Terminally Ill Adults (End of Life) Bill (Fourth sitting)

Stephen Kinnock Excerpts

Committee stage
Wednesday 29th January 2025 Public Bill Committees

[The Chair]

For the benefit of our guests, the next questioner, Stephen Kinnock, is our Health Minister.

[The Minister for Care (Stephen Kinnock)]

Q I have a specific question about the period between the legislation passing in your Parliament and the commencement of its provisions and the implementation of voluntary assisted dying. Can you say a little more about what had to be done in that period: the institutional arrangements that were needed between the Act’s passage and its commencement, and the training, capacity building and practical measures that you had to put in place? Did you do that from a standing start, so that in that 18-month period you went from having no training and no institutional set-up to being ready to take the system forward?

Dr Fellingham: Our law was passed on 19 December 2019 and came into effect on 1 July 2021. Ostensibly we had an 18-month period, but of course something fairly dramatic in health happened in 2020. Despite that, what happened at Department of Health level began first. The Department of Health set up an implementation leadership team and gathered specialists together from all across Western Australia in various different aspects. They had eight different workstreams looking at the eight different parts of the Act that they had to operationalise—the pharmacology, the substance and what that was going to look like, the doses and how it was going to be administered, the set-up of the pharmacy, and things like that. Each of those eight workstreams worked everything out at a Department of Health level.

Approximately six months before the law was enacted—on reflection, that was probably not long enough, but covid was very much complicating everything at the time—they set up a working group with the clinical leads in the various health service provider organisations. We were then tasked with taking that broad overview and turning it into a service at the point of delivery, on the understanding that we understood the nuances and expectations of the different hospitals and health systems in which we operated.

I will not lie: it was an enormous task. I leant very heavily on our wonderful Victorian colleagues who had gone first. I do not know what I would have done if I had been the first to pave the way. Subsequently, I have been able to offer that level of assistance to each of the other states and territories that have gone after Western Australia, and then of course to the UK, Scotland and Jersey, which I have been working with quite a lot. There is a wonderful international, collaborative sense of information sharing and wanting to get this right, learning from experience and not reinventing the wheel.

The vast majority of the laws that apply across the whole of Australia and New Zealand are quite similar, and they are similar to what you are planning to legislate for in the United Kingdom. A lot of fantastic groundwork has been laid already, and it can be done even in a challenging healthcare context, like covid or our resource limitations.

[Stephen Kinnock]

Thank you very much for that very comprehensive answer. Is there anything that our other guests would like to add?

Dr Mewett: As I was on the very first implementation taskforce, running blind, I probably could not add much more, except to say that it can be done. One has to focus on the readiness of practitioners, the readiness of health services, the readiness of the population and a whole range of other issues, including the pharmacy service. We have a state-wide care navigator service, which assists patients and doctors in the space. We had to set up a lot of services, and that gave us the time to do so. It was very successful and very challenging, but fortunately we did not have covid in our way.

[Danny Kruger (East Wiltshire) (Con)]

Q I am very grateful for your evidence; it is really useful. I want to state, for the record and for information, that we have before us today three professionals from Australia, all of whom support the laws in that country, and that we heard yesterday from two American doctors, who were also supportive of assisted suicide laws, even though in both countries there are many doctors who oppose what is happening. I regret that we are not hearing evidence from them, but it is very helpful to have your input.

Dr Fellingham, I was interested in your point about the distinction between the Australian model and the model in Canada and elsewhere. You are suggesting that most people who seek assisted death do so for what I think you called “existential reasons”. It is certainly not because of an absence of care, although we do see evidence of that in many countries. Can you expand on why you think it is so important that we have the terminally ill definition in the Bill, rather than recognising pain and suffering as the reason for seeking assisted dying, when I think most of the public who support a change in the law do so because they recognise that many people would naturally want to avoid pain and suffering? Yesterday, we heard from people who said that that is the right reason and that we should write that into the law. Why should we not do that?

Dr Fellingham: That is a very good question and I am grateful that you have asked it. We absolutely have to keep at front and centre that pain and suffering are primary drivers for people seeking access to relief of suffering, whether that is at the end of life or in any interaction that they have with healthcare providers. I speak to remind you that these laws apply to terminally ill people, because I feel that that is a lot easier for us to understand and get our heads around, but it does not detract from the fact that suffering can be a feature of non-terminal illnesses. There are people who can suffer terribly for very long periods of time—dementia being a clear example, but one that would be incredibly challenging to legislate for at this early stage.

What is interesting about the parallels you draw between pain and suffering is that it is a quite common conception that pain is suffering and suffering is pain, and that people seek access to relief of suffering at the end of life because it is the physical symptoms that are the most debilitating. Of course, the physical symptoms can be horrendous—pain, nausea, vomiting, anorexia; there are a multitude—but they are symptoms that we tend to be really quite good at treating. We have a whole range of medications in our palliative care spectrum that are very good at treating those physical symptoms, so it is quite rare that people prioritise those when thinking about this.

But suffering is subjective and it is context-dependent. What suffering is to me might be completely different from what it is to you, even if we are suffering from what looks to be, from the outside, the same disease. Suffering and distress—the thing that makes us human: the existential overlay of our own interaction with the world and how that is impacted by our disease process—is an incredibly personal journey and one that is extremely challenging to palliate, and it is very, very distressing for patients, their families and their practitioners if we cannot support people who are suffering at the end of life. Does that answer your question?

Speech and Language Therapy

Stephen Kinnock Excerpts

Monday 27th January 2025 Westminster Hall

[The Minister for Care (Stephen Kinnock)]

It is a pleasure to serve under your chairship, Mr Vickers. I congratulate my hon. Friend the Member for Lichfield (Dave Robertson) on introducing this important debate, and on the passionate, moving and powerful way in which he spoke, particularly about his mother. I would really like to thank him for sharing those personal experiences. I also thank every Member who has spoken today. We have heard really compelling accounts about access to speech and language therapy for both children and adults.

[Rachel Taylor (North Warwickshire and Bedworth) (Lab)]

I thank my hon. Friend the Minister for giving way, and my apologies, Mr Vickers; I had to leave earlier for a ministerial appointment.

In 2018 my father suffered a stroke, and the staff at my local hospital, the George Eliot, could not do enough for him—they were absolutely fantastic. I know that my father stayed in hospital longer than he needed because that was the only way in which he could access the speech and language therapy that he needed, as well as the help to enable him to swallow. It was fantastic to see him recovering that speech because of their intervention. As he had served for nearly 50 years as a volunteer magistrate, it is wonderful to see him now being able to challenge my ideas and give his comments on my contributions in this House.

Last week, I held a consultation event in my constituency where a dietician told me that she felt there was not enough ability for her and her team, as well as speech and language therapists, to give help in the community. She was quite excited about our ideas for virtual wards and asked me, on her behalf, to plead with the Minister to ensure that we give recognition to putting more speech and language therapy in the community. I know that my dad would have been very pleased to receive that.

[Martin Vickers (in the Chair)]

Order. Interventions should be brief— I was very generous.

[Stephen Kinnock]

I thank my hon. Friend for that wonderful example of the personal experience that so many Members on all sides of the House have of this service, which can be life-changing for so many people. I pay tribute to her father for coming through in the way that he has, and I also pay tribute to all those in the community care services. The care that he received was obviously vital and life-changing for him, and that is wonderful to hear.

My hon. Friend raises an interesting point on virtual wards. It is absolutely right that we build on the innovation and opportunities that they offer. Later in my speech I will say a word or two on the three big shifts that we will put at the heart of our 10-year plan: from hospital to community, from sickness to prevention and from analogue to digital. I think the virtual wards are a great illustration of how we can bring those three seismic shifts together to transform our health and care system. I can tell my hon. Friend that the 10-year plan is the right forum and opportunity for that, and I encourage her and all Members to get involved in that plan, which can be accessed at change.nhs.uk. Hon. Members may also wish to organise roundtables and discussion fora in their constituencies to talk exactly about the kind of innovations that we are looking to bring to the fore.

It would be remiss of me not to pay tribute to Mikey Akers; he is an outstanding young man and truly an example to us all. Of course, I also pay tribute to Chris Kamara and the whole team campaigning with such vigour and verve on this vital issue. I would of course be delighted to meet Mikey, Chris and the team at a mutually convenient time to discuss the project and how to take it forward.

As our debate today has shown, speech and language therapists work with people of all ages, providing specialist care and support. Their work takes place across a range of different settings in health, care and education. It responds to a wide range of communication needs, from those of children whose speech is slow to develop to those of older people whose ability to speak has been impaired by illness or injury, for example as a result of Alzheimer’s, a stroke or head injury. Speech and language therapists also support patients who have difficulties with eating, drinking and swallowing.

The variety of support that speech and language therapists provide means that they play a key role in a wide range of care pathways. A speech and language therapist is a core part of the multidisciplinary stroke rehabilitation team, providing long-term rehab for stroke patients. It is not just patients they support—a speech and language therapist also works with a patient’s family or carers on how best to facilitate communication and support the patient, sharing their expertise to upskill the support network of the person they are caring for.

Another example of the work of speech and language therapists is the role they play in supporting autistic people. They can offer interventions to improve communication skills where needed. For individuals who are unable to speak, speech and language therapists can design alternative communication systems.

Moreover, as part of a wider multidisciplinary team, speech and language therapists also contribute to a young person’s education, health and care plan. A therapist will carry out a detailed assessment of an individual’s speech, language and communication abilities, which will help to determine the additional support they may need to access education.

However, it is the key role that speech and language therapy plays in care and support pathways that creates complexity in funding and commissioning models for it. In some cases, full care pathways are commissioned as opposed to individual services within a particular pathway, while in some areas community health services are commissioned using block contracts. Both these things create challenges in clearly identifying specific funding streams for specific services.

Speech and language therapy is generally commissioned locally by integrated care boards and in some cases by local authorities. Funding is allocated to ICBs by NHS England. The allocations process uses a statistical formula to make geographical distribution fair and objective, so that it more clearly reflects local healthcare needs and helps to reduce health inequalities. This process is independent of Government, and NHS England takes advice on the underlying formula from the independent Advisory Committee on Resource Allocation. NHS England is also continuing to work with ICBs to develop their financial plans.

NHS planning guidance sets priorities for systems, and the Secretary of State has confirmed that this key document will be published in due course—indeed, imminently. Each ICB will then commission the services they need for their local area, taking into account their annual budget, planning guidance and the wider needs of the population they cover. Local commissioners are responsible for ensuring that their offer is tailored to the local population and that their communities are able to access the specific support they need. NHS England continues to work with ICBs to develop their financial plans, to ensure that communities can access the healthcare support they need when they need it. A complex patchwork quilt of systems and processes needs to be gone through by the people who know best about what is required in their community—those at the coalface—to deliver the care that is needed.

