Oral Answers to Questions
Steve Barclay Excerpts(1 year, 10 months ago)
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Jack Lopresti (Filton and Bradley Stoke) (Con)
The Secretary of State for Health and Social Care (Steve Barclay)
We have introduced a range of contingency measures, such as the provision of military personnel, who are available to assist with the driving of ambulances, and community first responders, who can help before ambulances arrive on the scene.
Jack Lopresti
Will my right hon. Friend join me in thanking call handlers at the South Western Ambulance Service NHS Foundation Trust—and the public—for halving the number of 999 calls to the trust over the last month, and reducing average call answering times by 95%, to just three seconds? Will he also join me in expressing dismay at the approach taken by the Leader of the Opposition during the most recent session of Prime Minister’s Question Time in seeking to sow fear in the hearts of my constituents and others for his own narrow political gain?
Steve Barclay
I am happy to join my hon. Friend in paying tribute to the work of call handlers at the South Western Ambulance Service, and to the staff there as a whole. He is right to draw attention to the improved performance that we have seen in recent weeks, and also right to point out that all parts of the United Kingdom have faced considerable challenges, particularly over the Christmas period when we saw a significant spike in flu levels.
Rachael Maskell (York Central) (Lab/Co-op)
We have just heard in the Health and Social Care Committee that on strike days there was a drop in service demand, but also value added by the increased clinical support, resulting in better and more cost-effective decisions. Why does that happen on strike days rather than on every single day of the year?
Steve Barclay
We are taking a number of steps to improve performance, and not just on strike days—but I thought the hon. Lady was going to refer to the comment that she made about those on her own Front Bench, when she said:
“I think what our health team need to do is really spend more time in that environment with clinicians to really understand what drives them.”
We on this side of the House are spending a significant amount of time with clinicians, and it is important that those on the hon. Lady’s Front Bench do so as well.
Janet Daby (Lewisham East) (Lab)
Karl MᶜCartney (Lincoln) (Con)
The Secretary of State for Health and Social Care (Steve Barclay)
The long-term workforce plan that is being developed by NHS England will help to ensure that we have the right staff numbers with the right skills to deliver high-quality services in the future.
Janet Daby
Is the Secretary of State fully aware that under this Government every part of the NHS is in crisis? Are the Government satisfied with the fact that, as medical students in their second year told me recently, the shortage of staff on hospital wards and the pressures on those wards are affecting their training? The students also told me that they had little aspiration to work as junior doctors in the UK after qualifying, because of the acute strain on the NHS and because they felt undervalued. Does the Secretary of State know about this, and what is he going to do about it?
Steve Barclay
We see a considerable number of applications for medical undergraduate places, far in excess of the number of places available. We have boosted the number of places—[Interruption.] The hon. Member for Ilford North (Wes Streeting) chunters from the Opposition Front Bench, but when I was last in the Department and the Chancellor had my role, we increased the number of medical undergraduate places by 25%. Indeed, we have more doctors and nurses than we had last year, and 3.5% more full-time equivalent staff: we have over 42,000 more people working in the NHS than we had last year.
Jim Shannon
The British Heart Foundation has reported that by the end of August 2022 a record 346,000 people were waiting for heart care. Despite the best efforts of NHS staff, workforce shortages are affecting primary and secondary care services. Can the Secretary of State explain how the Government’s comprehensive NHS workforce plan will address specific gaps in the workforce, especially those in cardiology services?
Steve Barclay
The hon. Gentleman has raised an important issue. I think that, in particular, we should look at our approach to major conditions, and I will say more about our thinking in that regard at the start of topical questions. I also think that we need to look at the issue of heart conditions in the context of the wider debate about excess deaths; we know that there is a particular issue in the 50 to 64-year-old cohort. As well as providing those extra doctors and clinicians—and from next autumn we will also have the additional medical doctor degree apprenticeship route—we need to look at methods of upstream testing, particularly in respect of heart conditions.
