vax rumour and speculation. I, for one, am willing to put my faith in healthcare professionals to ascertain why someone has been impacted in a certain way by the covid vaccines. The hon. Member for Central Ayrshire, who spoke before me, is not here as a healthcare professional; she is here as an MP, but she still has the expertise, knowledge and understanding of that, as do many outside. I previously added my name to present the private Member’s Bill earlier in the year, and I am very happy to do so again.

To conclude, we must stand by those who have stood by us in doing their civic duty to be vaccinated. I call on the Minister and Government, beseechingly, to engage with Health Ministers in the devolved nations in Scotland, Wales and Northern Ireland, and to collectively work to ensure that the Bill can be passed with the support of others. They must ensure that those impacted by the covid vaccines have something to ease burdens past and future. Along with other Members here today, I hope that the Government will address those issues with compassion and understanding, and do so now.

--- Later in debate ---

[Maggie Throup]

Yes, we will definitely look into that on my right hon. and learned Friend’s behalf.

The VDPS payment amount has significantly increased since the original VDPS payment of £10,000 set in 1979. It has been revised several times and, as the hon. Member for Denton and Reddish (Andrew Gwynne) said, the current level was set in 2007. This will be kept under review as part of business-as-usual policy work. As my right hon. and learned Friend the Member for Kenilworth and Southam is aware, a successful claim to VDPS does not preclude an individual from bringing a claim for damages through the courts.

[Dr Whitford]

Will the Minister give way?

[Maggie Throup]

I am getting a bit short of time. Lots of points have been raised and I want to make sure that I cover them all, so I will continue.

In line with the pre-action protocol should a claim be brought, where the Government are party to any claim, they will consider whether alternative dispute resolution might enable the settlement of the claim without the need to commence proceedings. The form of any ADR would depend on the details of claims that are made.

My right hon. and learned Friend the Member for Kenilworth and Southam also raised concerns about the 60% disability threshold. That threshold was lowered from the initial 80% to 60% in 2002, and it remains aligned with the definition of severe disablement set out under the DWP’s industrial injuries disablement benefit, a widely accepted test of disability. There is no evidence at present that the current level is a significant barrier; in 2019 and 2020, just one claim out of 70 was rejected due to the disability threshold not being met. We will review the latest data as covid cases are processed, but at present, evidence does not support lowering the threshold.

Working alongside NHSBSA, our focus is now on improving the service offered by VDPS by scaling up operations and improving the underlying processes. Since taking over operational responsibility in November 2021, NHSBSA has transformed the administration of the VDPS, which was previously a paper-based system. It has significantly increased its capacity to meet the demands placed on the scheme, expanding from four to 40 caseworkers and additional support staff, with further recruitment under way. This means claims can be processed more quickly, with personalised engagement with applicants through the allocation of named caseworkers.

NHSBSA awarded a new contract to an independent third-party supplier in March 2022 to provide additional medical assessment capacity to process covid-19-related claims. That has allowed for the conclusion of the first of those claims. NHSBSA is working to digitise applications and medical records, streamlining the process. A wider modernisation project is also being taken forward to digitise the application form, to create a simpler and swifter process and allow caseworkers to manage claims more efficiently. To allow more rapid assessments and processing, NHSBSA is setting time limits for the provision of medical records, with a call-back process in place. Further approaches are being looked at to secure relevant medical documents faster, as this has been a key limiting factor in processing rates.

My right hon. and learned Friend the Member for Kenilworth and Southam raised concerns about the rate of progress of VDPS. I am sure that he will appreciate, from what I have just indicated, that there have been vast improvements over recent months. As an update, NHSBSA has 2,458 live cases, of which 1,203 claims are awaiting returns on requested medical records, 181 claims are with medical assessors, and 261 claims are awaiting requests for medical records. The average claim takes around six months to investigate and process from the date NHSBSA requests the claimant’s medical records. The timeframe varies from case to case. NHSBSA has scaled up a dedicated team of caseworkers, as I have indicated, to move claims forward and update claimants on the progress of their claims.

My right hon. and learned Friend raised an interesting question about establishing a bespoke compensation scheme for covid-19 vaccines. Establishing a dedicated, stand-alone compensation scheme would risk favouring those potentially damaged by covid-19 vaccines over those damaged by other vaccines. That could create an inequality between vaccines, which could be detrimental to other vaccination programmes.

I thank my right hon. and learned Friend again for securing this important debate. Everyone has made really sensible contributions, and we will take everything that has been said into consideration. I am pleased that a number of covid-19 VDPS claims have now been concluded, offering outcomes to claimants, with further cases being progressed. Now is not the right time to review the VDPS: our focus must be on improving and scaling up its operations and continuing to process claims. We will continue to further improve the service so that outcomes can be provided sooner, giving additional support to those who qualify.

Health and Care Bill

Philippa Whitford Excerpts

Consideration of Lords amendments
Wednesday 30th March 2022 Commons Chamber

[Edward Argar]

I am grateful to the Father of the House, who I believe, in the course of our discussions about whether to accept the Lords amendment, wrote to me, along with other right hon. and hon. Members highlighting that particular case in the context of an open and transparent learning culture.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

I thank the Government for accepting the amendment. I raised the issue on Second Reading and I can see the Minister smiling at how many times we have talked about it in Committee and in the prelegislative Committee. It is critical that the safe space is safe. Systems make errors or do not prevent errors, so we need people to be candid. I pay tribute to the Government for accepting that, because it allows HSSIB to have a decent start and a decent chance.

[Edward Argar]

I am grateful to the hon. Lady not only for her comments just now, but for her work on this agenda and on HSSIB over many years on various incarnations of this legislation. She has a right to gently tweak my tail that I could have listened to her in Committee and got here faster, but as she will know, occasionally it takes a little time in Government to be able to move to the compromise that often we all seek.

Turning back to the advertising restrictions, the overall policy direction has been set out effectively through last year’s Government consultation response, this proposed legislation and the debate that has taken place in both Houses.

Covid-19 Update

Philippa Whitford Excerpts

Monday 6th December 2021 Commons Chamber

[Sajid Javid]

I thank my right hon. Friend for his support—he is right to talk about the importance of buying time—and for his comments about the NHS and the need to prepare. I reassure him that ever since we discovered omicron the NHS has been spending a substantial amount of time preparing.

My right hon. Friend mentioned the importance of discharges; they were important before but, where a patient is ready to be clinically discharged, they have become even more important now in the light of omicron. The recent funding that we provided for discharges—almost £500 million over this winter period—will help.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

As the Secretary of State has highlighted, we do not know about omicron’s severity, but its mutations certainly suggest a risk of increased transmissibility and possible immune escape. However, it is expected that vaccines will still provide protection—including, hopefully, against serious disease—so I echo the Secretary of State’s call for people to get vaccinated if they have not already done so.

With S-gene dropout providing an early PCR marker for omicron, can the Secretary of State clarify what proportion of labs in the UK assess the S-gene, and particularly what proportion of all the private labs providing travel testing, which are obviously critical in our defence against seeding cases into the UK?

I welcome the logical reintroduction of a pre-travel PCR, but does the Secretary of State recognise that the average incubation of covid is still five days, and does he not agree with the call from the Scottish and Welsh Governments to have a day 8 test for release?

Will the Government now hold a four-nation Cobra meeting to discuss the response and also commit to providing support for the travel sector and any other businesses that might be impacted by public restrictions going forward?

The Secretary of State described this as a global battle, and he is right, but the establishment of omicron in the UK is a stark reminder of the failure of wealthy nations to take a global response, as they promised last spring. While almost 90% of adults in the UK are doubly vaccinated, fewer than 4% in low-income countries have received at least one dose and less than a quarter of their healthcare staff are protected. The UK Government promised to deliver 100 million doses by next summer, but have so far delivered fewer than 10 million and, shamefully, destroyed 600,000 doses in August. It is estimated that the UK will be left with almost 100 million excess doses, so will this Government not accelerate their donations to COVAX?

Finally, 130 countries support the principle of waiving intellectual property rights and technological transfer to mount a global response to this pandemic, so why are the UK Government blocking the TRIPS waiver when most of these vaccines were developed with millions of pounds of public money?

[Sajid Javid]

First, let me thank the hon. Lady for her support for vaccination in general. Right across the UK, it is really making a difference, and I thank her for her comments on that, and especially on the importance of the booster programme.

On testing for this variant, she talked about the proxy measure, which is the S-gene dropout. There are other methods being deployed alongside that, which stop short of sequencing, but they take much longer, and the capability is not universal. Between these two proxy methods, the majority of testing centres can pick up the potential marker for omicron, but we are expanding that so that all testing centres will be able to do it very soon.

The hon. Lady talked about the restrictions. I point her to one of the important points that I made earlier, which is that the restrictions are temporary. As soon as they can be removed, we will remove them, and that is what industry and others want to see—as soon as we do not need them, we will remove them without any delay.

The UK can be proud of its commitment to vaccine donations to the developing world. We have a commitment of 100 million by June 2022. We have already delivered 22 million to COVAX and bilaterally. Another 9 million are on their way in the next couple of weeks, and we will meet our commitment.

Adult Social Care

Philippa Whitford Excerpts

Wednesday 1st December 2021 Commons Chamber

[Gillian Keegan]

Thank you, Madam Deputy Speaker. As was clear from their 13 years in Government, Labour Members are not interested in finding the answer, and they are certainly not interested in listening to my version of giving the answer.

Having 40% churn and such a high degree of insecurity in the workforce is not sustainable, so we need to fix that. We need to put the knowledge and skills frameworks in place. We need to invest in training and learning. We need to ensure it is captured and transferable. We need to have career routes that mean people can progress in the workforce. In my short time in the job, that has been immediately identifiable. The hon. Member for Sheffield, Heeley (Louise Haigh) and I worked on professionalising the social care workforce about four-and-a-half years ago, when we set up the all-party parliamentary group on social care. The issue has been recognised. It is not easy to fix. It is a large private sector. There is very large and increasing demand, but we are going to take the steps to fix it and the White Paper starts that process.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

The challenges in social care of increasing need and demand are the same across the four nations, but until now the approach has been very different. The Scottish Government have always believed in seeing social care as an investment in allowing everyone to participate in society and live as independent and satisfying lives as possible. I therefore welcome the change in narrative and tone in the statement.

The Feeley review, which was carried out last autumn in Scotland, plans a human rights approach to social care, and sets out a path to developing a national care service to ensure high quality standards right across Scotland for its users, and also fair terms, conditions and career development for staff. As has been said, workforce is absolutely central to all services and social care is delivered by people for people. The Scottish Government pay the real living wage—not some pretendy living wage, but the real living wage. Will the Minister commit to raising pay for social care staff in England to £10 an hour, as the Scottish Government have planned from this month?

Brexit and the loss of freedom of movement have, unfortunately, exacerbated workforce shortages in both the NHS and care systems, with a shortage of well over 100,000 in care. Will the Minister urge the Home Secretary to widen the eligibility of the health and care worker visa to actually include care workers? It is quite bizarre that it does not include care workers.

Scotland is the only nation that provides free personal care, which is now being valued by the UK Government at £86,000 a head. Will the Minister consider, in this redevelopment, providing free personal care to people in England? While the Scottish Government are planning a 25% uplift in social care funding over this Parliament, the national insurance uplift will go largely on tackling the NHS backlog over the next three years. Does she not recognise that the care crisis is right now? The problems in A&E are not caused by people coming to A&E, but by the difficulty of getting patients into beds due to delayed discharges, which are due to the lack of social care provision. Will she state, as has been called for, what funding will go to social care right now to tackle the crisis as we go into this winter?

[Gillian Keegan]

Many countries across the world are grappling with this issue. We have an ageing demographic and we now live in different ways. We live much longer with more complex needs, and often we are not close to our families as we have increasingly globalised. Many countries are looking to address those challenges, including Scotland. It is important that we build the talent pipeline here. It is important that we not only invest in and train our own people, but that we build sustainability. We cannot always rely on taking workers from many other countries. We have a visa route for senior social care workers and we have reduced salary levels—I think £20,480 is the salary level—so in Scotland that probably fits the minimum hourly rate. Of course, we have had different approaches. We had a commission on adult social care which gave results in 2011. That is what we have used to build the basis of our reforms and I know Scotland has taken a different approach.