That said, I reassure hon. Members that the Government are committed to funding the NHS properly. We recently provided a £26 billion boost for health and social care at the Budget through the policies and choices that the Chancellor laid out. We have been clear that funding must go hand in hand with reform, and we will ensure that every penny of extra investment in the NHS is well spent.

The community health services data plan, published by NHS England last year, goes some way to improving data about community health services. The plan sets out how the NHS aims to improve the quality and relevance of data, and the timeliness of its publication. It will improve our understanding of demand and capacity across community health services, including speech and language therapy, with high-quality data to generate helpful insight to shape interventions and improvements to services.

Data and clear funding lines are not the only challenge facing speech and language services. Our children and young people are stuck on waiting lists, some for more than two years. More than 65,000 children and young people were on a waiting list for speech and language therapy in November 2024. We know that more than 23,000 have been on those waiting lists for longer than 18 weeks. That is simply too long. Waiting times for adults are not as bad as those for children and young people, but there were more than 23,000 adults on waiting lists for speech and language therapy in November 2024.

We hear a lot about the increasing demand for speech and language therapy, and about the fact that our existing workforce are struggling to meet the increase in referrals—pretty much every hon. Member said that in the debate. The reason for the increase in waiting times is multifaceted. Although services are still recovering from the pandemic, there has also been an increase in demand, and analysis from the Royal College of Speech and Language Therapists shows that demand is increasing faster than the workforce are growing.

Speech and language therapy covers a broad spectrum of support. Therapists are often dealing with complex long-term cases, requiring a resource-intensive approach to supporting their patients, and referral pathways are often complex. Those referral pathways, and the services offered, also vary regionally.

As my hon. Friends pointed out, we are coming off the back of 14 years of failure, which have led to serious workforce challenges, and the reality is that we have a mountain to climb on recruitment and retention. The speech and language degree apprenticeship is now in its third year of delivery and offers an alternative pathway to the traditional degree route into a successful career as a speech and language therapist. We think that that has had a positive impact on recruitment, but much more needs to be done. We want to remove the barriers to training in clinical roles, which is why eligible students get a non-repayable grant of £5,000 a year. Further financial support is also available for childcare, dual accommodation costs and travel, but we know that that does not go far enough.

The training and retention of our talented NHS staff are absolutely key to our mission of rebuilding a health service that is fit for the future. A central part of the 10-year plan concerns our workforce and how we ensure that we train and provide the staff, technology and infrastructure that the NHS needs to care for patients across our communities.

This summer, we will publish a refreshed long-term workforce plan to deliver the transformed health service that we will build over the next decade and that will treat patients within the 18-week constitutional standard once again. We will ensure that the NHS has the right people in the right places, with the right skills to deliver the care that patients need when they need it. We must acknowledge that tackling this will take time, but we are committed to training the staff we need to ensure that patients are cared for by the right professionals and in a timely manner.

Community health services, and speech and language therapies in particular, speak to the three seismic shifts that will drive our 10-year plan: shifting healthcare from hospitals to communities, focusing on prevention, and embracing digital care. Effective, user-centred services are invariably delivered by multidisciplinary teams that are based in the communities they serve. The early language and support for every child—ELSEC—programme provides an example of different professions coming together to support children and young people, with local authorities, schools and the health and care system working together in the community. In our view, that is a potential building block for how our neighbourhood health service should work.

Nine regional pathfinder partnerships are trialling new ways of working to better identify and support children in early years settings and primary schools. We have asked the pathfinders to consider how to make the model sustainable after the project period. The therapy assistant roles have the potential to attract individuals to train to become speech and language therapists through the apprenticeship route. The ELSEC workforce model focuses on recruiting pre-qualification speech and language therapy support workers into the workforce to improve the capacity and knowledge of staff who support children with emerging or mild to moderate speech, language and communication needs in early years and school settings.

That will be important, because we hear a lot about the challenges our workforce face in meeting the increasing demand for speech and language therapy. Across all community health services, increasing demand and workforce availability are frequently cited as the main reasons that systems are struggling to reduce waiting times and get on top of the demand. The interim programme evaluation is due to be published in February, at which point we can explore insights into the effectiveness of ELSEC delivery at a local level. Reporting data shows that therapy support teams have supported around 13,000 children so far, and just over 1,000 staff in settings have been upskilled in delivering interventions. That is an encouraging set of achievements, and I will continue to work with my ministerial colleagues and officials across my Department and the Department for Education to support this important programme.

I referred earlier to our ambition to build a neighbourhood health service. We are firmly committed to moving towards our vision for such a service, and community health services will be an essential building block of it—keeping people healthy at home and in their communities, and providing more preventive, proactive and personalised care. Later this year, we are going to trial neighbourhood health centres, which will bring together a range of services and will ensure that healthcare is closer to home and that patients receive the care they deserve.

We have heard about the importance of adequate funding and timely access to speech and language therapy services for children and adults with communication and swallowing needs. The importance of such services is not in doubt, nor is the life-changing impact that timely access to high-quality services can have, from helping a child to develop the right skills to engage with education to supporting adults to regain their ability to speak. Speech and language services are facing challenges, but sustainable, accessible and high-quality community health services are vital, and I will continue to work closely with NHS England, the Department of Health and Social Care and the Department for Education on this critical issue.

[Dave Robertson]

I place on record my thanks to all the hon. Members who have contributed to the debate, starting with the hon. Member for Meriden and Solihull East (Saqib Bhatti), who made an excellent contribution, as I think we would all expect. I congratulate him on his campaigning on this important issue. I thank my hon. Friend the Member for Wolverhampton North East (Mrs Brackenridge) for raising the story of her constituent Samantha, who I am sure will be watching the debate closely.

I thank the hon. Member for Leicester South (Shockat Adam) and my hon. Friend the Member for Hyndburn (Sarah Smith) for reminding us of the importance of supporting the next generation and all those who come after. I thank my hon. Friend the Member for Altrincham and Sale West (Mr Rand) for raising the issue of unacceptably long wait times for speech and language therapy. I thank my hon. Friend the Member for Stoke-on-Trent North (David Williams) for highlighting the caseload faced by speech and language therapists in Stoke-on-Trent and the great county of Staffordshire. I also thank my hon. Friend the Member for Dulwich and West Norwood (Helen Hayes) for discussing the need for early intervention and the remarkable impact that it can have.

I thank my hon. Friend the Member for North Warwickshire and Bedworth (Rachel Taylor) for the story of her father’s experience in speech and language therapy. I thank the Liberal Democrat spokesperson, the hon. Member for Winchester (Dr Chambers), for his excellent contribution on the need to raise awareness around aphasia, which does not necessarily get spoken about enough in the community.

I thank the hon. Member for Sleaford and North Hykeham (Dr Johnson), on behalf of His Majesty’s official Opposition, for her considered remarks and for avoiding making the issue a political football. It is really important to highlight where we do agree, because there is often more agreement than people realise in this place. By working together, we can achieve those goals.

I especially thank the Minister for Care, my hon. Friend the Member for Aberafan Maesteg (Stephen Kinnock)—did I get that right?

[Stephen Kinnock]

Not bad.

[Dave Robertson]

Mam never quite got round to teaching me the Welsh that she speaks. I thank the Minister for his kind words about her and for outlining the complicated funding scenario that currently exists for speech and language therapy, along with the Government’s desires for the future of this therapy as an example of the three shifts that the Government will introduce in the NHS, and the need for people to engage thoroughly with the NHS 10-year plan consultation as a vehicle to securing those changes.

I thank the Petitions Committee for allowing me to lead the debate. It has been a real pleasure, not least because my constituency was the fourth most supportive of the petition. Finally, on behalf of all hon. Members who have been able to contribute today, I say an enormous thanks to Mikey, without whose campaigning we would not be here discussing this issue.

Question put and agreed to.

Resolved,

That this House has considered e-petition 657935 relating to speech and language therapy.

Terminally Ill Adults (End of Life) Bill (Money)

Stephen Kinnock Excerpts

Money resolution
Wednesday 22nd January 2025 Commons Chamber

[The Minister for Care (Stephen Kinnock)]

I beg to move,

That, for the purposes of any Act resulting from the Terminally Ill Adults (End of Life) Bill, it is expedient to authorise the payment out of money provided by Parliament of:

(1) any expenditure incurred under or by virtue of the Act by the Secretary of State, and

(2) any increase attributable to the Act in the sums payable under or by virtue of any other Act out of money so provided.

The Government are of the view that the Bill is a matter for Parliament rather than the Government to decide. In order for the Public Bill Committee that is now scrutinising the Bill to consider the clause that would have spending implications, the Government must first table this money resolution. This is purely to allow the Bill to be debated in Committee, and the Government have taken the view that tabling this motion does not act against our commitment to remain neutral. Only the Government can table such motions, so tabling it allows further debate to happen. To assist that debate, the Government will also assess the impacts of the Bill, and we expect to publish the impact assessment before MPs consider the Bill on Report.

[Madam Deputy Speaker (Ms Nusrat Ghani)]

I call the shadow Minister, Dr Kieran Mullan.

--- Later in debate ---

[The Minister for Care (Stephen Kinnock)]

I thank Members for their continued contribution to the debate. The Government are of the view that the Bill is an issue of conscience for individual parliamentarians and it is rightly a matter for Parliament, not the Government, to decide. The money resolution allows the Bill to be debated in Committee, where its detail will continue to be scrutinised. As I have said, the Government will also be assessing the impact of the Bill and we expect to publish an impact assessment before MPs consider the Bill on Report. I therefore commend the money resolution to the House.

Question put and agreed to.

[Jim Shannon (Strangford) (DUP)]

On a point of order, Madam Deputy Speaker. The right hon. Member for North West Hampshire (Kit Malthouse) made a comment that I feel impinged upon my integrity. I have spoken to the right hon. Gentleman and he knows what I am referring to. I underlined and highlighted that the Terminally Ill Adults (End of Life) Bill Committee went into private session; some 15 Members, who support the Bill, voted for the private session and nine Members, who oppose the Bill, voted against the private session. The record must be corrected about what the right hon. Gentleman said about the comments I made about that. Facts are facts; they matter to me, as does my integrity.

Auditory Verbal Therapy

Stephen Kinnock Excerpts

Tuesday 21st January 2025 Westminster Hall

[The Minister for Care (Stephen Kinnock)]

It is a great pleasure to serve under your chairship, Mr Western. I thank my hon. Friend the Member for Washington and Gateshead South (Mrs Hodgson) for securing this vitally important debate, and for her powerful and moving contribution to our discussion.