Karl MᶜCartney
In reference to my right hon. Friend’s earlier answers, we are keen to see the success of the new Lincoln medical school leading to more locally trained NHS professionals working across Lincolnshire. What more can the Government do to remove barriers to entry to ensure that anyone who can do so is able to train to become a doctor, nurse, dentist or dental nurse in our NHS, specifically in Lincoln and Lincolnshire?
Steve Barclay
My hon. Friend raises an important point on two levels. The first relates to how we boost recruitment in areas such as Lincolnshire, and the new medical school in Lincoln will play a key part in that. The second relates to how we increase the retainability of staff in those parts of the country, and having more on-the-job training and apprenticeships is a key way of doing that. That is why things like the new medical doctor degree apprenticeship will be particularly relevant to cohorts of the population in areas such as Lincoln.
Mr Louie French (Old Bexley and Sidcup) (Con)
One of the biggest issues my local hospitals raise with me in outer London is the impact of Sadiq Khan’s ultra-low emission zone expansion, with nurses and other staff facing charges of £12.50 per shift or £25 if they are working nights. Given that 50% of London’s emergency service workers live outside the capital, does the Minister agree that the Mayor and the Labour party should stop ignoring Londoners and drop their ULEZ tax rate?
Steve Barclay
My hon. Friend raises an important point about the additional costs that the London Mayor is imposing not just on NHS staff but on all staff working in the capital, in contrast to the approach the Chancellor has taken to energy support to help staff across the workforce, including in the NHS, with the cost of living.
Sir Gary Streeter (South West Devon) (Con)
Most of the GP practices in South West Devon report to me that their biggest challenge is recruiting new doctors. Does my right hon. Friend have an estimate of the number of young doctors finishing their training this year who are likely to want to become GPs, and can he reassure us that that is a greater number than the number who are likely to retire in the next 12 months?
Steve Barclay
My hon. Friend raises two important themes. The first relates to how many are in training, and I think it is around 4,000. We have boosted the number of GP training places and we have looked at medical schools as a specific issue. Also, he will have seen some of the changes being made around pensions in order to better retain staff, mindful of those clinicians who are leaving the profession, and further discussions are taking place with Treasury colleagues in that regard.
Helen Morgan (North Shropshire) (LD)
In Shropshire there are 14% fewer GPs and 29% fewer GP partners than in 2019, yet in the period from April to November 2022, they provided 6% more appointments. It is this additional workload that is causing burnout in GP practices and a flight from the profession. What is the Secretary of State doing to improve the retention of GPs as well as recruitment?
Steve Barclay
It is important to look at the number of doctors in general practice, and those numbers are up. There are 2,298 more than there were in September 2019, so we are increasing the number of doctors. What is also important is getting the right care at the right time within primary care, which is about the wider workforce—the paramedics, the mental health support and others working in primary care—and there are an extra 21,000 there. This is enabling GPs to see more patients a day and allowing more patients to get the right primary care, perhaps not from a doctor but from others who can offer specialised support.
Eddie Hughes (Walsall North) (Con)
One of the best ways to improve recruitment and retention is to make sure that staff have an excellent working environment, which is why I campaigned for a new urgent and emergency care department at Walsall Manor Hospital. I was successful, and it is opening in March. Will one of the ministerial team join me to celebrate this success?
Steve Barclay
I welcome my hon. Friend’s drawing attention to the investment that has been made, which is in no small part due to his campaigning and championing his constituents, as he does so assiduously. I think the Minister of State, Department of Health and Social Care, my hon. Friend the Member for Colchester (Will Quince) has plans to join him to mark the opening of that important facility, which shows our investment in the estate within the NHS.
Gareth Thomas (Harrow West) (Lab/Co-op)
One way to improve retention and recruitment of NHS staff at Northwick Park Hospital, which serves my constituency and which I believe the Secretary of State visited last Thursday, would be to invest in doubling its intensive care beds. Did the Secretary of State discuss that issue with the chief executive of Northwick Park when he visited last week? Will he tell us when he might be able to announce funding for the new 60-bed unit that Northwick Park needs?