Public Health

Philippa Whitford Excerpts

Tuesday 30th November 2021 Commons Chamber

[Alex Norris]

I cannot cast my mind back to that debate—I believe I had just started secondary school when it took place—but I can foresee the issues that were raised. I would not do down the idea of opening windows; that would be a good thing to do in and of itself, and I would support that. What I am saying is that there are certain places where that will work less effectively, and we ought to have some sense, certainly building by building, of what might be an effective measure. As I said, I do not think this is something that we can just click our fingers and do easily, but I would like to get a sense that we have tried to do any of it at all, and I have yet to get that. I hope the Minister will disabuse me of that.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

I raised the issue of ventilation last summer—we have known for a long time that covid is airborne—and I wrote to the Chancellor on two occasions asking him at least to remove VAT, to help businesses and public bodies that pay VAT to afford ventilation. Sticking 20% extra on the cost of a ventilation system seems quite weird in the middle of a pandemic.

[Alex Norris]

I am grateful to the hon. Member for that intervention, which gets to the root of the matter. We have been talking about ventilation for a long time. What I would really like to hear from the Minister is whether any progress whatsoever has been made in this area.

I turn to statutory instrument No. 1338 regarding self-isolation. The regulations introduce new rules for self-isolation after contact with a person who is suspected to have contracted the omicron variant of the virus, removing the exemptions to self-isolation. As we saw in the summer, this will be frustrating for those who would otherwise have been able to avoid self-isolation requirements by being vaccinated and who will now have to stay at home for the full period. However, as we wait to see how our vaccines and antivirals respond to the new variant, it is right that we prioritise caution and seek to limit community transmission as much as humanly possible. The Minister may have sensed colleagues’ eagerness to know more about this requirement. I hope that she will tell us when she thinks she is likely to have enough information about the variant to return to Parliament and say whether the Government feel that the regulations ought to remain.

There is, of course, a significant gap in the fence of these regulations. The gap has existed throughout the pandemic, and it is bewildering that we in the Opposition are still having to raise it. It relates, of course, to fixing sick pay. We have learned during the pandemic that the overwhelming majority of the British people want to do the right thing to protect themselves, their family and each other, but that falls short when they are forced to pit it against their need to feed their families. In both rate and availability, sick pay has proven insufficient to protect families against that horrendous choice.

These regulations will be weakened. They will be weakened when people ignore their symptoms and go to work, weakened when people say they are self-isolating and they are not, and weakened when people turn the app off to avoid being a close contact. Surely Ministers have learned this lesson over the last month. I am surprised that we did not hear more from the Minister about that.

The hon. Member for South Dorset (Richard Drax) raised the regulations relating to red list travel. My understanding is that we are not discussing those today because they were laid via the negative procedure, but the elements relating to testing will have an impact on SI No. 1338. Last week, we suggested that the Secretary of State should begin PCR testing for those entering the country, so I am pleased the Government have listened and included day-two PCR tests in the measures announced yesterday, but there are still holes in our defences on international travel.

I am keen to hear from the Minister how she and her colleagues reached the decision to introduce only day-two testing, and not to reintroduce pre-departure tests. I am keen to know the scientific basis behind that. We have heard many reports of private tests not being followed up, especially, perhaps, by those offering the cheapest prices. What are the Government doing to enforce this and to ensure that bringing back day-two PCR tests, which we support, is effective?

I will bring my remarks to a conclusion, because I am conscious of how many colleagues wish to speak in the debate. This is a concerning moment in the pandemic. We have learned over the last 18 months that it is vital that we act decisively at such moments. We are pleased to see these regulations come forward—indeed, in the case of mask wearing, it was premature to stop at all—but there is much more to do if we are to avoid being back here in the coming days and weeks, including working from home where possible, fixing sick pay and improving ventilation. The actions we need to take are clear. It is time for the Government to meet the moment.

--- Later in debate ---

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

Happy St Andrew’s Day to all Scots across the parliamentary estate, whether they were born in Scotland or are adopted Scots like myself.

We are in the early days and need more research on omicron, the new variant of concern, but clearly it is heavily mutated, including mutations that suggest increased transmissibility and mutations associated with immune escape, and that is what is causing the concern. Cases are surging in South Africa, but we do not yet have proof that those surges are directly related to omicron. One thing that has emerged from South Africa is evidence of the reinfection of people with previous proven covid infections, which we have not seen often during the pandemic.

The hon. Member for Altrincham and Sale West (Sir Graham Brady) talks about people’s freedom to choose, but the people they might infect—especially those who are immunosuppressed or vulnerable—have the choice removed from them. It is a network. If Members have ever seen the little gif where someone drops a ping-pong ball on to mousetraps, they will realise how things spread. You may have a choice. I, as an immunosuppressed person, may therefore not.

[Sir Graham Brady]

Is exactly the same not true of flu?

[Dr Whitford]

We do not suffer the same deaths, hospitalisations or outcomes from flu. [Interruption.] Well, we don’t. Look at 170,000 deaths over the last 18 months in the UK. We certainly have bad flu winters where we can get up into the teens towards 20,000, but we have never got close to 170,000 over 18 months.

[Mr Harper]

I know the hon. Lady has a great deal of medical experience, but she is referring to a period when we did not have vaccination. Am I not right in thinking that in a vaccinated population, the case fatality rate of covid is not remarkably different from that of influenza?

--- Later in debate ---

[Dr Whitford]

We are still seeing hospitalisations and deaths in people who are doubly vaccinated. The reason we are delivering boosters in all four health services is because that immunity is waning. What we are concerned about with omicron is that if it is able to immune escape, it could push us backwards. Therefore, we simply do not want it to become re-established and undermine the achievement that vaccines have made.

The British Medical Journal review, to which the right hon. Member for South West Wiltshire (Dr Murrison) referred, showed that masks had as big an impact as hand hygiene, so surely we should do both. Neither of them has a major economic impact. We are not talking about locking down. We are not talking about shutting businesses. We are talking about everyone trying to protect everyone else, so that they can continue to be active and continue to be out in society.

It is important to remember that even if our current vaccines were shown to be less effective against omicron, they would not have no impact. We already see that impact on delta with regard to spread: the reduction is only about 50% but it has markedly reduced hospitalisation and death. We would therefore still hope for that with omicron, so pushing vaccination and encouraging people to get boosted remains as important as it always was. Delta is still by far the most dominant variant circulating in the UK.

There is no evidence as yet of differing symptoms or severity, but one of the weaknesses of the data from South Africa is that the initial outbreaks were in students. Young people tend to get milder infections and we do not yet know what omicron will be like in an older or more vulnerable population.

We have one advantage in the diagnosis of omicron: the S gene, which is one of the three genes that common PCR tests look for, is missing. That means that rather than having to wait for genomic testing, which takes quite a long time, we get a heads-up or an early warning on the PCR test. There is a sub-group with S-gene dropout, which means that the chances are that it could be omicron. Those patients could be warned and their samples can then be sent for full genomic testing. In Scotland, a retrospective review of recent PCR results looking for S-gene dropout has identified the nine patients with omicron. I assume that similar work is happening in the other nations across the UK. In contact tracing of the nine patients, there is no evidence of a connection to either COP26 or the South Africa rugby game, but tracking continues.

PCR testing is, therefore, even more important. Lateral flow tests—which, hopefully, we are all doing regularly before coming here—cannot detect variants. It is a simple yes/no that someone does themselves, with no access to take further analysis. Lateral flow tests had been allowed as part of travel testing. In the Netherlands, 600 passengers arriving from South Africa were tested and one in 10 were found to have covid—an incredibly high incidence and much higher than we have anywhere in the UK—and a fifth of those cases were already omicron. Omicron is not just in southern Africa or in the UK. As a result of the use of lateral flow tests, it is probably already more widespread than we think. It is therefore welcome that today the Government returned to PCR testing for travellers rather than lateral flow tests, and that they are quickly re-establishing quarantine, but people should have a PCR test before they travel. It is rather like shutting the stable door if we find that someone is positive when they have just spent eight hours on a plane with hundreds of other people.

[Huw Merriman (Bexhill and Battle) (Con)]

Is the hon. Lady not concerned, as I am, that there is too much emphasis on PCR testing for tracking variants of concern? During a three-week period in July, there were 500,000 PCR tests, of which 7,000 were positive for covid. Only 5% of those 7,000 were tested for variants of concern, so this is not quite the silver bullet on variants of concern that she might hope it would be.

[Dr Whitford]

I was not claiming that it was, because genomic testing takes a couple of weeks generally and it is therefore too late for someone to isolate. What I am saying is that with this variant, as in alpha but not in delta, the missing S gene means that on that initial test—which takes six hours or until the next day, or whatever it is—we already get a heads-up that we are dealing with an omicron case. We can go on to do the genomic analysis, but we can say to the patient, “We think you have this variant. You need to isolate thoroughly and for longer.”

[Craig Mackinlay]

I thank the hon. Lady for bringing her medical knowledge to the House. It is very interesting, particularly on the S gene. I do not know what magic goes on in a lateral flow test. We put the drips in at one end and then one band, hopefully, appears and not two. Could a lateral flow test be adapted to be specific for this type of variant?

[Dr Whitford]

I think we would be talking about redesigning the test for a whole new antigen. I mentioned just one advantage that we get from PCR testing, which basically looks at genes—I will not talk about the whole long name and what PCR stands for—and the benefit is that we get a heads-up. I do not think it is feasible on any reasonable timescale to change lateral flow tests, so we are lucky that this one has S-gene dropout and that we will get an early warning.

One issue with focusing only on a day-two PCR and then, if someone is negative, they are released—unlike what is being discussed for domestic isolation—is that the incubation period of covid, generally, is much longer than two days. It has generally been reported as an average of five days and it can extend for longer. If someone who may have had contact arrives in the UK, gets a negative PCR result on day two and then goes about their business, there is a real danger that that is a false reassurance. That is why the Scottish and Welsh Governments have asked for a Cobra meeting to debate the evidence on a four-nation basis and to discuss having at least an eight-day isolation period for travellers, with a negative day-eight test required before people can be released.

The Prime Minister should listen on that, because one issue that we had in Scotland when we tried to maintain stricter and broader hotel quarantine was that the majority of long-haul passengers arrive through hubs such as Heathrow. The devolved nations have no ability to have an impact on that and we should be working with the Republic of Ireland to make the whole common travel area safer from the point of view of how we move about inside it.

[Karl MᶜCartney]

The Government Benches are not as sparsely populated as the Opposition Benches—and I do welcome the Opposition Members who are here—but considering what is happening later, am I right to presume that the Scottish National party, which the hon. Lady speaks on behalf of, will be supporting the Government in the vote at the end of the debate?

[Dr Whitford]

The reason that my colleagues are not here is that the debate is largely about the regulations in England and we do not normally vote on English matters. We have not normally voted on England’s covid regulations, but the one related aspect in these proposals is the testing and isolation of travellers. We support that but we think that it should go further.

On domestic precautions, Scotland never got rid of mandatory masks on public transport, in shops and in schools. We have not heard the Minister refer to whether the Government are planning to reintroduce mask wearing in schools. At the moment, with vaccination and its impact, we are seeing that the bulge and peak of cases among those who are unvaccinated is moving down to younger and younger teenagers and primary school children. If there will not be masks in schools, is there a plan to install CO₂ monitoring and ventilation? How do we reduce the incidence in schools?

[Mark Jenkinson]

The hon. Lady perhaps answered some of this question, but will she set out her assessment of the impact of mask wearing in Scotland on case numbers? Is what has happened with younger children not just testament to how well we have done at keeping them apart and proof that we cannot hide from the virus when we come back together?