I would also like to break with protocol and welcome Sam to Parliament today. He is clearly a remarkable young man, and an inspiration to us all—thank you for being here, Sam. Like the shadow Minister, the hon. Member for Hinckley and Bosworth (Dr Evans), I thank hon. Members for their excellent contributions today. We have had a range of contributions, including from the shadow Minister, and from the hon. Members for North Shropshire (Helen Morgan) and for Strangford (Jim Shannon), and my hon. Friends the Members for Bury North (Mr Frith), for Bolton North East (Kirith Entwistle), for Derby South (Baggy Shanker) and for Bolton South and Walkden (Yasmin Qureshi). I think that may be all, but huge apologies if I have missed anybody. All their contributions were excellent and very well put.

My hon. Friend the Member for Washington and Gateshead South has done so much work to champion the interests of children with special educational needs and disabilities, including non-hearing children. I know that she also has an excellent partnership with Auditory Verbal UK, which I welcome to Parliament today. I would, of course, be happy to meet its representatives to follow up on all the points made in this debate.

This Government are committed to raising the healthiest generation of children ever. We will deliver on this ambition through the health and opportunity missions, and through the Government’s child poverty strategy. This is not about silos, with each Department delivering one part of a puzzle that does not fit together properly; this is about systemic, holistic change, and ensuring that we join up analysis, expertise and delivery across Government. Our mission-driven Government will drive long-lasting and sustainable change for children now and in the future. We will break down barriers to opportunity and ensure that every child has the best start in life. This includes all children and young people with special educational needs and disabilities, including non-hearing children.

We know that developing early communication skills is a key foundation for life, and there are serious knock-on consequences when that development is delayed. That is why we are committed to improving access to early interventions so that every child can find their voice. With the right support, children with hearing loss can develop effective communication skills, live fulfilling lives and enjoy the same opportunities as everyone else. The Government recognise the importance of the earliest days of an infant’s life. There is strong evidence that the 1,001 days from conception to the age of two set the foundations for our cognitive, emotional and physical development. That is why we are giving a £126 million boost for families to give every child the best start in life.

Thousands of families across England will be able to access family hubs, which will act as a one-stop shop for help with infant feeding advice, parenting classes and perinatal mental health support, among other things. Figures from the National Deaf Children’s Society show that there were more than 45,000 deaf children and young people in the UK in 2023. Between one and two babies in every 1,000 are born with permanent hearing loss in one or both ears. This number increases to about one in every 100 for babies who have spent more than 48 hours in intensive care. Early and effective support is crucial for these children and their families. Permanent hearing loss can significantly affect a baby’s development, so early and effective support is crucial for these children and their families.

It is vital that we intervene at birth. The NHS newborn hearing screening programme—the NHSP—aims to find babies who have hearing loss as early as possible so that the right support and advice can be offered right from the start. As we all know, language is linked to social, emotional and learning outcomes. From birth through to childhood, children and young people with hearing loss might need a range of therapies, such as speech, language and auditory verbal therapy. However, as we have heard today, those children are not always receiving the support that they need.

We recognise the important role of auditory verbal therapy as one of the therapies that can be useful for children with hearing loss. NHS audiology services, including the provision of therapies for children with hearing loss, are locally commissioned, and responsibility for meeting the needs of children with hearing loss lies with local NHS commissioners, because local systems are best placed to meet the needs of their own communities.

After 14 years of Tory neglect, incompetence and austerity, our NHS and care service are on their knees, but this Government are committed to properly funding the NHS, and we recently provided a £26 billion boost for health and social care in the autumn Budget. NHS England is responsible for determining allocations of financial resources. Each ICB will then commission the services they need for their local area, taking into account their annual budget, planning guidance and the wider needs of the population they cover. NHS England is supporting integrated care boards to make informed decisions about the provision of audiology services so they can provide consistent, high-quality and integrated care to non-hearing children.

In July 2016, NHS England published “Commissioning Services for People with Hearing Loss: A framework for clinical commissioning groups”. The framework supports NHS ICBs to make informed decisions to address inequalities in access and outcomes between hearing services.

[Mr Frith]

Does the Minister agree that, for all the good intentions of ICBs, our healthcare system is atomised, but that if they were to take instruction from guidance provided nationally, the pillar-to-post experience of a lot of families seeking auditory verbal therapy would end? Will he commit to updating the nine-year-old guidance to ICBs, or at least acknowledge that it needs updating, with a national pilot that proves the efficacy of AVT for families seeking that intervention?

[Stephen Kinnock]

My hon. Friend will know that one of the constant challenges in the system is getting the right balance between empowering those operating at the coalface—those who are close to the communities and know them best—to ensure they are delivering the best possible services, and ensuring consistency and coherence, both strategic and operational, across the entire system. It is safe to say that we are not always getting that balance right. One of the key objectives of the 10-year planning process that we are going through will be to address the so-called postcode lottery—variation between regions—across the whole range of health and care. Without that cross-cutting strategic look at the system, it will not be possible to get the balance right. I absolutely take the point, but one thing I will say is that we are crystal clear when we issue guidance to ICBs that they must take that guidance into account, and their performance is monitored on that basis.

[Mrs Hodgson]

Am I right in thinking, from what the Minister has just said, that he will issue revised guidance following today’s debate? Am I right that the Government, having given an extra £26 billion to local areas, will give them guidance that they should be looking to commission these services on a much bigger scale, so that we have more than 33 AVT therapists?

[Stephen Kinnock]

I can certainly tell my hon. Friend that this is a very dynamic situation. A system never stands still. For a system to work, we have to be constantly reviewing its performance and whether it is delivering to its objectives. I believe that the 10-year plan that we are producing will absolutely lead to a radical rewiring of the way our health and care system works. It will be driven by three big shifts: from hospital to community, from sickness to prevention, and from analogue to digital.

There is no doubt at all that where there are therapies and treatments that are working—that are clearly delivering big results, and value for money for the taxpayer—it is right that we give those priority in the way that we deliver. It is clear that AVT has huge potential, and it appears to have unexplored potential. I cannot pre-empt today how this is all going to pan out in terms of the system and the reforms that we are looking to push forward, but I can assure my hon. Friend that we are committed to innovating and to building a system that is fit for the future.

In 2019, with input from the National Deaf Children’s Society, NHS England produced a guide for commissioners and providers who support children and young people with hearing loss. The guide provides practical advice on ensuring that non-hearing children receive the support they need. Auditory verbal therapy is one type of therapy to support children with hearing loss, and it is important that local commissioners know their population and have the discretion to decide how best to meet its needs. When it comes to commissioning and providing services for children with hearing loss, we have been crystal clear with ICBs and NHS trusts that they must take the relevant guidelines into account.

We recognise the real need to improve access to therapies for all children who need them, including children with hearing loss. In recent years, in very difficult circumstances, the NHS has increased the number of speech and language therapists working in the service, but we know that more needs to be done. That is why the Government are committed to fixing the NHS and building a service that is fit for the future, with the workforce it needs to get patients seen on time.

[Dr Luke Evans]

The Minister rightly points out the need to try to deal with the postcode lottery and to ensure that there are reviews and sharing of best practice, but may I draw him back to my comments about guidelines? One thing he could do is ask NICE to look at the current evidence and consider what national guidance should be in place. ICBs have the right to choose what kind of treatment they think works best, and they will be driven by the clinical evidence and clinical guidelines; if there are no clinical guidelines, they will simply make their own decisions. Will the Minister commit to doing that?

[Stephen Kinnock]

The hon. Gentleman will know that NICE has a prioritisation board, and ultimately that is the decision-making process for prioritising guidelines and the entire operating framework for what falls under NICE’s remit. This is something that absolutely should be on the radar, and of course we are constantly in conversation with NICE about its prioritisation, but it is important that it takes an objective clinical stance on the question.

We have committed to develop a 10-year plan to deliver a national health service that is fit for the future. The engagement process has been launched. As we work to develop and finalise the plan, I encourage those concerned about the availability of services to support children with hearing loss, including auditory verbal therapy, to engage with that process to allow us to fully understand what is not working, as well as what should be working better and the potential solutions. I encourage all hon. Members present to go to change.nhs.uk to make their voice heard.

This summer, we will publish a refreshed long-term workforce plan to deliver the transformed health service we will need to build over the next decade to treat patients on time and deliver far better patient outcomes. We are also in the process of commissioning research to understand the gaps between the supply and demand of different therapy types for children and young people with special educational needs and disabilities. That will help us to understand the demand for speech and language therapists and inform effective workforce planning.

[Helen Morgan]

I am pleased to hear that the Government have increased the number of speech and language therapists, which is so important for young people who are struggling to achieve their potential in an educational setting, but will the Minister address the specific point on commissioning by local authorities? Often, they are so strapped for cash that they are effectively trying to limit demand.

[Stephen Kinnock]

Commissioning is led by ICBs. It is important that ICBs have open channels of communication with local government. We in the Department of Health and Social Care have close contact and engagement with colleagues in the Ministry of Housing, Communities and Local Government, and it is important that that relationship and interaction feeds down through the entire system, but the leading organisations on commissioning are the ICBs.

A number of colleagues raised the question of a pilot scheme to identify how our existing workforce can work differently. The early language and support for every child programme is an excellent example of different professions coming together to support children and young people—local authorities, schools, and the health and care system working together in the community to support our children and young people. The ELSEC workforce model focuses on recruiting pre-qualification speech and language therapy support workers into the workforce to improve the capacity and knowledge of staff who support children with emerging or mild to moderate speech, language and communication needs in early years and school settings.

Nine regional pathfinder partnerships are trialling new ways of working to better identify and support children in early years settings and primary schools. We have asked pathfinders to consider how to make the model sustainable after the project period. The therapy assistant roles have the potential to attract individuals to train to become speech and language therapists through the apprenticeship route. I understand that Auditory Verbal UK is progressing a National Institute for Health and Care Research grant application to support a pilot, and I would welcome an update from AVUK about how that is going when we get the chance to meet.

We welcome the work that AVUK is doing to upskill health professionals to deliver auditory verbal therapy. On the point made by the shadow Minister, the hon. Member for Hinckley and Bosworth, there are as yet no NICE guidelines on hearing loss in children, and NICE has not made any recommendations on AVT specifically. Decisions on the need for guidelines on new topics and updates to existing guidance are made by NICE’s prioritisation board, in line with NICE’s published common prioritisation framework. I understand that NHS England met with AVUK and discussed the need for more high-level research evidence for the intervention and the need to develop evaluations of impact. I am pleased that AVUK has been invited to join the chief scientific officer’s audiology stakeholder group, where it will contribute to decision making.