Steve Barclay
The hon. Gentleman is right to highlight the importance of bed capacity at Northwick Park, but my discussions with the chief executive were more in the context of how step-down capacity will relieve pressure on A&E. The hon. Gentleman will know that Northwick Park has one of the busiest, if not the busiest, A&Es in London on many days, and the chief executive spoke to me about the value of adding extra bed capacity from a step-down perspective, much more so than from an intensive-care perspective. If there are specific issues for intensive care, I am happy to follow them up with the hon. Gentleman.
Dr Rosena Allin-Khan (Tooting) (Lab)
In mental health we rely on staff, not shiny machinery, so why is the Secretary of State rehashing old announcements and scrapping plans? It is because the Government have run out of ideas. Labour has a plan. We will recruit 8,500 more mental health professionals, ensuring a million more patients get treated every year. We will double the number of medical school places. We will train 10,000 extra nurses and midwives every year, and we will focus on retaining the fantastic staff we already have. Where is the Government’s plan? We have had our plan for two years, but they are binning theirs.
Steve Barclay
It is slightly odd for the hon. Lady to talk about a plan when she does not agree with the plan of the shadow Health Secretary, the hon. Member for Ilford North (Wes Streeting). He plans to use the private sector, which he describes as “effective and popular,” whereas the hon. Lady said:
“In my own brief in mental health we have use of the private sector, which ultimately often lets patients down.”
First, the hon. Lady does not agree with the shadow Secretary of State. [Interruption.] The hon. Lady chunters, but she asked about a plan when she does not agree with her own Secretary of State.
Secondly, the hon. Lady talked about shiny new equipment. I am delighted that she allows me to draw the House’s attention to yesterday’s announcement of a fleet of 100 new mental health ambulances, which will relieve pressure on A&E. I am delighted that she gave me an open door to highlight that investment, which is part of our £2.3 billion investment in mental health.
Ellie Reeves (Lewisham West and Penge) (Lab)
Mohammad Yasin (Bedford) (Lab)
The Secretary of State for Health and Social Care (Steve Barclay)
We recognise that increased demand has had an impact on GP services. That is why we are investing at least £1.5 billion to create an additional 50 million GP appointments by 2024.
Mohammad Yasin
There is a clear failure to invest in critical infrastructure across the primary care estate, for example, in modernising in-patient mental health services and GP hubs. To make matters worse, Government bureaucracy is holding up capital funding allocations. My constituents deserve better community care and hospitals need relief, so when will the Government finally release the funding to build the facilities desperately needed in Bedford and Kempston?
Steve Barclay
We have literally just heard in this questions session from my hon. Friend the Member for Walsall North (Eddie Hughes) about the investment the Government are making in infrastructure across the NHS. That is why we have also, alongside the investment we are making in primary care, invested in the new hospitals programme, as part of this Government’s commitment to the NHS estate.
Dame Caroline Dinenage (Gosport) (Con)
Since the beginning of January, Gosport patients have learnt that one of our GP practices is threatened with closure, while another is about to merge with an already very subscribed group of practices. Partners are retiring, with no replacements. Will the Secretary of State confirm what he is doing to ensure that my constituents can access a GP? Will he please meet me to discuss this issue?
Steve Barclay
My hon. Friend raises an important point, and we are investing over a fifth more than in 2016, as part of our wider investment programme. I am very keen to work with her on the role of her ICB. It was set up operationally last summer, and its role is to commission primary care services for the community and to assess the needs of her Gosport constituents. I am very happy to work with her and her ICB on the issues she raises.
Emma Hardy (Kingston upon Hull West and Hessle) (Lab)
Hull has the second highest ratio of GPs to patients in the country. Even though GPs see 46 people a day on average, it is clear that demand for their services outstrips supply. Of course the Labour Government will have a plan to resolve this, but in the meantime will the Secretary of State look at giving women direct access to specialist nurses and services, such as endometriosis or menopause specialists, to prevent them from having to go via their GP each time they need renewed treatment and updated medication?