[Dr Whitford]

It is very difficult at the moment. Cases go up and down and we swap positions. At the moment, Scotland has the lowest incidence of cases at 349 per 100,000. Northern Ireland has the highest at well over 600 per 100,000. Obviously, we have whole baskets of measures, so it is harder—other than in the review that the Royal Society published last June and in the BMJ paper from a week ago—to pick out exactly which measures are having the impact. The BMJ found that masks and hand hygiene were equal in their impact and, in fact, bigger in their impact than physical distancing. To me, they enable people to engage and enable people who are vulnerable to feel safe and to come out, because otherwise, those who were shielding will be stuck in their houses all over again.

Although mask wearing was not mandatory in England, it has remained in this Government’s guidance if someone is in a busy public space. I am sorry to say that that guidance has been undermined by what Members on the Government Benches have demonstrated on television every day. Initially, when we came back in the autumn, approximately five people wore masks, then the number more than doubled to 14, and after the measure was pushed, the proportion rose to about two thirds. On the day when mask wearing in busy places is meant to be promoted, about a third of Government Members are still not wearing masks.

People will be led by the example of not just the Prime Minister, but every one of us.

[Mr Harper]

Will the hon. Lady give way?

--- Later in debate ---

[Dr Whitford]

I have given way a lot, and lots of other hon. Members are waiting to speak.

As for the Leader of the House’s nonsensical claim that people cannot catch covid from their friends, I have to say that words fail me—and as Members can well believe, that is not a common occurrence. It is clear that the most common spread is within households. If the Leader of the House thinks that husbands, wives and children are not friendly with one another, I really worry about his home circumstances.

It is early days, but we should be following a precautionary approach. As Dr Ryan of the World Health Organisation has always said: go early and go hard. In the last three waves, the Government often delayed making decisions until the problem was proven. I welcome the changes that they are making to try to get ahead of the curve this time, but as well as taking action on masks, they should advise those who can easily work from home to do so. They should promote “hands, face, space” again, to push it to people who may have got a little complacent.

The Government should also look at how to support the installation and improvement of ventilation. Covid is airborne. Hon. Members will remember how smoke used to hang in a pub before the smoking ban. Any Member who has ever worked in pubs, as I did as a student, will know that smoke would still be hanging there the next morning. That is the issue with poorly ventilated spaces, as we have seen from the outbreaks associated with Committee Rooms in the House.

The arrival of such a variant was inevitable. Last spring, we heard warm words about a global response to a global crisis, but while more than 85% of adults in the UK have been double-vaccinated, the figure is less than 4% in low-income countries, including many that have not been able to vaccinate their healthcare workers.

[Dr Ben Spencer (Runnymede and Weybridge) (Con)]

Does the evolution of an immune escape variant, which omicron may be, occur because of a vaccinated immune population or because of a naive population?

[Dr Whitford]

I think that its emergence in southern Africa would suggest that it is from a naive population. One of the issues with our complacency here and reliance on vaccination while allowing very high case numbers is that through Darwinism it can pre-select for vaccine-resistant variants and mutations. Those are the ones that will get a grip; the ones that are vaccine-susceptible will not, because we are so vaccinated.

Allowing high spread, which means common mutations, is a problem wherever it happens, but in the naive populations in the global south there is a real danger. They do not have testing, they do not have the materials, they do not have genomics and they do not have vaccines, so the danger is that they will therefore get a variant that builds up and eventually comes to Europe and to the UK. Sending occasional batches that are almost out of date, as was reported recently to us in the all-party parliamentary group on coronavirus, does not allow Governments in the global south to prepare and use vaccines within date.

The UK is still among the countries blocking a TRIPS waiver. We must realise that it is not a matter of just sharing some leftover doses. We need to massively increase global population, which means sharing intellectual property and sharing technological expertise. If anything, this variant should be a reminder that no one is safe until everyone is safe.

Health and Care Bill

Philippa Whitford Excerpts

Report stage
Tuesday 23rd November 2021 Commons Chamber

[Edward Argar]

As ever, my right hon. Friend—my friend—makes his point well, and, as ever, I will commit to taking it away and reflecting on it very carefully. He is always very considered in the points he makes in this House, so I am happy to look at it.

I turn to Government amendment 127, which I bring forward with support of the Welsh Government. Clause 127 on professional regulation provides additional powers that will widen the scope of section 60 of the Health Act 1999 and enable the Privy Council to make additional changes through secondary legislation. One of the powers within this clause is to enable the regulation of groups of workers concerned with physical and mental health, whether or not they are generally regarded as a profession. This element of the clause falls within the legislative competence of the Senedd. When the section 60 powers are used, they are subject to the existing statutory requirements in schedule 3 of the Health Act 1999— namely, consultation and the affirmative parliamentary procedure. When legislation made using section 60 powers also falls within areas of devolved competence, it will be developed in collaboration with the devolved Administrations. Orders may require the approval of the Scottish Parliament where they concern professions brought into regulation after the Scotland Act 1998, or of the Welsh Assembly where the order concerns social care workers. In Northern Ireland, where the regulation of healthcare professions is a transferred matter, the UK Government will continue to seek the agreement of the Northern Ireland Executive when legislating on matters that effect regulation in its territory.

The amendment introduces a requirement to obtain the consent of Welsh Ministers before an Order in Council can be made under section 60 of the Health Act 1999 when it contains a provision that would be within the legislative competence of the Senedd. It would apply if we were seeking to bring into regulation in Wales a group of workers who are concerned with physical or mental health of individuals but who are not generally regarded as a profession. The UK Government recognise the competence of the Welsh Government regarding this provision and are respecting the relevant devolution settlement in making this amendment. For these reasons, I ask hon. Members to support the amendment.

Finally, I turn to the amendments related to part 4 of the Bill on the health services safety investigations body. These are the most significant set of provisions found within this Bill to enhance patient safety. The establishment of an independent healthcare body focused on learning from mistakes to improve safety and quality is a world first. For the health service safety investigations body to be able to perform this “no-blame” role, the integrity of safe space is paramount. Without it, health and care staff will not have confidence to come forward, and potential learning will be lost. This principle runs throughout the drafting of these clauses. We have made a small number of exceptions in the Bill—for example, to ensure that coroners can continue to perform their vital functions as judicial office holders and effectively as part of the judiciary. We have also provided for a regulation-making power to ensure that safe space can evolve in line with innovation in technology or medical practice. However, nothing in the Bill can or will undermine the imperative that the HSSIB is an independent organisation or the fundamental importance of safe space to the effective working of that organisation.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

Will the Minister give way?

[Edward Argar]

Yes, of course, although I do so with a degree of trepidation, because the hon. Lady is well versed in these issues.

[Dr Whitford]

The Minister does not need to be anxious, because he has already heard it all in Committee. Does he not recognise that there is nothing in HSSIB that takes away from coroners’ investigations that they carry out at the moment, and that HSSIB should not be seen as replacing that work by another health body? Adding coroners to it has already created a campaign relating to the ombudsman and freedom of information, and there is a real danger that it weakens the safe space.

[Edward Argar]

I am grateful for the manner in which the hon. Lady puts her points. She is right; we have debated this previously. We have been publicly clear that we do not believe that the exemption or exception should be extended to the ombudsman. She is right that there are campaigns saying we should have no exceptions or that we should widen the exceptions. We believe we have struck the right balance with this measure, while respecting the fact that a coroner is a judicial office holder and has a very specific function to perform, as set out in legislation in—this is where my memory may fail me—the Coroners and Justice Act 2009, which recognises their particular and special status. I suspect that she and I may have to agree to disagree on whether the appropriate balance is struck, but that sets out why we have done what we have done.

How best to achieve an effective safe space is complex and the current drafting has been arrived at through years of detailed policy work, including pre-legislative scrutiny before the Health Service Safety Investigations Bill was introduced in the other place in autumn 2019. The issue was also debated at length in Committee, and I look forward to hearing contributions from Members on that, particularly the hon. Member for Central Ayrshire.

Turning to the two minor and technical Government amendments to the health service safety investigations body provisions, amendment 24 is a technical amendment to clarify the definition of “investigation” that applies to part 4 of the Bill. Investigations carried out by HSSIB by agreement under clause 114, which relate to Wales and Northern Ireland, were never intended to be part of the main investigation function of HSSIB and therefore will not be covered by the safe space or other investigatory power provisions provided for in the Bill. The amendment ensures that the drafting of the Bill fully reflects that original policy position. I hope that hon. Members on both sides of the Chamber will be content to pass this technical amendment.

Finally, I turn to Government amendment 88 to schedule 13. Schedule 13 contains a regulation-making power which allows the Treasury to vary the way any relevant tax has effect in relation to associated transfer schemes. Regulations made under this power will be used to ensure that no unintended tax consequences arise. The amendment ensures that value added tax is included in the taxes which the Treasury can, by regulations, vary when considering the transfer schemes in this Bill. Without this amendment, it is possible that complications with VAT bills may arise when transfer schemes are made and transactions take place. It is for those reasons that I ask hon. Members to support this amendment.

I am conscious that other hon. and right hon. Members may wish to speak to their amendments. I look forward to addressing those that I have not directly addressed thus far when I wind up debate on this group of amendments. With that, I conclude.

--- Later in debate ---

[Justin Madders]

I thank the hon. Member for her intervention. The point about agencies and locum spend is not a new one. It will be interesting to see the figures for the last 12 to 18 months when the Minister has finally ratified them, because I suspect they will be even higher than those we have heard recently.

[Dr Whitford]

Having spent over three decades in the NHS, I know that this is not just about senior staff and what are called frontline staff. It is said, “We’ll protect frontline staff, but we’ll cut administrative staff or backroom staff.” However, if I am not in a clinic with the right results with the right patient at the right time, I am a waste of space. In actual fact, we need to look at the whole team. There is a sweet spot where I am working flat out but I have a team who are helping me. If we cut any of those, then we lose efficiency, and as the hon. Member for Twickenham (Munira Wilson) said, costs are going up, so we are becoming not more productive, but less productive.

[Justin Madders]

I thank the hon. Member for her intervention. Indeed, this actually covers some of the debate we had in Committee. There has been a rhetoric coming out of Government in recent months that managers are somehow a cost burden and that administrative staff do not actually help deliver the services. Of course, as the hon. Member has just pointed out, they are a vital source of support for those on the frontline.

--- Later in debate ---

[Dr Whitford]

It is not just that patients prefer to see a doctor long term. There are safety issues when locums in acute specialties move from hospital to hospital, particularly if they are dealing with an acute case. They do not know where things are or who to phone; passwords and phone numbers change. There is a real safety issue with having too many locum staff in the very exposed acute services.

[Jeremy Hunt]

I absolutely agree with the hon. Lady, who knows about acute services. I also point to recent evidence from Norway that shows the same for general practice: patients who see the same GP over and over again go to A&E departments less than patients who see different GPs.

[Jeremy Hunt]

My right hon. Friend is right that there are problems with the GP contract. I do not want to get into too many discussions about doctors’ contracts in this very consensual debate, but Conservative Members have to take responsibility for not having remedied the pensions anomaly, which gives people an incentive to retire much earlier than we would want. We have to address that issue.

Lots of people might reasonably ask whether I did enough to address the issues in the nearly six years that I was Health Secretary. The answer is that I set up five new medical schools and increased by 25% the number of doctors, nurses and midwives we train. However, that decision was taken five years ago and it takes seven years to train a doctor, so not a single extra doctor has yet joined the workforce as a result.

That is the nub of the problem: the number of doctors, nurses and other professionals we train depends on the priorities of the current Secretary of State and Chancellor. As a result, we have ended up with a very haphazard system that means that although we spend about the average in western Europe on health, as a proportion of GDP, we have one of the lowest numbers of doctors per head—lower than any European country except Sweden.

[Dr Whitford]

All Governments in the UK are expanding medical school places and trying to train more students, but that has led to a shortage of foundation places. In the first two years after a doctor graduates, they are not allowed to practise outwith a foundation job, and they can never practise if they do not go through a foundation job. In the summer, about 400 young graduates were still struggling to find a place. It took 19 years from my entering medical school to my becoming a consultant surgeon. We need to think not just about medical school, but about the whole pathway.