We recognise the impact on the lives of children of timely access to high-quality services, including different therapies to help children to develop the right skills to engage with education. The Government’s ambition is that all children and young people with SEND or in alternative provision receive the right support to succeed in their education and as they move into adult life. We will strengthen accountability on mainstream settings to be inclusive, including through the work of Ofsted, by supporting the mainstream workforce to increase their SEND expertise and by encouraging schools to set up resourced provision or SEN units to increase capacity in mainstream schools. That work forms part of the Government’s opportunity mission, which will break the unfair link between background and opportunity, starting with giving every child, including those with SEND, the best possible start in life. We will work with the sector, as essential and valued partners, to deliver our shared mission and restore parents’ trust.

I again thank my hon. Friend the Member for Washington and Gateshead South for securing this debate and sharing her insight on the vital issue of early interventions for non-hearing children. We recognise the importance of such services and the life-changing impact they can have on the lives of children. We are committed to ensuring that all children receive the support they need to live healthy, fulfilling lives. I will continue to work closely with NHS England and the Department for Education as we strain every sinew to deliver on those commitments.

Hospice and Palliative Care

Stephen Kinnock Excerpts

Monday 13th January 2025 Commons Chamber

[The Minister for Care (Stephen Kinnock)]

I pay tribute to the hon. Member for Wimbledon (Mr Kohler) for securing the debate and making such a powerful and thoughtful opening speech. I thank hon. Members from across the House—there are too many to list. It would be impossible to capture the richness of the contributions made. Something like 28 Back-Bench Members made speeches—I am sure Madam Deputy Speaker will correct me if my numbers are not quite right. It was an excellent debate, and I thank everybody for their contribution. I thank all those who work or volunteer in the hospice and palliative care sector for the deeply compassionate care and support that they provide to patients, families and loved ones when they need it most.

This Government are committed to building a society in which every person receives high-quality, compassionate care, from diagnosis through to the end of life. We will shift more care out of hospitals and into the community, to ensure that patients and their families receive personalised care in the most appropriate setting. Palliative and end of life care services, including hospices, will have a vital role to play in that shift. The reality is that we have a mountain to climb. Our health and care services are on their knees, but this Government will strain every sinew to build them, and to create a health and care system that is once again fit for the future.

In England, integrated care boards are responsible for the commissioning of palliative and end of life care services to meet the needs of their local population. To support ICBs in that duty, NHS England has published statutory guidance and service specifications. While the majority of palliative and end of life care is provided by NHS staff and services, we recognise the vital part that voluntary sector organisations, including hospices, play in providing support to people at end of life, as well as to their loved ones.

Most hospices are charitable, independent organisations that receive some statutory funding for providing NHS services. The amount of funding each charitable hospice receives varies both within and between ICB areas. The variation is dependent on demand in the area, and on the totality and type of palliative and end of life care provision from NHS and non-NHS services, including charitable hospices, within each ICB footprint.

We understand the financial pressures that hospices have been facing, which is why last month I was truly proud that this Government announced the biggest investment in hospices in England in a generation. It will ensure that hospices in England can continue to deliver the highest-quality care possible for patients and their families and loved ones.

[Danny Kruger]

I also welcome that, and congratulate the Minister on getting that money out of the Treasury, but will he acknowledge that there is a difference between capital and revenue? Hospices urgently need support for their day-to-day running costs, not just more money to support the capital. They also need capital support, but that is less crucial.

[Stephen Kinnock]

I take the hon. Gentleman’s point, but hospices face a range of pressures. The capital expenditure injection that we have provided will help them in the round. Clearly, anything that helps a hospice with its budget in the round, be it capital or revenue, will help the hospice.

We are supporting the hospice sector through a £100 million capital funding boost for adult and children’s hospices, to ensure that they have the best physical environment for care. There is also £26 million in revenue funding to support children and young people’s hospices. The £100 million in capital funding will deliver much-needed improvements—from refurbishments to overhauling IT systems and better facilities for patients and visitors—during the remainder of 2024-25 and throughout 2025-26. The investment will help hospices to improve their buildings, equipment and accommodation, so that patients continue to receive the best care possible.

Hospices for children and young people will receive a further £26 million in revenue funding for ’25-26 through what was known until recently as the children’s hospice grant. That investment demonstrates the Government’s recognition of the importance of integrating services to improve the treatment that patients receive. Furthermore, through our plans for neighbourhood health centres, we will drive the shift of care from hospitals to the community, which will bring together palliative care services, including hospices and community care services, so that people have the best access to treatment through joined-up services.

[Warinder Juss]

Money is not always the only solution, so will my hon. Friend confirm how the commission on palliative care that the Government announced last month will improve end of life care?

[Stephen Kinnock]

The Government announced a commission on the future of adult social care. A separate commission was announced by my hon. Friend the Member for York Central (Rachael Maskell) on palliative care. We will certainly monitor the findings of that commission very closely.

We will set out details of the funding allocation and distribution mechanisms for both funding streams in the coming weeks.

[Jim Shannon]

In my contribution, I made the House aware that the Northern Ireland hospice has to cut its beds from seven to six for five days of the week, and at the weekend, there are only three. The Minister knows that I respect him greatly. It is all very well to have capital money available, but there has to be money to run the system and provide beds. Otherwise, we can buy beds, but might not be able to keep them and run a service. There must be something seriously wrong with what he is putting forward.

[Stephen Kinnock]

As I said in a previous answer, hospices face a range of pressures that financial contributions from the Government will help to ease. The funding will, of course, have a knock-on impact on hospices budgets in the round.

In spite of the record-breaking package that we have announced, we are certainly not complacent. There is more work to be done, and through the National Institute for Health and Care Research, the Department is investing £3 million in a policy research unit on palliative and end of life care. The unit launched in January 2024 and is building the evidence base that will inform our long-term strategy. A number of hon. Members requested a long-term strategy and plan, which is sorely missing after 14 years of Conservative neglect and incompetence. I agree that we need a long-term plan, and assure Members that conversations are taking place between my officials and NHS England. The research needs to be based on evidence and facts, which the unit will help us to get.

[Dr Ben Spencer]

It is important that this debate is not a political ding-dong, and I really appreciate the tone that all Members, including the Minister, have taken. On evidence and facts, will he look into the impact of the national insurance contribution rises on hospice care and provision, how many hospices are running a deficit, and how many will likely go into deficit as a result of his policies?

[Stephen Kinnock]

The hon. Gentleman will not be surprised to know that I have a section in my speech on employer national insurance contributions. I will get to it.

A number of colleagues raised concerns about regional variations. Facts and evidence are very important in that context. To address that issue, NHS England has developed a palliative and end of life care dashboard, which brings together all the relevant local data in one place. The dashboard helps commissioners to understand the palliative and end of life care needs of their local population, enabling ICBs to put plans in place to address, and track the improvement of, health inequalities, and to ensure that funding is distributed fairly, based on prevalence.

[Gregory Stafford]

Will the Minister give way?

[Stephen Kinnock]

I will, but I have to finish at 9.58 pm, so there is only about five minutes left of my contribution.

[Gregory Stafford]

It is generous of the Minister to give way, so I shall be brief. Would funding continue to be produced through ICBs, or will the system be funded centrally?

[Stephen Kinnock]

That is precisely the topic of conversation for officials in my Department and NHS England, who are looking at this issue in the round and deciding how we will work. We need a system that empowers ICBs to deliver at the coalface, but we also need accountability from the centre to ensure that things are delivered. Getting the balance right is never easy, as I am sure the hon. Gentleman will understand; that is what we are trying to navigate.

Alongside NHS England, my officials and I will continue to proactively engage with our stakeholders, including the voluntary sector and independent hospices, to understand the issues that they face. In fact, I will meet the major hospices and palliative care stakeholders, including Hospice UK, early next month to discuss potential solutions for longer-term sector sustainability. That will inform our 10-year health plan.

[Munira Wilson]

On the children’s hospice grant, will the Minister confirm that it will be ringfenced, and that it will go beyond the one-year settlement?

[Stephen Kinnock]

Again, that is on the agenda for discussion with officials. Having inherited a disastrous situation, we are using 2025-26 to stabilise and to try to enable the sector to survive. The hon. Lady will understand that as well as doing that, we are looking at long-term reform solutions, but when we came into power on 4 July, it was one minute to midnight, and we had to rescue the sector. That is what we are doing, and we will look at the long-term issues in due course.

A number of Members have raised the concern around employers’ national insurance contributions. Since we came to office in July, we have been completely focused on repairing the catastrophic legacy of 14 years of Conservative neglect and incompetence. The first step was to fix the foundations of the public finances at the autumn Budget, and that enabled the spending review settlement of a £22.6 billion increase in resource spending for our health and care system. Our approach to ENIC exemptions has been consistent with the Office for National Statistics definition and the approach taken by previous Governments. It does not include an exemption for independent contractors, including charities like hospices, although December’s record funding announcement was a clear recognition of our commitment to financially supporting this vital sector more broadly.

I ask Opposition Members from all parties who luxuriate in criticising the means by which we have raised the record funding for hospices what they would do. How would they have raised the £22 billion that our autumn Budget delivered? Which taxes would they raise? Which public services would they cut? Answer comes there none. The Government recognise the need to protect the smallest businesses and charities, such as hospices, which is why we have more than doubled the employment allowance to £10,500, meaning that more than half of businesses and charities with ENIC liabilities either gain or see no change next year.

While the debate is not about assisted dying, I want to say a word on the matter. My hon. Friend the Member for Spen Valley (Kim Leadbeater) put forward her Bill, and it has received its Second Reading. It is vital that our approach to end of life care and patient choice is holistic and driven by an in-depth understanding of patient need.

I thank everybody across the House for this excellent debate. Actions speak louder than words. This Government have acted to deliver the biggest financial contribution to hospices in a generation.

Oral Answers to Questions

Stephen Kinnock Excerpts

Tuesday 7th January 2025 Commons Chamber

[Charlie Dewhirst (Bridlington and The Wolds) (Con)]

2. What assessment he has made of the potential impact of the increase to employer national insurance contributions on social care.

[The Minister for Care (Stephen Kinnock)]

This Government will never shy away from taking the choices necessary to fix the public finances and rebuild our public services. It is thanks to those choices that we are able to invest an additional £3.7 billion in 2025-26 in local authorities that provide social care. We are also delivering the biggest uplift to the carer’s allowance since the 1970s, an £86 million uplift to the disabled facilities grant, and a fair pay agreement for care workers.