Steve Barclay
First, that is exactly what the women’s health strategy is doing through designing women’s health hubs. It is exactly why we are appointing a wider portfolio of roles into primary care. The hon. Lady says that Labour has a plan, but Labour’s plan is to divert £7 billion out of primary care property, which will not improve services for women and will actually impede the ability to deliver exactly the sort of services she is calling for.
Paul Maynard (Blackpool North and Cleveleys) (Con)
Thornton Cleveleys will see a 17% increase in new patients registering for primary care in the next five years, exceeding the physical capacity. Cost-effective solutions have been found, but the obstacle is the integrated care board, which keeps changing its mind as to whether money is or is not available. The clock is ticking on the need for this new capacity. Will the primary care Minister meet me to resolve this impasse and get the ICB to sort its act out?
Steve Barclay
My hon. Friend brings welcome transparency to the issue. The Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Harborough (Neil O’Brien) was listening intently, and is nodding his head about meeting him to discuss it.
Justin Madders (Ellesmere Port and Neston) (Lab)
The Secretary of State for Health and Social Care (Steve Barclay)
I am pleased to announce that we will be developing and publishing a major conditions strategy. Around 60% of disability-adjusted life years in England are accounted for by just six conditions: cancer, cardiovascular disease, chronic respiratory disease, dementia, musculoskeletal disease and mental health. An increasing number of us live with one or more of these conditions. Tackling them is a significant opportunity to improve the lives of millions of people and to support our goal to improve healthy life expectancy.
This work will bring together our existing commitments to develop plans for mental health, cancer, dementia and health disparities, and our new strategy will shift our focus on to integrated, whole-person care, with a focus on prevention, early detection and the use of innovative technology to improve patient outcomes. It will also improve how the NHS functions, relieving pressure on hospitals, promoting integration and putting us on a sustainable long-term footing.
We look forward to involving partners in the NHS, the charitable and voluntary sector and industry in developing this important work. Further detail about the strategy is included in my written statement published today. The statement also confirms that we will publish a suicide prevention plan this year, building on the important work of my predecessor, my right hon. Friend the Member for Bromsgrove (Sajid Javid), and I look forward to updating the House in due course.
Justin Madders
During the passage of the Health and Care Bill in 2021, safe staffing levels in the NHS came up, and the Government told us then that they
“do not believe that there is a single ratio or formula that could calculate what represents safe staffing.”––[Official Report, Health and Care Public Bill Committee, 27 October 2021; c. 773.]
Is the truth not that the Strikes (Minimum Service Levels) Bill is not about safe staffing levels, but about preventing nurses, doctors and paramedics from exercising their fundamental right to withdraw their labour, because they have lost all confidence in this Government?
Steve Barclay
The hon. Gentleman is right to say that it is a fundamental right that people are able to strike, and the legislation will balance that right, in the same way that other countries in Europe do, with minimum safe staffing levels. That is something that the French, the Italians and many other European countries have, and the Bill is simply bringing the NHS into line with other health systems.
Sarah Atherton (Wrexham) (Con)
Steve Barclay
My hon. Friend makes an extremely powerful point. I hope the Labour-run NHS in Wales takes heed of her comments. She brings professional experience to this issue and is absolutely right that there needs to be investment in the NHS estate in Wales.
Steve Barclay
I can see from your reaction, Mr Speaker, and the reaction of colleagues in the House, that that is a misrepresentation of the Prime Minister’s position. For the majority of its existence, the NHS has been run by Conservative Governments. We remain committed to treatment free at the point of use. That is the Prime Minister’s position and the Government’s position.
Wes Streeting
I note that the Secretary of State did not rule out any future extension of user charging, and I am sure that patients will have noticed too. Given that the chief executive of NHS England has said that the NHS needs to expand training; that many of the Secretary of State’s own Back Benchers are echoing Labour’s calls to double the number of medical school places; and that he has no plan whatsoever to expand NHS medical school training places, nursing and midwifery clinical training places, to double the number of district nurses qualifying, or to provide 5,000 more health visitors, is it not time for the Conservatives to swallow their pride, admit that they have no plan and adopt Labour’s workforce plan instead?