[Jeremy Hunt]

The hon. Lady is absolutely right. Medical school, the foundation years and, as my right hon. Friend the Member for South West Wiltshire (Dr Murrison) said, the retention of staff—all those things need to be built into long-term planning and baked into the system.

That long-term planning strikes a contrast, if I may say so, with some of the short-termism that we have seen recently. Even in the recent Budget and spending review, the budget for Health Education England, which funds the training of doctors in this country, was not settled. Although I think that the proposed merger with NHS England is probably the right thing to do, I fear it will mean that the budget is not settled for many more months, at precisely the moment when the workforce crisis is the biggest concern for the majority of people in the NHS.

--- Later in debate ---

[Jeremy Hunt]

I thank the hon. Lady, who before entering this place spent her time campaigning to support NHS and care staff. She speaks with great experience, and I think that the fundamental point she makes is very important. Unless there is long-term strategic planning, when we have a priority such as the one we have at the moment of tackling the backlog, we will often make progress on that priority by sucking in staff from other areas, which then suffer. That is an unintended consequence which happened when I was Health Secretary, and I fear that it will happen again without a long-term strategic framework.

Amendment 10 has wide support. It is supported by 50 NHS organisations, including every royal college and the British Medical Association—an organisation which, to be honest, is not famous for supporting initiatives from me—and by six Select Committee Chairs and all the main political parties in this place. I am sure that the Government will ultimately accept it, because it is the right thing to do, but if they are intending to vote it down today, I would say to them that every month in which we delay putting this structure in place is a month when we are failing to give hope to NHS staff on the front line.

Let me end by quoting the Israeli politician Abba Eban, who said that

“men and nations behave wisely when they have exhausted all other alternatives.”

Let us prove him wrong today by supporting amendment 10.

[Dr Whitford]

I am delighted to follow the Chair of the Health and Social Care Committee, and, in this rather unnerving outbreak of consensus and good humour, to mirror his speech and add my support to his amendment on workforce planning.

It is important to remember that healthcare is not delivered by hospital buildings or fancy machines; it is delivered by people to people, which is why the most important asset in any health service is its workforce. As I pointed out in an earlier exchange with the right hon. Gentleman, we need a long-term view, because it takes a long time to train senor specialists. As I said to him, it took 19 years from my entering medical school to my becoming a consultant breast cancer surgeon. We will struggle to work out what specialties we might need in 20 years’ time, because medicine is evolving, but many aspects and many sectors of staff do not change. If we do not get even those right, we are constantly in a position of drought and thirst, and it is not possible for staff to evolve—to pick up new rules, to use new techniques and to develop new services.

Although this workforce strategy would apply only in England, I would encourage consultation with the Health Secretaries and the workforce bodies in the devolved nations, because junior doctors in particular tend to move around during their training. During the junior doctors’ strike, which the right hon. Member for South West Surrey (Jeremy Hunt) might remember rather painfully, I talked to students on the picket lines whom I had trained. People move around, and it is important that such a strategy does not end up just sucking staff out of the three devolved health services. Also, many aspects of medical training are controlled on a UK basis. Foundation places for new graduates are decided on a UK basis, for example, so it is important to take that wider view.

The workforce shortage is the biggest single challenge facing all four national health services across the UK. It has been exacerbated by the loss of EU staff after Brexit, with an almost 90% drop in EU nurses registering to come and work in the UK. Early retirements are being taken due to the Government’s pension tax changes, which, as has been highlighted, have not been sorted out and are resulting in senior doctors paying to go to work. There is only so long that they will continue to do that. Finally, there is the exhaustion of dealing with a pandemic for the past 18 months. This is why it is really important, when we talk about NHS recovery, to have a greater focus on staff wellbeing and on their recovery. There can be no recovery of the NHS without them. I am really disappointed to see how the clapping of last spring has turned to severe criticism and attacks directly from members of the public, from sectors of the media, and even from some Members in this place and members of the Government.

I shall now speak to my own amendments 40 to 43, which seek to tightly define the materials covered by the safe space protections as part of Health Service Safety Investigations Body investigations. The idea behind HSSIB was to learn from air accident investigations and to provide a confidential and secure safe space in which healthcare staff could be open and candid in discussing any patient safety incidents. I was on the pre-legislative scrutiny Committee, which was chaired by the hon. Member for Harwich and North Essex (Sir Bernard Jenkin), and the recommendations of that cross-party—and indeed cross-House—Committee were very clear: evidence gathered under the safe space protocols should be protected and disclosed to third parties only in the most pressing situations, such as an ongoing risk to patient safety or criminality. Despite that, there are aspects of this Bill that could undermine the principle of the safe space, and that is what I am seeking to amend.

Amendment 40 would define he safe space materials much more tightly, because it seemed as though anything that HSSIB was using would be covered by the safe space protocol and that exemptions would then be made, whereas it makes much more sense to be very clear about the materials that are defined as protected materials. Therefore, all the original clinical information—medical notes, etc—would still be available to all the other bodies to enable them to carry out their investigations as they do now.

Amendment 43 would remove the ability of the Secretary of State to use regulation at a later date to authorise the wider disclosure of protected materials beyond the provision that is finally passed in this Bill. Amendment 42 would remove the provision allowing coroners to require disclosure of protected materials, as this has already led to calls for access by other health bodies and even freedom of information requests, as I highlighted in my earlier intervention. If a coroner uses safe space materials in their report, that report is public. The question is: how are they going to handle that so that the safe space materials are not further disclosed? It is critical to defend this. It is important to stress that HSSIB does not limit anyone else’s access to original materials, but nor should HSSIB be seen as an easy way for other bodies to avoid doing the legwork and carrying out their own investigations.

HSSIB will not apply in Scotland, where the Scottish patient safety programme is focused more on preventing patient safety issues in the first place. My interest is purely personal, as a surgeon. I experienced the impact of the Scottish patient safety programme when it was introduced to operating theatres in 2007. It cut post-operative deaths by 37% within two years. It has subsequently been rolled out to maternity, psychiatry, primary care and all the main sectors. It has not just reduced hospital mortality, but prevented morbidity—such as pressure sores, leg thrombosis or sepsis, which all in their own way cost the NHS a huge fortune.

--- Later in debate ---

[Caroline Nokes (Romsey and Southampton North) (Con)]

It is a pleasure to contribute to this debate and specifically to speak to new clause 1, tabled in my name and the names of the right hon. Member for North Durham (Mr Jones) and many other Members throughout the House. First, though, I pay tribute to my right hon. Friend the Member for South West Surrey (Jeremy Hunt) for his incredibly important amendment on the workforce. I also pay tribute to my hon. Friend the Member for North West Durham (Mr Holden) for his crucial new clauses on virginity testing and hymenoplasty. As the Chair of the Women and Equalities Committee, I was pleased to be able to support those amendments and am delighted that the Government have introduced their own new clauses on those issues.

I wish to talk specifically about aesthetic non-surgical cosmetic procedures, which may seem quite trivial in comparison with the important matters I just referred to, but I vividly remember visiting a doctor in my constituency and talking to her about her experience when a patient came to her after she had had far too much lip filler placed into her lips by an unqualified and inexperience practitioner. The poor girl’s lips had, frankly, exploded, leaving her permanently scarred and with the prospect of many years of corrective surgery to try to rebuild her face. That is the stark reality.

The hon. Member for Brent Central (Dawn Butler) spoke about people being able to call themselves nurses when they are not nurses; aesthetic cosmetic practitioners can not only call themselves that but perform all sorts of procedures, some of which we would find it bizarre and disturbing to talk about and, indeed, at some of which we might look with absolute horror when they are reported on the internet and in the pages of national newspapers. I am talking about semi-permanent make-up and permanent tattooing, which can leave people permanently disfigured. The semi-permanent variety can fade to leave people with bizarre blue eyebrows that require many different procedures to be put back to normal. The list is long: we are talking about tattooing, botox and laser treatment—just imagine the damage that high-powered lasers can do to somebody’s skin when in unqualified, untrained hands.

[Dr Whitford]

Along with the damage to patients who trustingly go for such procedures, is it not also about the fact that when they go horrifically wrong, as sometimes they do, it is the NHS that ends up having to pick up the pieces?

[Caroline Nokes]

I thank the hon. Lady for using exactly that term because she is right: it is about the NHS picking up the pieces and spending taxpayers’ money trying to correct something that should not have been done in the first place. If it is to be done to somebody, it should be done only by the qualified, trained and, as my new clause argues, licensed. I call today for some form of licensing or regulation. I absolutely accept that the Minister may view my new clause as deficient and not doing what he would want it to do. I appreciate the fact that he took the time to meet me and other Members last week to discuss the issue, because there are concerns throughout the House.

I pay particular tribute to my hon. Friend the Member for Sevenoaks (Laura Trott), who has done so much work on injectables in respect of under-18s and deserves absolute credit for getting her private Member’s Bill on to the statute book. That is amazing work and I really appreciate the fact that she has done it. Nevertheless, we need to do more and to go further.

I pay tribute to a number of my constituents who, following the work I did last year on the beauty industry, approached me on this issue. In particular, I pay tribute to Dr Chris Rennie of Romsey Medical Aesthetics, and to Dr Mitra Najafi, who has developed an incredible process by which plasma-rich platelets are extracted from a patient’s blood and injected back into them. It is a highly medicalised procedure and her big worry is that if it falls into the hands of somebody who is unregulated and unlicensed, it could be extremely dangerous indeed. Those with medical qualifications absolutely understand how they have to treat blood products; the stark reality is that those without do not.

I pay tribute to aestheticians—I struggle to say that word—such as Naomi O’Hara who came to me, as someone who practises, to call for regulation and licensing.

I pay tribute to a lady who is not my constituent but travelled to Romsey to see me: Tania Gough, who publishes the Image Directory. Her concern was that it is perfectly possible for someone to set themselves up in practice with next to no training whatsoever. She spoke to me of some of the horror stories that she herself had seen and some of the training courses she had gone on that she said were quite simply not worth the money she paid for them or the waste of her time. She said that certificates were issued at the end of such courses that gave the impression that people were qualified and trained when in fact they had had no more than a couple of hours—in one case it was 90 minutes—of training.

I also pay tribute to the Chartered Institute of Environmental Health and the Joint Council for Cosmetic Practitioners; they have been incredibly supportive and helpful in the drafting of new clause 1. The Joint Council for Cosmetic Practitioners says:

“The creation of a national licensing scheme for practitioners of aesthetic non-surgical cosmetic procedures would ensure that all those who practise are competent and safe for members of the public.”

To my mind, that is the abiding word: safe. We want those who receive these sorts of treatments not to be putting themselves in harm’s way.

I look forward to the Minister’s response; I know he is listening on this issue. He can expect me not to push my new clause to a vote, but I very much hope he can show us a constructive way forward that may take us to the regime that we want to see.

--- Later in debate ---

[Paul Bristow]

I would ask the hon. Member to listen a bit more carefully, because nowhere have I said admin should be carried out by the private sector. I said that it should not be carried out by medical professionals. They did not go to medical school to work in admin; they went to medical school to treat the sick. That is what we want our medical professionals doing—operating at the very top of their licence.

I also do not want to see situations where untold numbers of consultants are spending just one day a week in the operating theatre. I understand that consultants need the opportunity to train junior colleagues and to continue their own professional development, but they should be operating in our theatres a lot more frequently than that.

[Dr Whitford]

I gently point out that surgeons do not just operate—we run clinics; we run endoscopy lists and colonoscopy lists—so it is not that they are only working one day a week. They investigate the patient before they operate, and that is one of the strengths of the system in the UK in comparison to other countries, where surgeons only operate and someone else has done the diagnostics.

--- Later in debate ---

[Mrs Theresa May (Maidenhead) (Con)]

I rise to speak in support of amendments 93 to 98, whose purpose is very simple.