[Charlie Dewhirst]

The increase in employer national insurance contributions comes at a time when we simply cannot afford to lose any more provision from care providers. Age UK estimates that 2 million people aged 65 and over already have unmet care and support needs. What assessment has the Minister made of the potential increase in unmet care needs as a result of the increase to employer national insurance contributions?

[Stephen Kinnock]

There is a pattern here. The Conservatives welcome the additional investment in health and care but oppose the choices that we have made to raise the revenue. They need to tell us which services they would cut or which taxes they would raise instead.

[Mr Speaker]

I call the Liberal Democrat spokesperson.

[Helen Morgan (North Shropshire) (LD)]

Coverage Care, a not-for-profit adult social care provider in North Shropshire that operates 11 care homes and employs around 1,000 local staff, has been in touch to say that it expects the impact of the increase in national insurance contributions to be £840,000 in the first full year of implementation. Given that there are huge numbers of vacancies across adult social care in North Shropshire, will the Secretary of State consider exempting social care providers from the national insurance increase? Otherwise we are putting money into social care with one hand and taking it away with the other.

[Stephen Kinnock]

I refer the hon. Lady to my previous answer on the very substantial funding that we are providing to local authorities, which of course are key to the adult social care system. However, funding must always be married with reform. We have brought forward a packed programme of reform—from data sharing and empowering care workers to take on basic healthcare to promoting better use of care technologies—and in the spirit of cross-party collaboration that we believe is absolutely vital and urgent in this area, I gently encourage her to see those reforms as the first step towards rebuilding our care service and making it fit for the future.

--- Later in debate ---

[Gideon Amos (Taunton and Wellington) (LD)]

20. What steps his Department is taking to improve access to mental health services.

[The Minister for Care (Stephen Kinnock)]

As Lord Darzi’s independent investigation found, around 1 million people are waiting to access mental health services in England. This Government will fix our broken mental health services by recruiting 8,500 more mental health workers, providing access to specialist mental health professionals in every school and rolling out young futures hubs in every community.

[Tom Gordon]

In my constituency of Harrogate and Knaresborough we have heard harrowing stories from people who have tried to reach out and get access to mental health services before they reach crisis point. Often, people end up facing months-long if not years-long waiting lists. When all too often they reach a crisis point, they end up having to access services as far away as Newcastle or Manchester. What are the Government doing to make sure that we can root local community mental health facilities in communities such as Harrogate and Knaresborough?

[Stephen Kinnock]

In addition to the measures that I just set out, in the Budget the Chancellor made funding available to expand talking therapies to 380,000 extra patients. We have a £26 million capital investment scheme for mental health crisis centres and, as always with this Government, investment goes with reform. We are finally reforming the Mental Health Act—that was first talked about when Theresa May was in 10 Downing Street. This Government are rolling up their sleeves and getting on with the job.

[Gideon Amos]

Taunton and Wellington is a trailblazer in taking mental health from hospital to community and from sickness to prevention. The trust is the first in the country to merge mental health with the hospital trust. Will the Minister meet the trust and me to understand how successful that programme is, and to discuss the much needed maternity and paediatric unit at Musgrove Park hospital?

[Stephen Kinnock]

It sounds like there is some interesting, dynamic and innovative work going on in the areas that the hon. Gentleman mentioned. I would be happy to meet him to discuss it further.

[Peter Prinsley (Bury St Edmunds and Stowmarket) (Lab)]

I have just been visited by my former medical student, a young doctor in Yorkshire working in an intensive therapy unit, who told me that 40 of the 50 patients who were admitted with covid died. Many healthcare workers are suffering from flashbacks and post-traumatic stress disorder. What measures will the Government take to look after the mental health of the healthcare workers who so bravely helped us during the covid pandemic?

[Stephen Kinnock]

My hon. Friend raises an important point, which provides an opportunity for us all to reflect on the incredible work of those working in our health service; they are, in many ways, heroes, and we should absolutely acknowledge that fact. We need to explore the point he has raised—we could meet to discuss it further, or I would be happy to write to him.

[Anna Dixon (Shipley) (Lab)]

In England, more than 200,000 people were waiting for an autism assessment in September 2024. In my constituency, some adults have waited more than two years for an autism assessment, and one child has been waiting eight years—and is still waiting—to receive support from child and adolescent mental health services. These delays have a profound impact on people’s lives. Will the Minister commit to the mental health investment standard and ensure that as the Government reduce waiting times, they do so for both physical and mental health services for young people and adults?

[Stephen Kinnock]

We remain absolutely committed to the mental health investment standard. We have prioritised the expansion of NHS talking therapies and individual placement and support schemes, and provided £26 million of capital funding to open new mental health centres. However, we are not complacent on this issue. My hon. Friend spoke about autism assessments, which is a red light that is flashing on my dashboard. I would be happy to discuss that further with her.

[Sir Desmond Swayne (New Forest West) (Con)]

11. Whether his Department plans to improve integration of counsellors and psychotherapists into the mental health workforce.

[The Minister for Care (Stephen Kinnock)]

Counsellors and psychotherapists form an integral part of the NHS mental health workforce, delivering support to people with mental ill health across a range of settings in services for both children and young people and adults. We will publish a refreshed NHS long-term workforce plan to ensure that the NHS has the right people in the right places with the right skills to deliver the care that patients need.

[Sir Desmond Swayne]

Is there a plan to maintain service provision where psychotherapists and counsellors operating in the charity sector have been hit by eye-watering cost increases as a consequence of the national insurance increase?

[Stephen Kinnock]

As I have said in answers to previous questions, and as my right hon. Friend the Secretary of State has said, there is something of a pattern emerging here: Opposition Members say that they welcome the investment the Government have made, but oppose the revenue-raising measures and refuse to set out whether they would increase taxes or cut services. I still have not heard an answer on that from those Members.

--- Later in debate ---

[Mr Speaker]

Can Members please remember that these are topical questions?

[The Minister for Care (Stephen Kinnock)]

We are making a priority of resuming consultations with the sector to stabilise community pharmacy. Pharmacy First has built on existing services to increase the clinical scope. The conditions treated under Pharmacy First vary across the UK, and the NHS will keep this under review.

[Claire Young (Thornbury and Yate) (LD)]

T3. When we think of social care, we often think of those who are older, but at a recent advice surgery I met the mother of a 20-year-old with complex needs that local services are unable to meet, so the only option that would allow him to engage with his peers is residential care further afield, taking him away from his family. Will the Minister meet with me, my constituent and his mother to discuss how we ensure that those with complex needs are properly supported?

[Stephen Kinnock]

I am sure the hon. Lady will welcome the fact that we have found an £86 million uplift for the disabled facilities grant, but on the specific question she raises, I would be happy to meet her and discuss that further.

[Jo Platt (Leigh and Atherton) (Lab/Co-op)]

T6. Groups such as Action for ME and Long Covid Support tirelessly advocate for improved care for over 2 million people living in the UK. How will the Minister ensure that NHS reforms deliver timely diagnosis, effective treatment and long-term support for those affected?

--- Later in debate ---

[Natasha Irons (Croydon East) (Lab)]

T7. The Family Dental Practice in my constituency has faced significant challenges caused by dental contracts introduced by the previous Government. The pilot scheme it took part in caused long-lasting operational financial damages to the practice. How will the Secretary of State support such practices, and will he consider measures such as rebasing the unit of dental activity targets to help them overcome these challenges?

[Stephen Kinnock]

My hon. Friend is absolutely right: the NHS dental contract simply is not working. We are working with the sector to reform the contract, with a shift to focusing on prevention and the retention of NHS dentists. We will deliver on our pledge to provide 700,000 more urgent dental appointments at the earliest possible opportunity, targeting areas that need them most.

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

One in five social care jobs in Cumbria are currently unfilled, and the consequences are unbearable for those who are vulnerable; indeed, they are causing pressure on the rest of the NHS. Will the Secretary of State look carefully at the specific needs of rural communities such as ours, where it is so much harder to recruit and retain social care workers?

--- Later in debate ---

[Mr Richard Quigley (Isle of Wight West) (Lab)]

T10. The Isle of Wight does not just have a problem with its ferries, as the House would expect; we also have a huge problem with dentistry. We are a true dental desert. However, the size of our community means that we are an ideal place to try new approaches to dentistry, especially for children. Will the Minister meet me to discuss those approaches and improve dentistry on the island?

[Stephen Kinnock]

My hon. Friend is absolutely right to describe the Isle of Wight as a dental desert. That is perhaps one of the reasons why the good people of that island elected a Labour Member for the first time in history. Our ambition is to make sure that everyone who needs a dentist can get one. Sadly, 28% of adults in England—13 million people—have an unmet need for NHS dentistry. I would be glad to meet my hon. Friend to learn more about how the experience of the Isle of Wight can improve services nationally.

[Rishi Sunak (Richmond and Northallerton) (Con)]

Prostate cancer is the most common cancer in men, yet it has no national screening programme. We worked on this issue in government, and I thank the Secretary of State for taking an interest in this area. Will he join me in commending Prostate Cancer Research’s excellent new report and urge his team to consider the findings, not least on increasing screening of at-risk groups so that we can not just save the NHS money but, more importantly, save thousands of lives?

[Deirdre Costigan (Ealing Southall) (Lab)]

The last Government treated mental health as a Cinderella service, with my constituents waiting days in A&E to be admitted to hospital mental health wards. The Solace Centre in Ealing Southall provides help and support in the community for those with mental health problems, at a fraction of the cost of a hospital stay. How does the Minister intend to move more mental health services from hospital to the community, and to create more great services like the Solace Centre?

[Stephen Kinnock]

I thank my hon. Friend for her excellent question. She is right that it is vital to move services from hospital to community. The Chancellor made funding available for 380,000 more talking therapies for patients and put in place a £26 million capital investment scheme for mental health crisis centres. A lot of work has been done, but there is a lot more still to do.

[Vikki Slade (Mid Dorset and North Poole) (LD)]

Will the Secretary of State confirm what is being done to ensure that patients with rare and complex conditions, such as functional neurologic disorder and achalasia, can access consistent and co-ordinated care, including referrals to the multidisciplinary teams they need for the different symptoms they experience?

Community Pharmacies: Devon and the South-west

Stephen Kinnock Excerpts

Tuesday 17th December 2024 Westminster Hall

[The Minister for Care (Stephen Kinnock)]

It is a real pleasure to serve under your chairship, Mr Betts. I thank the hon. Member for Tiverton and Minehead (Rachel Gilmour) for ensuring that this really important debate can take place today. I start by acknowledging and paying tribute to the outstanding work of community pharmacy teams in Devon, the south-west and right across the country. I have heard so many examples, showing just how many patients and communities rely on pharmacy services, and the lengths to which they go to deliver care. I thank them for their professionalism, hard work and dedication in providing excellent standards of patient care.