Steve Barclay
I am not surprised that the hon. Gentleman wants to misrepresent the Government’s plan, not least because his own plan is disintegrating before his own Front Bench. The hon. Member for York Central (Rachael Maskell), who spoke earlier, contradicted his point. Not only have the hon. Gentleman’s Front-Bench colleagues contradicted it; even the deputy chair of the British Medical Association has said that Labour’s plan would create higher demand and longer waiting times. I am not surprised that the hon. Gentleman does not want to talk about his own plans anymore; that is why he has taken to distorting ours.
Paul Holmes (Eastleigh) (Con)
Eastleigh, Hedge End and the villages have many vibrant pharmacies, but it is disappointing that Lloyds has closed two branches in my constituency. I welcome the additional £100 million that this Government are investing in community pharmacies, but can my right hon. Friend confirm how that funding will cut NHS waiting times and, more importantly, reverse the trend of closures?
Steve Barclay
Those discussions are ongoing with my right hon. Friend the Chancellor. The hon. Gentleman will know that we made progress in the summer on a couple of areas in relation to pensions, and my right hon. Friend is having further discussions with us in that context.
Dr Luke Evans (Bosworth) (Con)
I declare an interest as a GP and the immediate family of a GP and doctors. GPs are working incredibly hard in tough times. It is true that supply has gone up, but so too has demand. Change needs to happen in primary care, but one of the bedrocks is the GP partnership model. Does this Government agree?
Priti Patel (Witham) (Con)
The Secretary of State is well aware of the challenges facing Essex mental health care and the independent inquiry there into so many patients who have died. Can he tell the House and my constituents what steps he is taking to make this a statutory inquiry?
Steve Barclay
My right hon. Friend raises an extremely grave and serious issue that I know is of concern to a number of colleagues. Following representations from parliamentary colleagues, I had discussions with the chair of the inquiry, and I then with the chief executive and leadership team, in terms of the level of engagement with the inquiry. The Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Lewes (Maria Caulfield), and I are closely involved in that issue, and I am happy to have further discussions with my right hon. Friend.
Stephen Morgan (Portsmouth South) (Lab)
Steve Barclay
The hon. Gentleman is just factually wrong. We have increased medical undergraduate places by a quarter—I was in the Department at the time the decision was taken—so he is wrong on the facts. We also need to look at new ways of getting medics in and having more diverse recruitment in relation to social profile. That is why the apprenticeship route is an extremely important one that I am keen to expand.
Kelly Tolhurst (Rochester and Strood) (Con)
The Kent and Medway integrated care board reported that we had an increase of over 230,000 in the number of GP appointments offered to patients between September 2020 and September 2022. However, Medway has some of the lowest numbers of GPs per head in the country, and demand has increased. What support is the Department giving to the ICB to further increase access to GP appointments in Medway?
Steve Barclay
I welcome the increase in appointments and the numbers that my hon. Friend has drawn to the House’s attention. There is targeted funding of up to £20,000 for areas that are having difficulty recruiting; I am happy to discuss with her how we ensure that Medway can adequately access that fund.
Jessica Morden (Newport East) (Lab)
Steve Barclay
I agree that that is an important issue and I am keen to expedite it; we are having urgent discussions about how we maximise the use of physician associates. The hon. Lady raises an important point that we are discussing with the devolved Administrations, because it applies across the United Kingdom. I am keen to move quickly on that important area.
Anna Firth (Southend West) (Con)
“The Future of Pharmacy” report was published yesterday and highlighted again the funding pressures on the sector, including for the brilliant Belfairs Pharmacy in Leigh-on-Sea, which asks whether the Minister will urgently consider writing off the £370 million of covid loans given to pharmacies during covid-19.
Lucy Allan (Telford) (Con)
In today’s Shropshire Star, my local paper, there is an eight-page spread on what is happening to healthcare in Shropshire, which is described as a war zone. Will the Secretary of State meet me and other Shropshire MPs to discuss the challenges we face?