The Health and Social Care Act 2012 established parity of esteem between physical and mental health in their treatment in the national health service. The Bill is silent on the issue. I know that Ministers have given assurances, in a variety of ways, that it is not the Government’s intention to move away from that parity of esteem, but if that is the case, the answer is simple: accept the amendments. The Government do not even have to write them; they have been written for them. There would then be absolutely no doubt about the continued commitment to ensuring parity of esteem between physical and mental health.

Mental health was clearly in the long-term plan for the national health service that I was pleased to see introduced. It was there because of the need to accept, as Members across the House do, that for too long mental health has not been given the attention that it deserves. People who were suffering with mental health problems were not getting the services that they need.

It will take time to ensure that we can provide for all, but sadly the issue has been exacerbated by the pandemic. In March 2021, there were 26% more referrals for mental health services than in March 2019, before the pandemic. The Centre for Mental Health reckons that 10 million additional people will need mental health care as a result of the pandemic. I am particularly concerned about the impact on young people; I am sure that Members across the House are seeing young people in their constituencies whose mental health may have been suffering anyway, but has suffered even more as a result of the pandemic.

More people now require mental health services. The Government talk a lot about dealing with the backlog that is a result of the pandemic, but it is only ever spoken about with reference to surgery or operations. The great danger is that in their focus on dealing with that backlog, which we all accept is necessary, the Government will push the issue of mental health services to one side.

The amendments stand in the name of my hon. Friend the Member for Broxbourne (Sir Charles Walker), in my name and in the names of Members across the House—there is cross-party concern. I say to the Minister once again: it is very simple. If the Government wish to maintain parity of esteem between physical and mental health and ensure that people with mental health problems are given the services and care that they need, they must put uncertainty to one side, accept the amendments and make it clear that physical and mental health will be treated with parity of esteem in our national health service.

[Dr Whitford]

I rise to speak to my amendment 82, which is on legislative consent if the Bill is used in the devolved aspects of healthcare in future. The bulk of healthcare—certainly its delivery through the Scottish NHS—is devolved. Having been on the Bill Committee, I was surprised that in the original version of the Bill there was not one mention in that context of the word “consultation”, let alone the word “consent”.

I do welcome amendments 118 and 121. I recognise that the Minister is trying to work constructively with the devolved Governments, but health is devolved. I am sorry, but after the United Kingdom Internal Market Act 2020, because of how the funds to replace EU funding post Brexit are being used to cut the devolved Governments out of decision making, there is a real fear among the public in Scotland that their health services could be changed in future. I ask anyone who supports devolution in principle to support amendment 82.

[Matt Hancock (West Suffolk) (Con)]

I rise to support new clauses 60 and 61, which relate, like the amendments that the hon. Member for Central Ayrshire (Dr Whitford) spoke about, to the UK-wide application of the Bill.

Health is rightly devolved, and as Secretary of State I worked very closely with Ministers in the three devolved nations, but there are nevertheless areas in which it is vital that the NHS, as a British institution, supports all our constituents right across this United Kingdom. Two areas in particular are critical and, in my view, need legislative attention.

The first area is the interoperability of data. As well as being vital for stronger research, it is necessary not least so that if you travelled to Caerphilly or Glasgow and were ill, Mr Deputy Speaker, the NHS could access your medical records to know how best to treat you. We can see right now, in the application of the NHS app for international travel, what happens without the data interoperability that new clause 61 would require.

--- Later in debate ---

[Matt Hancock]

On the contrary: data protection laws are UK-wide, so it is appropriate that this should be done UK-wide.

The second area is services. For instance, if a new treatment is available to Scottish patients in Edinburgh, which has one of the finest hospitals in the country, and if on rare occasions it is available to a Welsh person in Wales with a rare disease, should that person not be able to benefit from it? Likewise, if a treatment is available in one of the great London teaching hospitals and somebody from Stirling needs it, should they not be able to get it? At the moment, access to such specialist services is available on an ad hoc basis, but it is not broadly available. That is what new clause 60 seeks to address.

[Dr Whitford]

I simply point out that it is available; it is just that funding has to follow from the domestic health board to pay for it. I have sent patients to Leeds for MRI-guided biopsy, and patients used to come to Glasgow to have eye melanoma removed without losing their eye. That already exists.

[Matt Hancock]

It happens on an ad hoc basis, but it is not a right. The NHS is a great British institution, and access should apply right across the board.

Finally, in my last few seconds, may I simply say how strongly I agree with my right hon. Friend the Member for Maidenhead (Mrs May) about amendments 93 to 98?

--- Later in debate ---

[Mr Baron]

I tend to agree, and that is in part what the new clause is intended to address.

I chaired the all-party parliamentary group on cancer for nine years. We were painfully aware that the Government had once estimated that if the country matched the best survival rates in Europe, 10,000 lives a year would be saved. In 2013, the OECD confirmed that that our survival rates ranked near the bottom when compared to those of other major economies. As we have improved our rates, so have other countries, and we are not closing the gap. A more fundamental change is required.

Back in 2009, when I first became its chairman, the APPG conducted a major inquiry which showed that the main reason our survival rates lagged behind others was not that the NHS was any worse than other healthcare systems at treating cancer once it was detected, but that it was not as good at catching cancers in the crucial early stages. In other words, late diagnosis lay behind our comparatively poor survival rates. The APPG had some success in getting the one-year survival rates—rates of survival one year after diagnosis—into the NHS DNA.

A key advantage of focusing on this kind of “outcome measure” is that it gives healthcare professionals much greater freedom and flexibility to design their own solutions, which could include running wider screening programmes and better awareness campaigns, and establishing greater diagnostic capabilities at primary care. A further advantage of focusing on outcome measures is that it will better align NHS priorities with patient needs. Survival rates are what really matter to patients. However, clinical commissioning groups are too often focused on “process targets”—the 62-day wait for treatment being an example—because they are often linked to funding. The one-year survival rate measure was not.

Research produced by the House of Commons Library found that nine such process targets were applicable to cancer alone, such as the 62-day wait. Process targets have a role to play in improving the NHS, but all too often they are a blunt tool offering information without context, and they can be exclusive, especially when funding flows are attached. Also, I consider it unacceptable that, in the case of certain cancers at least, patients should have to wait for 62 days—two months, in effect—for treatment. That is simply not right. Furthermore, process targets can easily become a political football between the two Front Benches, and only short-term points are scored. All sides are guilty of this, but it rarely helps patients.

In addition, process targets are not the best way of helping those with rarer cancers, with often fall between the cracks because data on those cancer types have not been routinely collected. That is a real problem. If we want to drive up survival rates, we cannot exclude rarer cancers, if only because they account for more than half all cancer cases.

Given the advantages of outcome measures such as one-year survival rates, I have tabled my simple amendment, new clause 19. Its aim is to ensure that NHS England puts outcome measures above process targets.

[Dr Whitford]

Will the hon. Gentleman give way?

[Mr Baron]

I will not. I do apologise, but time is short.

New clause has been endorsed by the founding chief executive of Cancer Research UK, Professor Sir Alex Markham, who has commented that

“comparable health services abroad continue to outperform the NHS in terms of cancer survival. They all remain focused on cancer outcomes and the UK would be foolish not to do likewise.”

The new clause has also been endorsed by others, including the Teenage Cancer Trust. I assure those who are concerned that it will not detract from process targets; quite the opposite because, by implication, improved outcomes can only be facilitated by improved processes and inputs.

I urge the Minister to adopt the new clause. He will then have more time to assess its impact, and perhaps, following consultation, suggest amendments—if necessary —in the other place. I am confident that sufficient cross-party support could be achieved if acceptable nuances were required. If that is not possible, I intend to press the new clause to a vote, but I sincerely hope that I—we—can work with the Government and other parties to drive up survival rates in the NHS across the United Kingdom.

Health and Care Bill

Philippa Whitford Excerpts

Report stage
Monday 22nd November 2021 Commons Chamber

[Mary Kelly Foy]

Again, I could not agree more.

In Committee, the Minister said that the Department could already legislate under the Children and Families Act 2014 to require the insertion of such information messages. In that case, why do the Government not commit themselves to doing so now?

New clauses 4 to 6 address loopholes in current legislation. Now that those loopholes have been identified to the Government, they should be fixed without delay, and today we have the opportunity to do so. New clause 4 would give the Secretary of State powers to remove child-friendly branding elements from nicotine products. There are e-liquids on the market that are given sweet names, such as “gummy bears”, and that have branding that is in garish colours and features cartoon characters. Surely more evidence is not necessary to prove that such branding risks attracting children.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

Is this not one of the most important of the hon. Lady’s new clauses? As people age and die—events often driven by cigarettes—or perhaps manage to give up, the tobacco companies must recruit the young, with the indefensible aim of persuading them to start smoking.

[Mary Kelly Foy]

I entirely agree. Tobacco is the only legal product that kills one in two of those who use it, and most people start smoking at a young age. These new clauses are therefore extremely important, because they would tackle that problem.

--- Later in debate ---

[Richard Fuller]

It is a great pleasure to follow the hon. Member for Nottingham North (Alex Norris). I will speak to new clause 14 and the other amendments in my name. I am grateful for the Opposition’s support for amendments 6, 7 and 8 and for an industry-led alternative—in spirit, if not necessarily in voting. I think the hon. Gentleman, as well as many of my hon. Friends, will be wanting to hear something from the Minister to show that he has been listening to concerns that have been raised across the House.

I was surprised and delighted to see on some of my amendments the name of the hon. Member for Central Ayrshire (Dr Whitford), but she advised me that that was an error, so I am sorry that the potential amity between me and those on the Scottish National party Benches will have to wait for another day.

[Dr Whitford]

I am grateful to the hon. Gentleman because that has saved me from having to put a disclaimer at the start of my speech, as I was rather shocked to find my name on his amendments. I just reiterate the point made by the hon. Member for Nottingham North (Alex Norris). It is a concern that the names of companies, as we saw in F1 racing and other things, simply promote certain types of food and drink and you cannot separate the brand from the product.

--- Later in debate ---

[Richard Fuller]

I absolutely do not agree. The reason why the Opposition Front-Bench team are probing on this is that we are not harnessing all the talents to come up with the solution. As the hon. Member for Nottingham North said, he does not have, or want, any objection to the objective—he just feels that there may be better ways to do it. That is what my amendments are trying to create. They would introduce a better way, working with established principles and with the industry—let us face it, it has the experts in this—rather than undermining issues to do with how the Advertising Standards Authority has managed how products are advertised and rather than bulldozing through the industry, which is the current process that the Government, or this Department anyway, are proposing.

Let us just remember that this pressure on our food and drink manufacturers is part of a wider effort of social responsibility that we are putting on them. The proposal does not sit alone, but with other things, in particular around environmental protection. The Food and Drink Federation has calculated that the cost of the UK Government’s proposed environmental health policies is at least £8 billion. That is equivalent to £160 a year on household food bills that we are asking the industry to take on.

It is estimated that the introduction of this policy will cost £833 million, but the Government’s own impact assessment estimates that the benefits are likely to be in the order of only £118 million. That is a real dead loss that we will be putting, let us face it, on food bills, primarily of those in lower income brackets. Members on all sides should take a moment to consider whether this is the right time and the right process for doing that. As the Government’s own assessment shows, the actual effect on diet for those who are targeted is estimated to be 1.7 calories a day, so it is a lot of effort and cost, but not very much impact.

New clause 14 proposes an alternative that would require the regulator to implement an alternative set of increased restrictions for online, but developed through the industry by the Committee of Advertising Practice. The new clause would legislate for a three-step filtering process drawn up by the industry to appropriately manage the targeting of online ad campaigns.

Another of my amendments would introduce brand exemptions. I take a different view from the hon. Member for Central Ayrshire, who said that brands are intrinsically tied to their product. The truth of the matter is that Coca Cola is made by Coke and Coke Zero is made by Coke. Coke Zero is advertised with the word “Coke” on it. This issue is not necessarily covered by the legislation, but Coke is not tied to one thing. Brands are extraordinarily flexible in how they can assist progress in achieving some social means. The Minister should consider looking again at this area.