It is a credit to them that surveys show that nine in 10 people who visit pharmacies feel positive about the experience. Community pharmacies are often the most accessible part of our NHS, allowing people to access professional healthcare advice right there on the high street. They are also vital in supporting rural communities and people living in remote locations. Furthermore, as community pharmacies provide more clinical services, they help to relieve pressure in other areas of the NHS. That includes freeing up GP appointments, preventing hospital admissions and reducing overall pressure on secondary care.

For far too long, however, Governments have failed to recognise the essential role of community pharmacies in safeguarding the nation’s health. On 4 July, we inherited a system that has been starved of funding, with a 28% cut in funding in real terms. In many ways, it is on its knees, with far too many closures happening across the country. Lord Darzi’s report laid bare the true extent of the challenges facing our health service. Even he, with all his years of experience, was truly shocked by what he discovered. His report was vital, because it gave us a frank assessment—a diagnosis—so that we can face the problems honestly and properly. It will take a decade of national renewal, lasting reform and a long-term plan to save our NHS. We have committed to three key shifts: from hospital to community, from analogue to digital, and from sickness to prevention. Our 10-year plan will set out how we will deliver these shifts to ensure that the NHS is fit for the future.

To develop the plan, we must have a meaningful conversation with the country and those who work in the system. We are therefore conducting a comprehensive range of engagement activities, bringing in views from the public, the health and care workforce, national and local stakeholders, system leaders and parliamentarians. I urge Members, their constituents, and staff across health and social care to tell us what is working and what needs to change. They should visit change.nhs.uk and make their voice heard.

The Government are committed to restoring the NHS to its founding promise that it will be there for all of us and our constituents when we need it. However, as identified by Lord Darzi’s review, primary care is under massive pressure and in crisis. I recognise that it is a really challenging environment for colleagues in all parts of the NHS, including in community pharmacy, but we remain resolute and determined to fix this situation.

Pharmacies are based in, and are a key part of, the communities that they serve. They are ideally placed to help to tackle inequalities and to increase the reach of and access to NHS services. This includes delivering a range of health advice and support services, helping to relieve pressure on and improve access to the wider NHS. Community pharmacies are a vital part of our NHS that must be recognised in the development of the Government’s 10-year plan. They are central to the three big shifts in healthcare that I outlined earlier. I know that pharmacies can and should play an even greater role in providing healthcare on the high street. This will be imperative if we are to deliver across the Government’s mission—not just on the health mission, but on growth and opportunity.

A healthy society and workforce are pre-conditions for prosperity and growth. We have a staggering 2.9 million people who want to work, but are unable to do so because they have been failed by our health and care system for the last 14 years. Community pharmacy has a pivotal role to play in getting our economy back on its feet and fit for the future, whether that is by identifying those with risk factors for disease such as high blood pressure, or ensuring that people can access and use their medicines to best effect. As a Government, we are fully committed to working with the sector to achieve what we all want: a community pharmacy service that is fit for the future.

I am keen to unlock the potential of the whole pharmacy team. We want pharmacists to be providing new and impactful clinical services, including our future pharmacies prescribing service. We want pharmacy technicians to have more responsibility in supporting the pharmacists, to help people to deliver the best possible health outcomes.

Every day, pharmacy teams facilitate the safe supply of medicines to patients, enabling them to manage health conditions as part of their daily lives in Devon, the south-west and right across the country. They also provide vital advice on prescriptions, over-the-counter medicines and minor ailments. But pharmacies do not just dispense medicines and offer advice. They do much more. They positively impact patients’ health and support the wider NHS by providing a wide range of clinical services. Many offer blood pressure checks, flu or covid-19 vaccinations, contraception consultations and many more locally commissioned services.

[Dr Evans]

The Minister is espousing brilliantly what community pharmacies do. That all comes under a contractual framework, and one of the key things that pharmacies are asking for is when the negotiations will start and what the terms of reference will be. Will the Minister address that point?

[Stephen Kinnock]

I thank the shadow Minister for that intervention. I am as frustrated as everybody else about the delay. The reason for the delay is that the negotiations did not get over the line before the general election. The general election came, and we have spent a lot of time now clearing up the disastrous mess that the previous Government made of the system. I can say that we are now very focused on getting these negotiations started early in the new year. I know that hon. Members across the House will be very interested in that, in terms of the contractual framework, the medicines margin and all of the funding. We have a statutory duty to consult with the sector before we can make any announcement, but we are confident that we will start the negotiations early in the new year.

We supported Pharmacy First in opposition, and we will build on that programme in the future. We look to create an independent prescribing service, where prescribing is an integral part of the services delivered by community pharmacies. We are also doing a lot of work on the IT infrastructure to make sure that the sector can more easily prescribe and refer through better IT. That is an important part of our shift from analogue to digital. We need pharmacies delivering services that help patients to access advice, prevention and treatment more easily—services that help people to make best use of the medicines they are prescribed and that ease some of the pressures in general practice and across parts of the NHS.

There are more than 10,000 pharmacies in England. They are busy dispensing medicines, offering advice and providing these services. Patients across the country can also choose to access around 400 distance-selling pharmacies that deliver medicines to patients’ homes free of charge. They play a vital role in reaching the most isolated members of our society.

I am very keen to ensure that the hon. Member for Tiverton and Minehead has a minute at the end of the debate to sum up. In the short time I have, I want to say a couple of words about her constituency, where there are 15 pharmacies. We are aware of the closure of one pharmacy in her constituency since 2017 and that the local population instead get their medicines from the neighbouring dispensing GP. I also note that, according to the latest data, there are 203 pharmacies in Devon; across the south-west, there are 916. Where closures have occurred across the south-west, the ICBs are working through the process of approving applications from new contractors. Some applications have already been granted. Following approval, the new pharmacy contractor has 12 to 15 months in which to open a pharmacy, so the ICBs are also working with GP practices and other contractors to minimise any temporary disruption for patients.

Community pharmacies are a vital part of the NHS and communities across our country. The Government are committed to supporting them now and into the future. I look forward to working with pharmacists across the country and hon. Members across this House as we progress our plans to embrace the skills, knowledge and expertise in pharmacy teams.

Dental Healthcare: East Anglia

Stephen Kinnock Excerpts

Wednesday 11th December 2024 Westminster Hall

[The Minister for Care (Stephen Kinnock)]

It is a pleasure to serve under your chairship, Mr Dowd. I thank the hon. Member for Broadland and Fakenham (Jerome Mayhew) for securing this vital debate on dental healthcare provision in East Anglia, and I thank hon. Members on both sides of the House for their important interventions.

The debate follows hot on the heels of a debate on 3 September that my hon. Friend the Member for Norwich South (Clive Lewis) led on healthcare provision in the east of England. We know that huge swathes of the region are dental deserts. These areas are facing great pressures from challenges in the recruitment and retention of dentists, leaving patients struggling to access the NHS dental treatments that they need. As has been pointed out, it is a scandal—frankly, it is Dickensian—that the No. 1 reason for children aged five to nine to be admitted to hospital in our country in 2024 is to have rotten teeth removed.

Norfolk and Waveney integrated care board had 31.5 dentists per 100,000 of the population in 2023-24, which is the lowest number in England. That is why I have met with colleagues from the east of England, including the hon. Member for Broadland and Fakenham, to discuss the specific challenges in the region and to discuss the University of East Anglia’s plans to open a dental school. The UEA’s proposal to begin training dental students is very welcome news. As I said to all the colleagues I met recently, and to the hon. Gentleman at oral questions last month, the Government strongly encourage the UEA to continue its progress towards establishing a dental school by submitting its bid to the General Dental Council as rapidly as possible.

The independent Office for Students is another key player. It has statutory responsibility for allocating funded training places to dental schools. As the hon. Gentleman has pointed out, the OfS is independent from the Government. I cannot make specific commitments about allocating additional training places for future years, because to do so would be to cut across the independence of the OfS. The OfS makes decisions based on its own assessments, following guidance issued by Government. What I can say to the hon. Gentleman is that our guidance is influential, but I cannot guarantee its outcome.

The guidance for the 2026 academic year will be published in due course. Provided that the UEA meets those requirements, it would absolutely be considered for Government-funded dental training places. That would certainly help to retain local dentists in East Anglia. As a Member for a rural constituency, I absolutely understand how important that is to the hon. Gentleman and to the many other hon. Members present who represent his part of the country.

We also need a clear-headed diagnosis of where we are. It is beyond doubt that NHS dentistry was left in an appalling state of disrepair by the previous Government. As the Prime Minister said last week, the precious contract between the state and the British people has been broken. He rightly said that our public services are

“in crisis, unable to perform their basic functions”

and that they are

“unable to provide the timely care and dignity that Britain relies on”.

Almost five years on from the beginning of the pandemic, NHS dentistry has still not recovered to pre-pandemic levels. Only 40% of adults were seen by an NHS dentist in the 24 months to June this year, down from almost 50% before the pandemic. Although 34 million courses of dental treatment were delivered in England in 2023-24, that is down from almost 40 million courses five years ago. As I say, it is disgraceful that having rotten teeth removed is the single most common cause of hospital admissions for children aged five to nine, causing them untold pain and suffering and affecting their ability to sleep, speak and socialise.

On the subject of the general state of dentistry, I thank the National Audit Office for its recent investigation of the previous Government’s dental recovery plan. Its report lays out in black and white something that was already apparent to millions of people across the length and breadth of our country: the dental recovery plan that we inherited did not go far enough. We are reflecting on every line of the NAO report as part of our efforts to rebuild dentistry, get it back on its feet and make it fit to serve people of all ages. We have launched the largest ever national conversation to inform our 10-year plan to reform the NHS, and our workforce will play a central role, because they are key to unlocking improvements across our communities.

The golden hello scheme offers dentists £20,000 to work in underserved areas of the country for three years. The recruitment process is well under way, with posts being filled by dentists in those areas as we speak. As of 7 November, 64 posts had been advertised. Our manifesto pledged 700,000 more urgent dental appointments, and we are working to ensure that patients can start to access them as soon as possible. They will be targeted at the areas that need them most.

Strengthening the workforce is key to our ambitions, but for years dentistry has faced chronic workforce shortages. We have to be honest that bringing in the staff we need will take time. To rebuild dentistry in the long term and increase access to NHS dental care, we will reform the dental contract with a shift to focusing on prevention and the retention of NHS dentists. There are no perfect payment systems, and careful consideration needs to be given to any potential changes to the complex dental system, so that we deliver a system that is better for patients and the profession.