Steve Barclay
I am happy to meet my hon. Friend to discuss the issues in Shropshire. I draw her attention to the fact that we have more doctors, more nurses and more funding going into the NHS, and more people are being treated.
Dr Rupa Huq (Ealing Central and Acton) (Ind)
James Morris (Halesowen and Rowley Regis) (Con)
Although I welcome the new investment in emergency mental health services that was announced this week, does the Secretary of State agree that we must not lose sight of the fact that we need a long-term plan for the transformation of mental health services so that we achieve parity of esteem between mental and physical health in the NHS?
Steve Barclay
I do agree. That is why the long-term plan signalled the importance of mental health and the parity of which my hon. Friend speaks. It is also why, as the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Lewes (Maria Caulfield), has said, additional funding is being targeted at mental health—the extra £2.3 billion a year from 2024—signalling this Government’s commitment to mental health, as he will have seen with the announcement on mental health ambulances this week.
Liz Twist (Blaydon) (Lab)
Steve Barclay
What we have signalled, and I agree with the hon. Member on this, is the importance of the suicide prevention plan. It is something my predecessor, my right hon. Friend the Member for Bromsgrove (Sajid Javid), highlighted. I am keen to work with him and Members across the House on that. I set out in the written ministerial statement today not a specific date, but our commitment to a bespoke plan, and I am very happy to work with her and other Members on that.
Jack Brereton (Stoke-on-Trent South) (Con)
Current plans for community diagnostic hubs in North Staffordshire would see only a single facility, which is meant to serve over half a million people. That is totally insufficient, so will the Secretary of State look at my suggestion that there should be two of these facilities in North Staffordshire?
Richard Burgon (Leeds East) (Lab)
Will the Secretary of State for Health—today, on the record—condemn the call from his predecessor to impose charges on visits to the GP or to A&E?
Steve Barclay
I am not sure how many times one needs to say the same point. The Government’s position on this is clear: we are committed to treatment free at the point of use. That is the Government’s position, and it has been throughout the NHS’s history, the majority of which has been under Conservative Governments.
Mr Philip Hollobone (Kettering) (Con)
How many operations have been lost to strike action in the NHS so far?
Maggie Throup (Erewash) (Con)
The all-party group for diagnostics will hold its inaugural meeting on 8 February, and plans to conduct a short inquiry with the aim of providing a blueprint for how community diagnostic centres should operate in the longer term. As part of the inquiry, will my right hon. Friend commit to meeting members of the group to discuss what more the Government can do to maximise the role of diagnostics in addressing the pressures on the NHS?
Steve Barclay
I am very happy to give my hon. Friend that commitment. She is absolutely right to highlight the centrality of diagnostics and its importance in our overall plan to get elective numbers down.
Major Conditions and Diseases
Steve Barclay Excerpts(1 year, 10 months ago)
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The Secretary of State for Health and Social Care (Steve Barclay)
As this House is aware, the health and social care system faces long-term challenges to ensure the public enjoy longer and healthier lives. Currently in England, 5.4 million people live with cardiovascular disease, around 8.6 million live with chronic respiratory disease and 8.2 million live with mental health issues.
An increasing number of us live with one or more major conditions. People with diabetes are twice as likely to have depression. Nine in 10 dementia patients have another long-term condition. Half of people with a heart or lung condition have musculoskeletal disorders.
Tackling the major conditions that lead to people spending more years in ill health is a significant opportunity to improve the lives of millions of people. That is why today, I am announcing that, in consultation with NHS England and colleagues across Government, my Department will develop and publish a “Major Conditions Strategy”.
The strategy will set out a strong and coherent policy agenda that sets out a shift to integrated, whole-person care, building on measures that we have already taken forward through the NHS Long Term Plan. Interventions set out in the strategy will aim to alleviate pressure on the health system, as well as support the Government’s objective to increase healthy life expectancy and reduce ill health-related labour market inactivity.