Finally, on the nutritional profile, the issue is consultation. I can see that the Secretary of State has tabled some amendments on that, and perhaps the Minister can talk about that. They do not seem to make the changes I would like to see, but I would be interested to hear what he has to say.

It is worrying that the Government have undermined the Advertising Standards Authority with their approach. One of the other things is targeted advertising. I am sure it has struck hon. Members here as it has me that the tech revolution of the dotcom era was 20 years ago, and two decades of technical expertise in understanding how adverts are targeted is being swept away or ignored by the Department of Health and Social Care, which would much rather have “nanny knows what’s best”. The truth of the matter is that, by harnessing technology, the Government could get a better outcome than this official ban. As my hon. Friend the Member for Buckingham said, there are plenty of other ways to do it that would be hard for advertisers to get around.

I say to the Minister that I am trying to be helpful, as always, and, to be serious, as are the Opposition. The Government have made a slight misstep by adopting a top-down, state-driven model. I say to the Minister that the path of good intentions is littered with unintended consequences. The essence of conservatism is not to use the state to bully or, as perhaps the advisers in the various Departments say in modern parlance, to nudge. It amounts to one and the same thing. The Department’s attempt to censor products such as these is profoundly un-Conservative. Our party believes in individual responsibility and that families are the foundation of society where choices and power in society most naturally lie. Nowhere is that more important than in health matters, yet these proposals extend the role of the state and undermine parental responsibilities.

The measures make the Department of Health and Social Care look like a new outpost of cancel culture that denies free speech and has a predisposition that individuals should conform to what the state determines, rather than enabling informed free choice. It is desperately sad to see them being pushed through by a Conservative Administration. I say to my colleagues on the Back Benches: when will we wake up and realise that we need a Government who support free enterprise and individual responsibility, and who understand that the way to create growth in the economy is through enabling people to make free choices, rather than expecting the state to be the answer to every problem? With that question, I will wait to listen to what the Minister has to say.

[Dr Whitford]

I thank the hon. Member for North East Bedfordshire (Richard Fuller) for clarifying that I had not voluntarily added my name to his amendment.

Whenever we talk about such subjects, we hear a lot about the nanny state. As a surgeon working in A&E in general surgery, however, the difference when seatbelts, airbags and speed limits came in was night and day in how much time I spent dealing with people in operating theatres who had been involved in car crashes. Sometimes the state has to take action to protect people’s health and wellbeing.

The Bill focuses largely on reversing some of the most egregious aspects of the Health and Social Care Act 2012, which I welcome, but these measures focus on improving public health. There is no question that obesity, type 2 diabetes and other diseases associated with obesity pose not just a real threat to individual health but a threat that will overwhelm national health services in future. When I looked at the original Bill, however, I was surprised that, apart from the measures around obesity, there was little in the way of public health policy to improve and promote health, and there is also little enough about care.

It is not the national health service that delivers health. I have often said that it would be more appropriate to call it the national illness service, but who would want to work somewhere called that? The NHS spends most of its time catching people when they fall. Health comes from a decent start in life, a warm dry home, enough to eat and a decent education. Those are the things that deliver health, but there is nothing like them in the Bill.

Particularly, and surprisingly, there is nothing in the Bill on reducing harm from tobacco products and alcohol, which is why I rise to speak in support of new clauses 2 to 4, which seek to strengthen the health warnings on all tobacco products; new clauses 7 to 10, which seek to allow regulation of tobacco pricing; and particularly new clause 6, because the use of sweet flavourings to entice children and young people to take up smoking is indefensible.

[Barry Gardiner]

I heartily commend the hon. Lady for her comments. Does she experience in her constituency, as I do in mine, that smoking cessation services are diminishing and becoming less successful? As the tobacco industry concentrates on a core group of existing addicts, it is desperate to move down the age range and encourage new addicts. That is why that element of the new clause is important.

[Dr Whitford]

I agree that new clause 6 is the most important of the new clauses, because tobacco companies are driven to recruit new victims—as I would have to call them, as a doctor—and they are recruiting them from young people.

Public health is devolved, so we have not had the cuts in public health funding that we have unfortunately seen in England since 2016. Therefore, we have not had the cuts to smoking cessation and sexual health services that many local authorities experienced across England when public health moved into local government.

Smoking does not just cause respiratory problems such as chronic obstructive airway disease, but affects all the blood vessels causing peripheral vascular disease, vascular dementia, strokes, heart attacks and many forms of cancer, not just lung cancer. Stopping smoking is the best favour anyone can do themselves, but many people require the very smoking cessation services that the hon. Gentleman mentioned.

--- Later in debate ---

[Christian Wakeford]

Obviously, as the chairman of the all-party parliamentary group on alcohol harm, I know that part of the issue with treatment—I am thinking in particular of new clause 16—is the stigma behind alcohol dependency and its still being seen as a personal choice. While we need to overcome the stigma of addiction, we first need to be having a conversation about alcohol. Does the hon. Member agree that, as part of the treatment, we need to be having this conversation on a national level?

[Dr Whitford]

I would say that really no one who has a health problem should be stigmatised. Having dealt over 33 years in the NHS with many people who were problem drinkers, I know that the public image of someone who abuses alcohol is quite a caricature. There will be many people across this House who drink more than is healthy for them and I have met many people as patients from the middle and upper classes who had serious alcohol problems, so we should get away from the stigma and the caricature. We will not spot everyone who needs to deal with alcohol just by looking at them.

[Catherine West]

I commend the work of my hon. Friend the Member for Liverpool, Walton (Dan Carden) in this regard. Does the hon. Lady agree with me that the whys and wherefores are all very well in this debate, but in the end the cuts to local government, which would primarily be providing services in relation to alcohol abuse, have been most disgraceful, and that is why we are seeing the huge increase in the number of people who have passed away from alcohol disease in the last couple of years following covid?

[Dr Whitford]

There is no question but that, after public health moved into local government—we can absolutely defend that because, as I have said, health is often delivered by things that are nothing to do with the NHS—the problem was that the budget was then cut, so the potential benefit of putting public health into local government was lost due to the cuts to services.

On alcohol not being classed as a less healthy food, with this Government I find it hard not to ask: why not, and what or who may have influenced that decision? I certainly support amendments 11 to 13 from the hon. Member for Liverpool, Walton (Dan Carden), which would include alcohol, particularly the medium and high-strength alcohols, under less healthy foods, so that alcohol is covered by advertising regulations. I also support his new clause 15, which would mandate much clearer labelling of alcohol units, or whatever measure, on labels. It is no good just saying “Drink aware” or “Drink Responsibly” when the consumer has not actually been given the tools on the product to make a proper choice, such as by asking, “How much is in this?” Why not agree to use a simple, straightforward approach? A lot of public health advice is in units, so why not actually use them? People would then learn to be aware and ask, “How many units have I already drunk today?” or “How many units have I already drunk this week?”

New clause 17 calls on the UK Government to follow Scotland, and now Wales, by introducing a minimum unit price for alcohol. The UK Government have the advantage in that they can do that by setting alcohol duty based on unit, instead of on classes of drink. In every Budget we hear about a penny on a pint of beer, or so much on spirits, but why not do it by unit? It is much more accurate, and it would still allow the raising of taxation to help fund alcohol services, as well as those public services most hit by alcohol abuse, such as healthcare and policing. Under devolution the Scottish Government, and now the Welsh Government, did not have that power.

Over the past year and a half of the pandemic we have, unfortunately, seen a big increase in both smoking and alcohol consumption, as people struggled to cope with the loneliness and boredom associated with lockdowns and pandemic restrictions. However, the initial valuation of minimum unit pricing in Scotland showed that alcohol sales fell, for the first time in many years, by more than 7% in Scotland, compared with a continued rise in England and Wales. It was not possible to demonstrate a reduction in overall alcohol-associated admissions to hospital, which may include car accidents, violence and so on, but there was a drop in admissions due to alcoholic liver disease, suggesting that the policy was working. More evaluation after the pandemic will be required, but an immediate impact was an almost three-quarters drop in the sales of cheap white cider. That product is cheaper than soft drinks, and predominantly used by young—indeed, often under-age—drinkers, who purchase it, or get someone else to purchase it, so that they can drink it at home. However, that sector is literally disappearing overnight.

It will be important to review and maintain the pressure of the unit price on a regular basis, because young drinkers also drink many other products—this is the same issue as young smokers; more people are being recruited, often into problem drinking and problem products. Minimum unit pricing does not affect good wine, high-end spirits, or what is sold in a pub, but it does affect what someone can buy in a small shop to then hang out with their mates in their bedroom. Some of those products are not affected by the 50p unit price, and that must be kept under review.

I was disappointed that new clause 30, which is listed for discussion tomorrow, was not included in this group. It calls on the Government to reform the out-of-date Misuse of Drugs Act 1971, and to devolve it so to allow the devolved nations to take a public health approach to tackling drug addiction, in the same way as we take a public health approach to dealing with alcohol. Such an approach has already been demonstrated in many countries across the world, yet the Government keep sticking their head in the sand.

[Hywel Williams]

I am grateful to the hon. Lady for mentioning new clause 30, which I still hope against hope we might be able to discuss tomorrow. I am sure she will agree that problematic drug abuse is an illness and a social ill, not a crime, and our emphasis must be on harm reduction, treatment, and support for the problematic drug user.

[Dr Whitford]

That is the policy of the Scottish Government, and we would absolutely support the new clause if it is voted on tomorrow.

As Opposition Members have said, key to improving public health would be restoring the non-covid related public health budget in England. We cannot hide behind covid funding, because that is used up by the pandemic and does not help us with smoking, alcohol, or drug addiction. The biggest contribution the Government could make would be to abandon their plans for yet another decade of austerity. We hear the slogan all the time—levelling up—but it rings hollow after taking away £1,000 a year from the poorest families and most vulnerable households. Over the past decade, cuts to social security have caused a rise in poverty among pensioners, disabled people, and particularly children. Sir Michael Marmot was mentioned earlier, and his research was clear: poverty is the biggest single driver of ill health, and the biggest driver of poverty is Tory austerity.

[Bob Blackman (Harrow East) (Con)]

It is a pleasure to follow the hon. Member for Central Ayrshire (Dr Whitford), who brings her knowledge of the medical profession to this House on every occasion. I agreed with almost everything she had to say, apart from the last comment.

I declare my interest as chair of the all-party group on smoking and health, and I support all the new clauses tabled in the name of the hon. Member for City of Durham (Mary Kelly Foy). These comprehensive proposals are complementary and can be picked up by the Government. The new clauses were tabled in a different form in Committee. They were discussed and debated, and I think Ministers said they would take them away and have a further look. We have refined the proposals on the basis of the debate in Committee, strengthened them, and brought them back again, and they address the loopholes in current legislation. They strengthen the regulation of tobacco products still further, and they provide funding for the tobacco control measures that are so desperately needed if we are to deliver the Government’s Smokefree 2030 ambition.

We had an excellent debate in Westminster Hall last week, to which the new Under-Secretary of State for Health and Social Care (Maggie Throup) responded. Questions were posed to the Government from across the Chamber about when we will see the long-promised tobacco control plan, which is presumably due to be delivered by 31 December this year. We got no firm commitment on when we will see it, and I would like my hon. Friend the Minister to bring that forward as soon as possible. We can then measure what will happen.

The problem we have with tobacco control right now is that if we do nothing and none of these measures is introduced, the risk is that, as the hon. Member for City of Durham rightly articulated, we will miss the target by seven years. For those on low incomes and in deprived circumstances, it will be 14 years. We must consider how many people will die from smoking-related diseases as a direct result of the Government’s failure to achieve their Smokefree 2030 ambition. It is clear that we need to take further action, and I urge the Minister, who I know is a doughty campaigner for public health, to make sure that we deliver on the proposals.

My main focus is obviously on the new clauses that seek to provide funding for tobacco control. We all accept that not only can we implement measures, but we have somehow to fund them. That is critical. We must also consider raising the age of sale, as that, unfortunately, is a key proponent in encouraging young people to start smoking. The spending review failed to address the 25% real-terms cut to public health funding since 2015. Reductions in spending on tobacco control have bitten even deeper, by a third, since 2015. We need new sources of funding.