[Adrian Ramsay]

I thank the Minister for reiterating the Government’s commitment to reforming the dental contract. Please will he set out a timescale for that work commencing?

[Stephen Kinnock]

I was just going to say that we are continuing to meet the British Dental Association and other representatives of the dental sector to discuss how we can best deliver our shared ambition to improve access for NHS dental patients. We are working on this as a matter of urgency. I cannot give a specific timeframe, but it is a top priority for the Department.

[Charlotte Cane (Ely and East Cambridgeshire) (LD)]

I understand that the Government have inherited a big problem, but the situation is urgent. I have a constituent who has heart problems, so his oral health is really important to him. He cannot get an NHS dentist, so constituencies such as Ely and East Cambridgeshire need urgent action.

[Stephen Kinnock]

I share the hon. Lady’s belief that we need urgency and focus. We have a big mountain to climb, but we have to crack on. I completely take her point about the need for urgency.

We need to ensure that the process to register a dentist in the UK is as efficient and fast as possible, while retaining robust safeguards for patient protection. The Department regularly engages with the General Dental Council to understand what it is doing to improve the waiting times for the overseas registration exam. Earlier this year, the Department ran a consultation on introducing a further piece of legislation to give the GDC powers to provisionally register overseas qualified dentists, which will help to address some of the workforce challenges.

In summary, this is an immense challenge. There are no quick fixes or easy answers, but we will choose change, not because it is easy but because it is what we have to do. We have to do the hard yards, and I look forward to working with the hon. Member for Broadland and Fakenham and other colleagues to deliver what is needed.

Question put and agreed to.

Suicide and Mental Health of Young People: Tatton

Stephen Kinnock Excerpts

Tuesday 26th November 2024 Westminster Hall

[The Minister for Care (Stephen Kinnock)]

It is a pleasure to serve under your chairmanship, Mr Dowd. I am grateful to the right hon. Member for Tatton (Esther McVey) for securing this debate and raising many important issues. I also thank her for sharing the tragic story of Olivia. My heart goes out to Olivia’s family and loved ones; it is a truly heartbreaking situation and process that they have gone through.

The right hon. Lady made a number of important points about withdrawal from SSRI antidepressants. A number of those points are quite specific, and I do not have in specific responses my notes. With her leave, I would like to write to her with responses on those points. She made a point about the coroner’s advice, which contained a lot of useful counsel on how we might address and tackle the issues raised. I will certainly look at that in detail, and will happily take those matters forward with her. We have a shared interest in addressing the issue. If the system is not working and people who are on that antidepressant are not being supported with withdrawal, we need to look at that in detail. We need to tackle it—I share her views on that.

I will turn to some more general points about the Government’s position on mental health. We have made suicide prevention and mental health a priority, especially for young people. Many of the issues raised today are symptomatic of an NHS that is broken. Looking at the figures, the challenges that face the NHS are truly sobering.

About 50% of lifetime mental health conditions are established by the time an individual is 14 and 75% by the time they are 24. Evidence suggests that the prevalence of mental health conditions is rising among children and young people. In 2023, 20.3% of eight to 16-year-olds had a probable disorder, compared with 12.5% in 2017. Of course, the covid-19 pandemic exacerbated needs, with analysis showing that 1.5 million children and young people under the age of 18 could need new or increased mental health support following the pandemic.

According to the Darzi review, 343,000 referrals for children and young people under the age of 18 are waiting for mental health services, including 109,000 referrals waiting for more than a year. Under the NHS Cheshire and Merseyside integrated care board, as of the end of September 2024, 10% of children and young people still waiting for first contact with NHS-funded mental health services were waiting for more than 951 days, equating to 1,301 people. Half of those still waiting had been waiting for more than 300 days. There are 13,010 children and young people still waiting for first contact with NHS-funded mental health services.

Until recently, there had been an upward trend in suicide rates for children and young people. For women between the ages of 10 and 24, the rate has nearly doubled since 2012, rising from 1.6 per 100,000 to 3.1 per 100,000 in 2023.

[Helen Grant (Maidstone and Malling) (Con)]

Over the past 10 years in England and Wales, one student has died every four days as a result of suicide. Despite that forlorn tragedy, the law remains unclear about the duties and responsibilities universities have towards their often very vulnerable young students. Will the Minister meet me and members of the LEARN Network and ForThe100 to discuss the introduction of a statutory duty of care for all higher education providers?

[Stephen Kinnock]

I thank the hon. Lady for that important intervention. I am happy to meet her and the LEARN Network. The Government cannot do all this alone; we need to work in partnership with all sorts of different stakeholders, including universities and the higher education sector. We would support any partnership working that we can do.

Until recently, there had been an upward trend in suicide rates for children and young people. For women between the ages of 10 and 24, the rate has almost doubled, but the trend for children and young people has flattened in the past year, despite overall increases in suicide. Although those rates are low compared with those for other age groups, children and young people are a priority group in our mission to tackle suicide. The Department is commissioning research via the National Institute for Health and Care Research to advance our understanding of why rates of suicide have been increasing in certain age groups.

We are committed to reforming the NHS to ensure that we give mental health the same attention and focus as physical health. It is unacceptable that too many children, young people and adults are not receiving the mental health care that they need. We know that waits for mental health services are far too long. We are determined to change that. That is why we will recruit 8,500 additional mental health workers across children’s and adult mental health services. We will also introduce a specialist mental health professional in every school and roll out young futures hubs to provide timely mental health support to our children and young people.

We are working with our colleagues at NHS England and the Department for Education as we plan delivery of those commitments. Furthermore, the Government are also committed to tackling suicide as one of the biggest killers in our country. The suicide prevention strategy proposes targeted support for priority groups such as children and young people. The Department for Education is reviewing the statutory guidance on relationships, sex and health education, and the Secretary of State for Education is clear that children’s wellbeing should be at the heart of it.

Some 79 voluntary, community or social enterprise organisations up and down the country have been allocated funding through the Department of Health and Social Care’s £10 million suicide prevention grant fund over the two years to March 2025. These organisations—from local and community-led through to national—deliver a broad and diverse range of activity that will prevent suicides and save lives.

Early intervention on mental health issues is vital if we want to stop young people reaching crisis point. Schools and colleges play an important role in that early support, which is why we have committed to providing a mental health professional at every school. Mental health support teams help to meet the needs of children and young people in education settings; such teams, which are made up of mental health practitioners and education mental health specialists, are available in schools in Tatton.

However, it is not enough to provide access to a mental health professional when young people are struggling. We want the education system to set young people up to thrive, and we know that schools and colleges can have a profound impact in promoting good mental health and wellbeing. Doing this well takes a holistic approach, drawing in many aspects of the school or college’s provision. Many schools are already doing that, and my Department is working alongside the Department for Education to understand how we can support such good practice across the sector, and across the length and breadth of our country.

The opportunity mission will break the link between people’s background and their success. The mission will build opportunity for all by giving every child the best start in life: high-quality early education, early child health, home learning environments and family support. The mission will also support children to achieve and thrive, ensuring high school standards with a broad curriculum, excellent teachers and targeted interventions, an inclusive approach to special educational needs and disabilities, mental health support, access to arts, culture and sport, and youth services and provision.

In our manifesto, the Government committed to rolling out young futures hubs. This national network is expected to bring together local services, deliver support for teenagers at risk of being drawn into crime or facing mental health challenges, and, where appropriate, deliver universal youth provision. The hubs will provide open-access mental health support for children and young people in every community.

We are concerned about the widespread availability of harmful material online, promoting content on eating disorders, suicide and self-harm, that can easily be accessed by people who may be young and/or vulnerable. We have been clear that the Government’s priority is the effective implementation of the Online Safety Act 2023, so that those who use social media—especially children—can benefit from its wide-ranging protections as soon in their lives as possible. Earlier this year, Ofcom concluded its consultations on the draft illegal content and child safety codes of practice. We expect the illegal content codes to be in effect by spring 2025, with the child safety codes following in the summer.

I will turn to other aspects of our plans to improve mental health services. The Mental Health Bill, which was announced in the King’s Speech, will deliver the Government’s manifesto commitment to modernise the Mental Health Act 1983 by giving patients greater choice and autonomy and enhanced rights and support, and aims to ensure that everyone is treated with dignity and respect throughout their treatment. It is important to get the balance right to ensure people get the support and treatment they need when necessary for their protection and for that of others.

I am pleased to say that the Bill has been introduced in the Lords and will be coming to the Commons in the new year. The Bill will make the Mental Health Act fit for the 21st century, redressing the balance of power from the system to the patient and ensuring that people with the most severe mental health conditions get better, more personalised care. It will limit the scope to detain people with a learning disability and autistic people under the Act unless they have a co-occurring mental health disorder that needs hospital treatment.

I conclude by once again commending the right hon. Member for Tatton for securing the debate and colleagues from across the House, including the hon. Members for Maidstone and Malling (Helen Grant) and for Strangford (Jim Shannon), for sharing their insight on the vital issue of suicide prevention and mental health care for children and young people. I am committed to working with the right hon. Member for Tatton and her hon. Friend, the hon. Member for Maidstone and Malling, to take forward these issues, and I hope that we can, together—across the House—address this vital issue.

Question put and agreed to.

Oral Answers to Questions

Stephen Kinnock Excerpts

Tuesday 19th November 2024 Commons Chamber

[Jerome Mayhew (Broadland and Fakenham) (Con)]

4. What estimate he has made of the number of new dental training places needed in the east of England.

[The Minister for Care (Stephen Kinnock)]

Fourteen years of Conservative neglect and incompetence have left huge swathes of the east of England as dental deserts. As part of our 10-year plan, we will be working with NHS England to assess the need for more dental trainees in areas such as the east of England where we know that many people are struggling to find an NHS dentist. I am aware of the University of East Anglia’s plans to open a dental school and I recently met MPs from the east of England, including the hon. Gentleman, to discuss that process. I encourage the UEA to continue with its bid for a new dental school.

[Jerome Mayhew]

The Minister well knows that there is a lack of dentists in the east of England, because there is no undergraduate training facility. The nearest place is either Birmingham or London. He has kindly mentioned the University of East Anglia, which is ready to go with a new building under construction. It has wide cross-party support, as he also knows from the meeting that he held recently, so when will he make the announcement?

[Stephen Kinnock]

I thank the hon. Gentleman for that follow-up question, but he will recall that, when we met, I and my officials made it clear to him that the UEA has not yet submitted its bid for a dental school. In that meeting, we said: “Please go back to the UEA and encourage them to submit that bid. When they do, we will look at it very carefully.”