The Government promised to consider a polluter pays levy in the 2019 Prevention Green Paper, when they announced the Smokefree 2030 ambition. The all-party group on smoking and health has done the analysis, and we estimate that in the first year alone of a polluter pays levy, £700 million could be raised. That would benefit not only England, but the whole United Kingdom. It is more than twice the estimated cost of the tobacco control measures that we are proposing tonight, and that would then leave the Government with further funding to spend on other health priorities. The proposal is for a user fee, along United States lines, rather than an additional tax. Now that we have exited the European Union and can set our own rules, EU tobacco manufacturers’ profits can be controlled. They cannot pass the cost on to the consumer, but we can control their profits and use those for preventing people from smoking in the first place. It is quite justified that we should tax the manufacturers’ profits. This is the most highly addictive product that is legally available, and it kills those who use it for the purpose for which it was intended.

--- Later in debate ---

[Jeremy Hunt]

I am happy to do that, because I know my hon. Friend has a great interest in social care issues. I feel conflicted by new clause 49. I think that what we will end up with after this measure will be a whole lot better for people on low incomes than what we had, because the means-test threshold will be raised from £23,000 to £100,000, and that is a very significant improvement. However, I have to be honest and say that it is nothing like as progressive as we had hoped, but it is a step forward. My concern when it comes to social care is that our entire debate is focusing on what does and does not contribute to the cap, when the fundamental problem in social care is the core funding to local authorities; that, though not a matter for this Bill, has a direct impact on the care received by our constituents.

I conclude by thanking the Government for their support for amendment 114. I will move it formally later, but I am not expecting to divide the House on it.

[Dr Whitford]

I initially want to touch on new clause 49. Like other members of the Bill Committee, I sat through hours and hours from September to November, and the Government have suddenly pounced on us with this at the last minute. It is such a complicated new clause, but it has not been interrogated.

It is quite clear that the Government’s original spin that no one would pay more than £86,000 for social care and no one would have to sell their house is completely misleading. All the accommodation costs are on top of this. As has been highlighted in the media and by Members in the Chamber, those with assets of about £100,000 will not see any real gain from this policy, while those sitting on assets of £500,000 or more will keep a lot of their wealth. That means it exacerbates the differences, and penalises those in the north of England and areas where house values are not so high. Basically, it is feeding the frenzy down here of people sitting on over-inflated house prices. As has been said, this is not levelling up, just doubling down.

The cap applies only to personal care, which means things like washing and dressing. That has been provided free in Scotland both within the care home and in home care since 2002. It was expanded in 2011 to provide more hours so that people with greater need could stay at home longer, and it was extended to those under 65 with care needs in April 2019. Scotland is the only UK nation that provides free personal care, and we see it as an investment. It is an investment that we spend 43% more per head on social care in Scotland, but it is an investment in people’s independence and their inclusion in society. The problem is that we spend far too much time talking about social care just as a burden, instead of actually seeing it from the point of view of the user.

The Scottish Government have already added an extra penny on taxation for medium and high earners to cover things such as our wellbeing policies, health or social care, but this Government’s plan to increase national insurance contributions will disproportionately hit low-paid workers and young workers. I would say that the biggest weakness of all, as we know from the original debate on the national insurance change, is that the funding is not going to go to social care initially; it is going to go to the NHS, yet it is social care that is in crisis. This is what is causing the pressure in accident and emergency, because people who are ready to be discharged simply cannot be, as the care support is not there. I do not think that this fixes the problem. There will actually be very little money, because a lot of it is going to go on capping the overall payment. I do not see social care benefiting from this at all, yet it is social care that needs investment more than anything else.

Turning to the main substance of the Bill, which is meant to some extent to unpick the damage and fragmentation of the Health and Social Care Act less than a decade on, I wish to express support for amendments 9 and 72. Many in the NHS, including me, will be glad to see the back of section 75 enforced tendering. Others in the Chamber know that it was the Health and Social Care Act that brought me into politics, as I just could not believe anybody thought what they were doing was a good idea. It is still clear from the pandemic that this Government are absolutely wedded to outsourcing services to private companies, and to the flawed notion that financial competition somehow drives up clinical quality. I am sorry, but that simply is not the case. As the Chair of the Health and Social Care Committee has highlighted, we have to focus on safety, on clinical audit, and on peer review if we want to drive up care quality for patients, not just on the money in the system.

The Government appear to have conceded that integrated care boards should be statutory bodies, as health boards have always been in Scotland, but partnership boards can include private providers, such as with Virgin Care in Bath. As the partnership boards will be involved in devising the local strategy for health services, that is likely to lead to a blatant conflict of interest, and I do not see a resolution to that. The NHS simply should be the presumed provider of health services. That is not just, as the shadow Health Minister said, because the NHS is in it for the long term, or for a quick contract, but because the NHS provides the training to nurses and doctors who are the vital workforce of the future. Private providers do not do that; private providers largely live off the NHS. As well as not training staff, where there are major problems or complications, patients inevitably end up in the intensive care unit of an NHS hospital.

In conclusion, for all the size of the Bill, and the scale that the reorganisation will involve for staff in the NHS, who we all know are frankly exhausted, the Government have failed to take the opportunity to repair fully the damage of the Health and Social Care Act 2012, and to recreate in England a unified public health system, such as the one we are lucky enough still to have in Scotland.

Health and Care Bill (Twenty Second sitting)

Philippa Whitford Excerpts

Committee stage
Tuesday 2nd November 2021 Public Bill Committees

[Justin Madders]

The proposed new clause was inspired by the Royal College of Surgeons of Edinburgh, who made representations about what we think is a lacuna in the current regulations that needs filling. According to the National Health Service (Appointment of Consultants) Regulations 1996 and subsequent guidance issued by the Department in 2005, only the Royal College of Surgeons of England is permitted to review surgical consultant job descriptions and send a Royal College representative to the advisory appointment committee. Although the process applies only to non-foundation trusts, the 2005 guidance encourages foundation trusts to follow that process as it provides a structured, quality approach to consultant appointments. Given that the 2005 guidance remains the most up-to-date advice available to trusts, the Academy of Medical Royal Colleges continues to recommend that foundation trusts follow the process.

The net effect of the regulations and guidance has been to formally exclude the Royal College of Surgeons of Edinburgh from the entire surgical consultant appointment process. Given its size and the distribution of its fellowship throughout England, it is keen to help trusts, whether they are foundation trusts or otherwise, in their ability to appoint and retain senior surgical professionals. I understand the Royal College of Surgeons of Edinburgh has raised this anomaly with the Department on a number of occasions—I can see the Minister nodding—and it has been told that any changes to the regulations or the guidance would require legislative approval, so the opportunity has been taken today to slip the new clause in to try to resolve that.

As we know, we have record waiting lists of some 5.7 million—probably rising. It is clearly an important priority for everyone that the backlog is tackled, and the new clause would go some way to ensuring that the NHS is a resilient and sustainable surgical body to be able to meet the challenge. We see it as a tidying-up exercise that is long overdue.

New clause 70, tabled by the Scottish National party spokesperson, the hon. Member for Central Ayrshire, goes a little further than new clause 65 in terms of the requirements put on the Department. I hope the Minister understands the sentiment behind our tabling the new clause. This long-standing issue needs legislative remedy, and I hope that this is the opportunity to put it right.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

I rise to speak to new clause 70 and in support of new clause 65. I agree with the shadow Minister that these are very much technical new clauses to correct an anomaly. There are three royal colleges of surgeons in the UK: the Royal College of Surgeons of England, the Royal College of Surgeons of Edinburgh and the Royal College of Physicians and Surgeons of Glasgow. Consultant surgeons may be appointed from among the fellows of any of the three colleges. The exams they sit and the qualifications they carry are considered absolutely equal.

The challenge when recruiting a new consultant, as the shadow Minister highlighted, is that the appointment panel, which must review the job description and take part in the interview, is limited purely to those who have graduated with their fellowship from the English college. The appointment panels have a mix of representatives from local organisations, specialty bodies, if it is a specialty surgical appointment, and the royal colleges, so while fellows of all the royal colleges may be involved in appointments to English trusts as specialty representatives—such as breast cancer, which was my specialty—some are excluded from being college representatives. It is often really challenging to bring these panels and committees together.

The aim of the new clause is simply to widen the pool of assessors available to trusts in England and, indeed, as the shadow Minister highlighted, to foundation trusts. It is simply an anomaly that two of the colleges in the UK are not included. The new clause aims to correct that and to make the appointment of new consultants easier for trusts and foundation trusts in England. I hope that the Minister will accept both the spirit and the detail of new clause 70.

[Edward Argar]

I am grateful to hon. Members for bringing this issue before the Committee: I think we have all received correspondence on it from the various royal colleges. New clause 65 would amend the Bill so as to require that a review is undertaken of the National Health Service (Appointment of Consultants) Regulations 1996 and its most recent guidance. It is important that the regulations governing consultants and the accompanying guidance ensure that prospective consultants are highly capable and safe to practise while not hindering effective recruitment.

The current regulations govern the appointment of all consultants to NHS trusts and special health authorities. Reviewing the regulations only in relation to surgeons would risk diminishing consistency in the regulations. We believe the current regulations ensure consistent standards across all specialties. Those regulations are kept under review, and we therefore do not believe that this new clause would improve what already exists under the current policy. Similarly, responsibility for reporting on recruitment practices relating to a specific specialty would fall to the royal colleges rather than the Department. Should the royal colleges recognise an issue with recruitment and appointment to a particular specialty, the Department would expect the relevant royal college to report on that, which we would always consider in detail.

New clause 70, tabled by the hon. Member for Central Ayrshire, would amend the National Health Service (Appointment of Consultants) Regulations 1996 to confer authority on the Royal College of Surgeons of Edinburgh, the Royal College of Physicians and Surgeons of Glasgow and each of their associated dental faculties to sit on the panel concerned with the appointment of consultants in England. I sympathise with that. The Government agree that including those colleges would potentially be significantly advantageous. However, the challenge is that the National Health Service Act 2006 stipulates that consultation with affected parties must be undertaken before any changes to these regulations can be made. As such, our concern is timing: it would go against normal practice and not necessarily be appropriate to make such a change without consulting the relevant parties.

[Dr Whitford]

I have no objection to the need to consult. The Royal College of Physicians and Surgeons of Glasgow would indeed like section 2(1) of the regulations changed so that its members could be involved in the appointment of consultant physicians. I was unable to consult with the Royal College of Physicians of Edinburgh in time to allow the new clause to include that. I totally recognise that there is a role for consultation in order to get the change to those regulations right. However, surely with such legislation going through, this is the opportunity to agree to correct this anomaly, and therefore make appointments of new consultants in English trusts simpler.

[Edward Argar]

I think that is where the hon. Lady and I slightly diverge; we do believe that it is right that we follow the normal process of consultation before bringing any changes forward. I hope, in my final paragraphs, I can give her a little reassurance in respect to her intent. I hope that I can reassure her that, although the Royal College of Surgeons of Edinburgh and the Royal College of Physicians and Surgeons of Glasgow are not formally named in the regulations as relevant colleges in relation to the appointment process, the regulations do not prevent trusts from seeking alternative members to contribute to the process. That does provide discretion to involve these colleges where appropriate.

My further reassurance, which I hope will go some way towards satisfying the hon. Lady, is that the letters and requests came in relatively late in the Committee’s proceedings: I will undertake to review that request with my officials. I will look at whether what we have already got is sufficient, or whether there is merit there that does not require that consultation and those changes—

[Dr Whitford]

rose—

[Edward Argar]

I have one sentence to go, so the hon. Lady gets in just in time.

[Dr Whitford]

A trust could include other members of the panel, but they could not be recognised as the Royal College representative. That is often one of the challenging roles, because the panel cannot go ahead if it does not have a Royal College representative.

[Edward Argar]

I hope I can reassure the hon. Lady that in respect of the specific request that the two Royal Colleges have made, I will take that away, look at it and consider whether it works now, or whether there is something we can do. That will be either in this legislation, or following consultation, via another mechanism to address the underlying issue that they have drawn to our attention.

[Justin Madders]

Thank you, Mr Bone, but I am sure you would not want me to attempt any medical procedures.

I have heard what the Minister has said; clearly it is still under active consideration by the Department. As we know, there will be many more legislative opportunities in the coming months and years—I hope we will get an opportunity to crack this. I beg to ask leave to withdraw the clause.

[Dr Whitford]

I accept the Minister’s reassurance that they will finally look at correcting this anomaly; I hope that he will take that forward. It is something that we will be looking for. I beg to ask leave to withdraw the clause.

Clause, by leave, withdrawn.

New Clause 66

Support provided by the NHS to populations at risk of malnutrition

“(1) Each integrated care board must—

(a) assess, or make arrangements for the assessment of, the need for support for patients and/or populations at risk of malnutrition, including social and clinical/disease related malnutrition, using their services;

(b) prepare and publish a strategy for the provision of such support in its area;

(c) monitor and evaluate the effectiveness of the strategy; and

(d) designate a malnutrition lead.

(2) An integrated care board that publishes a strategy under this section must, in carrying out its functions, give effect to the strategy.

(3) Before publishing a strategy under this section, an integrated care board must consult—

(a) any local authority for an area within the relevant Integrated care board’s area; and

(b) such other persons as the relevant local authority considers appropriate.

(4) For the purposes of subsection (3), ‘local authority’ means—

(a) a county council or district council in England; or

(b) a London borough council.

(5) An integrated care board that publishes a strategy under this section—

(a) must keep the strategy under review;

(b) may alter or replace the strategy; and

(c) must publish any altered or replacement strategy.

(6) The Secretary of State may by regulations make provision about the preparation and publication of strategies under this section.

(7) The power to make regulations under subsection (6) may, in particular, be exercised to make provision about—

(a) the procedure to be followed by an integrated care board in preparing a strategy;

(b) matters to which an integrated care board must have regard in preparing a strategy;

(c) how an integrated care board must publish a strategy;

(d) the date by which an integrated care board must first publish a strategy; and

(e) the frequency with which an integrated care board must review its strategy or any effect of the strategy on the provision of other provision in its area.

(8) Before making regulations under this section, the Secretary of State must consult—

(a) all integrated care boards; and

(b) such other persons as the Secretary of State considers appropriate.” —(Alex Norris.)

This new clause would require integrated care boards to publish a strategy for the provision of support for patients and/or populations at particular risk of malnutrition using their services, and designate a malnutrition lead.

Brought up, and read the First time.

[Alex Norris]

I beg to move, That the clause be read a Second time.

This new clause would put responsibility on integrated care boards to take the lead on tackling malnutrition in their community. We spoke about malnutrition in the context of hospital food standards, and we were not able to move the Minister to extend those hospital food standards to other care settings. I thought that was a shame, and I hope the Government will continue to look at the issue. I want to broaden the conversation on malnutrition to try, via another way, to improve the standing of our communities.

Malnutrition is a serious condition that occurs when a person does not get the energy or vitamins that their body requires to function properly. It affects at least 3 million people every year, and it costs the health and social care system £23.5 billion each year. The condition is particularly common amongst certain groups. Those groups are: older people; hospital patients; people in mental health units and care homes; people living in sheltered housing; and those living with chronic diseases, such as cancer. Malnutrition can seriously threaten patients’ health. Hospitalised malnourished patients are three times more at risk of infection than the well-nourished, while hospital patients at high risk of malnutrition are 12 times more likely to die early than those at no risk. It is a very significant issue. Unfortunately, the figures are not moving in the right direction. The number of adults being admitted to hospital with malnutrition has more than doubled in the last decade—that is the bill for austerity. The evidence is clear that malnutrition impacts a wide range of people in different health settings; again, those are hospitals, mental health units, care homes and sheltered housing. It has a knock-on effect on other conditions.

Earlier this year, the media reported the death of a young disabled woman after a routine operation. Her death was partially caused by malnutrition, and the coroner said there had been a gross failure of care in managing her nutrition. A July 2021 report on malnutrition called it a widespread yet historically overlooked and undertreated issue in the NHS and social care, and attributed that to two factors that block progress—a lack of understanding, and a lack of systematic leadership. The new clause seeks to address that at a local level, which is why we think it is a good one.

The tragic case that I have mentioned shows how important it is to have a clear strategy to tackle malnutrition, to have designated leads and to have targets and co-ordinated policy. The Government say that integrated care boards are about ensuring proper integration between health staff and community services, and this is a really good example of a way in which that could be done. I am keen to hear the Minister’s assessment of the new clause, which should be included in the Bill. We have a significant issue that we are not addressing and that is getting worse, so what are we going to do differently?

--- Later in debate ---

[Alex Norris]

I am grateful for that intervention. It is sobering to hear that 55% was what we started with; we know that it will be less than that now. That rather picks away at the idea of a universal healthcare service.

To finish where I was going with my previous point, if I am wrong about where recovery funding for the NHS is going, and there is to be investment in dentistry, I hope that the Minister will correct me. I would be delighted if that was the case, because the BDA is warning—again, this is something that we will have picked up on in our constituencies—that morale among NHS dentists is at an all-time low. Almost 1,000 dentists in England have stopped providing NHS services in the last financial year. There was the failed contract—I know there is enthusiasm for contract reform in the Department and we will support the Department on that, but we are running out of time to have anything ready for April. In fact, we are probably already too late in that regard. The shambles of the negotiations before Christmas last year that led to the breakdown and the imposition of targets really whittled away at good will and caused a lot of upset.

Almost half of NHS dentists are saying that, unless things change, they intend to hand back their contracts or reduce their NHS commitment. This exodus of dentists from the NHS will have a disastrous and lasting impact on our ability to access NHS dentistry. If 55% is the summit of our ambition, goodness me, where will we go from there? The British Dental Association talks about the last-chance saloon; it is not hyperbole to say that we will not have NHS dentistry in the medium term if we do not have a course change.

More and more people are being pushed into the private sector. That creates market forces that mean that it is almost a self-fulfilling prophecy that dentists—both new ones entering the profession and those who have come to the end of their tether with their NHS contract—go into the private sector. We are seeing significant growth in that space as people living in pain seek drastic action. We will see more pushed on to dental insurance if people do not want to be worried about their finances. That is what privatisation looks like. We will not have NHS dentistry in the medium term unless we do something about this issue—that is the wrong way forward.

New clause 68 makes a very modest ask; it asks the Secretary of State to do what any Secretary of State should want to do: commit to universal access to NHS dentistry and say how it will practically be achieved. At the moment, we have a yawning gap. In that lack of leadership, we will see the drip, drip, drip of the loss of NHS dentistry, until we no longer have it.

[Dr Whitford]

I rise to support new clause 68, which is linked to new clause 67. We are aware of the impact of the pandemic, particularly on dentistry. Using a drill on someone’s teeth generates aerosols in their mouth, and that would vastly increase the risk of spreading covid to the dental staff, or to any patient who entered the space soon afterwards. Despite that impact, there has not been significant funding from the UK Government for the dental industry in England to fund the establishment of ventilation and air purification systems. The Scottish Government have committed £5 million specifically for this. As the hon. Member for Nottingham North highlighted, the pandemic impact comes on top of an underlying issue, the core of which is the 2006 dental contract in England and Wales, which breaks provision down into units of dental activity. It does not reward preventive dentistry. It does not reward any practice for taking on someone who already has dental issues, because it will not be properly funded for that.

Out of that comes the failure to focus on child dental health and making sure that this generation of young children grow up with good dental health. Scotland set up Childsmile in 2007, and Wales set up Designed to Smile in 2011. There is plenty of data from both of these programmes to show that providing free dental treatment to children—along with supported tooth brushing at school, fluoride coating and so on—can decrease caries found in children in primary school and at the beginning of secondary school.

Poor dental health has a big impact on general health and self-confidence, yet we hear repeated reports of families and children struggling to access an NHS practice. In the last five years, NHS practice numbers in England have dropped by over 1,250. BDA surveys suggest that almost half of remaining NHS practices are planning to reduce their NHS commitment over the next 12 to 24 months. There was a promise that the contract would be changed by next April, and 100 practices have been trialling a new method of contract. According to the BDA, it has been warned of a return to using units of dental activity from next April. This would be an enormous missed opportunity to improve NHS dental access for everyone, and particularly to take the further step of ensuring that every child in England does not just have access to a dental practice, but is involved, as they grow up, in a programme promoting good dental health.

[Edward Argar]

As ever, I am grateful to hon. Members for highlighting issues relating to new clauses 67 and 68 for debate.

I reassure the Committee that the Government continually assess the capacity of the dental laboratory sector in the UK. It is an important issue, as was highlighted by the shadow Minister, and one we already take seriously. However, it is not necessary to include a specific report requirement, especially as that could focus activity away from addressing the recovery of activity in the sector.

As colleagues will know, and as the hon. Member for Nottingham North set out clearly, dentistry has been significantly impacted throughout the pandemic due to the specific risks associated with aerosol-generating procedures, as the hon. Member for Central Ayrshire set out. The steps we have had to take during the pandemic to ensure the safety of dental patients and staff has led to a reduction in the number of NHS patients who can be seen, although activity continues to grow quarter on quarter. This reduction in NHS dental activity, including for band 3 treatments such as crowns, bridges and dentures, has had a knock-on effect on the laboratory sector. The Government recognise this, and we are already taking steps to secure the capacity of the sector.

First, throughout the pandemic, dental laboratories, where eligible, have been able to access a range of financial support that Her Majesty’s Treasury has made available to private-sector businesses and individuals affected financially by covid-19. Dental laboratories that satisfied the eligibility criteria were able to access financial support through the coronavirus business interruption loan scheme and bounce back loans. In addition, up to September 2021, technicians and lab workers had been able to access the coronavirus job retention scheme, known colloquially as the furlough scheme. The recovery loan scheme, now open until 30 June 2022, supports access to finance for UK businesses as they recover from the pandemic.

During the pandemic, we carefully considered the impact on the sector, including on dental laboratories and their important role, partly through work led by the chief dental officer. We continue to work closely with all relevant parts of the sector. I am happy to confirm that officials from the Department, together with the chief dental officer and others, will be happy to again meet representatives from the dental laboratory sector to better understand their concerns on capacity, what they are seeing in terms of the recovery of their business and trade, and what further action may be needed as we work to recover from the pandemic and safely increase levels of dental activity, for patients, the profession and the industry surrounding it.

Secondly, we are committed to building and maintaining a robust dental workforce and appreciate the important role played by laboratory technicians as part of that. In September, Health Education England released their “Advancing Dental Care” review, which provides recommendations on the reform of education and training for dental care professionals, including dental technicians.

Although this is not directly in my portfolio of responsibilities, I have asked officials to work closely with HEE on the recommendations and actions of this report, including, where it falls into my area of work more broadly, how apprenticeship places for clinical dental technicians are developed, based on an assessment of the role they could play in the delivery of NHS care. The Government are therefore already taking action to help secure the capacity of the dental laboratory sector and ensure it continues to meet the needs of patients in this country.

I turn to new clause 68. It would require the Secretary of State to publish a statement on measures taken to ensure universal access to NHS dentistry. In addition to the actions I have highlighted, I assure the Committee that this Government are taking action to ensure access to NHS dentistry and, again, I do not consider it necessary to include a requirement to make a statement on this issue on the face of the Bill.

[Dr Whitford]

rose—

[Edward Argar]

I will give way to the hon. Lady—not least so that I can have a glass of water.

[Dr Whitford]

That is not the least of my reasons for intervening. Rather than just stating that the Government are taking action, does the Minister plan to explain what action they will be taking?

[Edward Argar]

The hon. Lady is psychic, because I was just turning to that.

[Dr Whitford]

I am only thinking of the Minister’s welfare.