[Mohammad Yasin (Bedford) (Lab)]

Many of my constituents in Bedford are struggling to get an NHS dentist. I am also hearing from those who have tried to book an appointment only to discover that they have been removed from the NHS list without any warning. The Government have committed to improve the dental contract. In doing so, will they ensure that dentists can no longer drop people from their books—leaving them without any access to care—without prior notice?

[Stephen Kinnock]

My hon. Friend is right: we will reform the dental contract to rebuild dentistry in the long term and to increase access to NHS dental care, with a shift to focusing on prevention and the retention of NHS dentists. We continue to meet representatives from the British Dental Association and other representatives of the sector to discuss how we can best deliver our shared ambition to improve access for NHS dental patients.

[Wendy Chamberlain (North East Fife) (LD)]

5. What recent assessment he has made of the potential impact of proposed changes to employer national insurance contributions on staffing costs for health and care providers.

--- Later in debate ---

[Antonia Bance (Tipton and Wednesbury) (Lab)]

6. What discussions he has had with Cabinet colleagues on staff salaries in the care sector.

[The Minister for Care (Stephen Kinnock)]

I was proud that the Chancellor raised the salaries of hundreds of thousands of care workers in the Budget. Last month, the Government introduced legislation to deliver the first ever fair pay agreement for adult social care. While we were giving care workers a pay rise, the Leader of the Opposition was belittling their work as merely wiping bottoms. I gently say to the Conservative party that it is better to be wiping bottoms than talking out of them. This is an important issue, and I am dealing with ministerial colleagues on it.

[Antonia Bance]

According to last month’s Skills for Care report, most care workers are paid only a couple of pennies above the national minimum wage, while the sector cannot recruit and retain the people it needs. Will the Minister set out the timetable for establishing the fair pay agreement and adult social care negotiating body, and will he give the House an assurance that the care trade unions will be closely involved in its design?

[Stephen Kinnock]

We took quick action on the Employment Rights Bill, which includes the fair pay agreement, within 100 days of taking office. The consultation process on the negotiating body can begin only once the Bill has become an Act. We are engaging widely with stakeholders, and I assure my hon. Friend that unions will play a central role in that process, but let us remember that, through the national living wage, we are giving the lowest-paid full-time care workers a pay increase of £1,400 per year.

[Seamus Logan (Aberdeenshire North and Moray East) (SNP)]

One barrier to better staff salaries in the care sector is the additional employer national insurance contributions. Are the Minister and his colleagues considering an exemption for GP practices, charities and hospices from national insurance employer contributions?

[Stephen Kinnock]

As my right hon. Friend the Secretary of State for Health and Social Care pointed out, when we won the general election on 4 July, we inherited public finances in their worst state since the second world war. Through the Chancellor, we have taken responsible action to deal with those issues. My right hon. Friend the Secretary of State has also said that we are looking at the Budget in the round, and we will report on that in due course.

[Andrew Pakes (Peterborough) (Lab)]

7. What assessment his Department has made of the adequacy of access to NHS dentists.

[Dan Aldridge (Weston-super-Mare) (Lab)]

23. What assessment his Department has made of the adequacy of access to NHS dentists.

[The Minister for Care (Stephen Kinnock)]

After 14 years of Tory neglect and incompetence, NHS dentistry in England has been left in a parlous state. Tooth decay is the most common reason why children aged five to nine are admitted to hospital, and 28% of the country—13 million people—have an unmet need for dentistry. Rescuing NHS dentistry will not happen overnight. We will expand the provision of urgent dental appointments across the country, and we are working with the sector to reform the dental contract in order to increase access and incentivise more NHS care.

[Andrew Pakes]

Yesterday, I heard from a disabled constituent who has spent over a year trying to find an NHS dentist, but without success. The only solution was to come to London for emergency treatment—that became a shockingly common story under the previous Government. As a first step, our integrated care board is putting 12 extra dentists into Peterborough and the surrounding towns to increase access. Will the Minister update the House on progress and on how we will further improve access to NHS dentistry?

[Stephen Kinnock]

I am very pleased to hear about what my hon. Friend’s ICB is doing. Working with the dental sector, we will deliver measures to improve access, targeting areas that need it most. Those measures include 700,000 additional urgent appointments and reform of the dental contract. The golden hello scheme, which incentivises dentists to work in underserved areas, is under way across the country, and dentists are also being offered a new patient premium to treat new patients.

[Richard Baker]

Does the Minister agree that it is unacceptable that more than 40,000 people in Fife are not registered with an NHS dentist? Will he share any learning from this Government’s action to increase access to dentistry with his colleagues in the Scottish Government, and urge them to fulfil their responsibilities so that people in my constituency can get the dental treatment that they need?

[Stephen Kinnock]

Responsibility for dental services in Scotland is of course a matter for the Scottish Government, but Governments across the UK work together to spread best practice and deliver on our common goals. The Scottish National party Government have an extra £1.5 billion this year, and £3.4 billion next year, through the Barnett formula. I hope that they will prioritise health, including dentistry, and undo some of the damage that they themselves have done to dentistry in Scotland.

[Dan Aldridge]

Some 37% of five-year-olds in Weston-super-Mare have enamel or dental decay—a figure well above the national average. The Better Health North Somerset team does amazing work to promote good oral health, but regular dentist check-ups are the oral health silver bullet. Will the Minister explain and outline the work he is doing to ensure that children in Weston and Worle and across the country get the dentistry service that they so desperately need?

[Stephen Kinnock]

My hon. Friend is absolutely right to raise this vital issue. Prevention is of course always better than cure, so I am very proud of the fact that we are introducing supervised toothbrushing for three to five-year-olds in the most deprived communities and where there is the most unmet need. We are also working to sort out the NHS contracts so we can ensure that children get the care they need.

[James Wild (North West Norfolk) (Con)]

Having training locally at the University of East Anglia is important for my constituents, but in the short term, what steps is the Minister taking to speed up the process by which dentists get on the dental performers list, so that they can work in the NHS and not just privately? Is he also considering bringing in a provisional overseas registration scheme?

[Stephen Kinnock]

I thank the hon. Gentleman for that question. We are looking at provisional registration. As I also mentioned to his hon. Friend the Member for Broadland and Fakenham (Jerome Mayhew), we are very open to the idea of a dental training school at the University of East Anglia. We need to ensure that we push on the full spectrum of all these measures, because there is a crisis in NHS dentistry and we need to get on and fix it.

[Ben Obese-Jecty (Huntingdon) (Con)]

Toothless in Huntingdon in my constituency has written to me highlighting that 36% of patients under Cambridgeshire and Peterborough integrated care system no longer have an NHS dentist. It wants dental practices to provide access to those needing emergency treatment and a priority pathway for referrals from hospital departments such as cardiology and oncology. To that extent, what steps are being taken in Huntingdonshire to improve dental access across rural Cambridgeshire? How are the Government helping the Cambridgeshire and Peterborough integrated care system to address those issues?

[Stephen Kinnock]

Obviously the golden hello scheme for rural areas is very important. We are pushing forward on that, and I am pleased to say that hundreds have expressed interest in it and appointments are starting on that basis. The hon. Gentleman is right about training places. As I have already mentioned, we are very open to establishments and institutions coming forward with proposals for that. We are living in a country where the biggest cause of hospital admission for five to nine-year-olds is having their rotten teeth removed. That is a truly Dickensian state of affairs, and it needs to be fixed as a priority.

[Tom Gordon (Harrogate and Knaresborough) (LD)]

Earlier this year, I was at an orthodontist’s practice that carries out work on behalf of the NHS. It said the issue is that when people are referred to it by their general dentist, it cannot go on to do the orthodontic work because their teeth are in too bad a state, so they are referred back to the dentist, but they cannot get in because of waiting lists and issues. When we look at reforming dental contracts, will we look at orthodontic ones too?

[Stephen Kinnock]

Absolutely. As my right hon. Friend the Secretary of State has said, we have already met with the British Dental Association, and no issues are off the table. We absolutely need to look at orthodontists in the round as part of the contract negotiations, and we will certainly report back on that in due course.

[Tristan Osborne (Chatham and Aylesford) (Lab)]

9. What plans he has to reform NHS health and social care services.

--- Later in debate ---

[Helen Morgan (North Shropshire) (LD)]

The Conservatives’ disastrous legacy on dentistry means that more than 4.4 million children have not seen a dentist in the past year. In Shropshire, dentists continue to hand back their contracts, including one in Wem in recent weeks. Will the Minister outline his plan to reverse that terrible decline and ensure that the issue is addressed in rural areas where there are dental deserts?

[The Minister for Care (Stephen Kinnock)]

There will be 700,000 extra urgent appointments, golden hellos, and a prevention and supervised toothbrushing scheme for three to five-year-olds.

--- Later in debate ---

[Damien Egan (Bristol North East) (Lab)]

T6. On the doorstep in Bristol North East, people regularly talk to me about the difficulties they have getting a GP appointment. Will the Minister assure primary care services in my constituency, such as Kingswood health centre, that the Budget will help them and marks the first steps in transforming our NHS?

[Stephen Kinnock]

We have pledged to bring back the family doctor, and we have already invested an additional £82 million in the additional roles reimbursement scheme to recruit 1,000 more newly qualified GPs in 2024-25. We are also committed to fixing the front door of the NHS, for example through £100 million of capital funding that was announced in the Budget. We are fully aware of the pressures, and we will set out further details on funding allocations for next year in due course.

[Charlie Maynard (Witney) (LD)]

T5. Will the Secretary of State give a clear date by which QR codes will be incorporated into the NHS app at the point of care, thereby making the process faster and safer, as was highlighted to me by Dr Steve Bright at the Windrush health centre in Witney?

--- Later in debate ---

[Mr Lee Dillon (Newbury) (LD)]

When the Secretary of State reviews GP funding, will he also consider the burden that sits on GP practices when they have to hold the lease for their surgeries and what role integrated care boards could have in holding that risk, which is stopping the recruitment of GPs to join practices as partners?

[Stephen Kinnock]

NHS England currently accepts ICBs holding leases only as a last resort or by exception due to the significant capital required. While we know that is not the most effective use of ICB resources, it is an important safeguard. We are committed to fixing the front door of the NHS by supporting GPs and ICBs through, for example, the £100 million of capital funding announced at the Budget for GP estate upgrades.

[Jacob Collier (Burton and Uttoxeter) (Lab)]

My constituent Ollie Horobin’s life has been completely transformed after contracting covid, leaving him wheelchair-bound with a feeding tube and battling debilitating symptoms every single day. His story is a stark reminder of the devastating impact that long covid can have. Will the Minister commit to meeting Ollie and me to hear about his experience at first hand, and prioritise further research into the causes, treatments and long-term impacts of extreme long covid?