Our approach will be rooted in the best understanding of the evidence to tackle the major conditions that contribute to the burden of disease in England, namely:
Cancers
Cardiovascular diseases, including stroke and diabetes
Chronic respiratory diseases
Dementia
Mental ill health
Musculoskeletal disorders
These areas account for around 60% of total disability adjusted life years in England. Tackling them is critical to achieving our manifesto commitment of gaining five extra years of healthy life expectancy by 2035, and our levelling up mission to narrow the gap in healthy life expectancy by 2030.
Our approach will harness the potential of whole person care, addressing the fact that our health and care system has been built in silos, often focused around specific diseases or organs in the body. Our workforce model needs to adapt, reflecting that the NHS is caring for patients with increasingly complex needs and with multiple long-term conditions. We need greater emphasis on generalist medical skills to complement existing deep specialist expertise in the NHS, supporting clinical professionals to heal with whole person care. The Major Conditions Strategy and the upcoming NHS Long Term Workforce Plan work together to set out the standards patient should expect in the short term and over a five year timeframe.
This is about shifting our model towards preserving good health, and the early detection and treatment of diseases. We have a proud record of opening new treatment possibilities in the NHS. Diseases that were once a death sentence have become conditions that can be managed over the long term. By harnessing innovation and technology, we are increasingly capable of detecting diseases at an early stage, in some cases before symptoms emerge. Intervening at this point will reduce demand downstream on health and care services.
Healthy, fulfilled, independent and longer lives for the people of England will require health and care services, local government, NHS bodies, and others to work ever more closely together. People living in England’s most deprived places live, on average, 19 fewer years in good health than those in the least deprived places. The strategy will set out the supporting and enabling interventions the centre can make to ensure that integrated care systems and the organisations within them maximise the opportunities to tackle clusters of disadvantage in their local areas where they exist, informed by the Hewitt Review. This will include addressing unwarranted variation in outcomes and the care people receive in the context of the recovery from the pandemic.
This work combines our key commitments in mental health, cancer, dementia and health disparities into a single, powerful strategy. It will align to the Government’s ambitious life sciences missions. We will take forward a separate suicide prevention strategy this year.
Alongside work on common diseases, the Department and the NHS also continue work on rare diseases, under the 2021 UK Rare Diseases Framework. All four nations of the UK have now published their first action plan, and England’s second Rare Diseases Action Plan is currently being finalised.
As we develop this strategy, I continue to be grateful for the thoughts and contributions from colleagues across the House, stakeholders, citizens and industry. I will set out opportunities to contribute further in due course. We also intend to publish an interim report on the strategy in the summer.
Strategies alone will not change outcomes. Delivery will require concerted effort from Government and the NHS working in tandem, alongside social care, patient representatives, industry and partners across the health and care system.
[HCWS514]
Mental Health: Expected Spend
Steve Barclay Excerpts(1 year, 10 months ago)
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The Secretary of State for Health and Social Care (Steve Barclay)
Last year, the Health and Care Act 2022 received Royal Assent, enacting the most significant health legislation for a decade into law. The Act introduced a statutory requirement for the Secretary of State for Health and Social Care to set out expectations for the year ahead on NHS mental health services spending. This is to ensure better transparency as part of the Government’s commitment to parity of esteem, ensuring that patients are able to access services that treat both mental and physical health conditions equally and to the same standard. 2022-23 2023-24 Recurrent NHS baseline (£bn) 142.4 153.0 Total forecast Mental Health spend (£bn) 12.7 13.6 Mental Health share of recurrent baseline 8.90% 8.92%
This requirement supports the Government’s existing commitments to increase spending on mental health services in real terms by at least £2.3 billion a year by 2023-24 and to uphold the mental health investment standard, which requires that integrated care boards’ spending on mental health grows at least in line with growth in overall recurrent funding allocations.
Today I lay before Parliament the first annual statement in fulfilment of this commitment.
In this statement I will set out the Government’s expectation for mental health spending by NHS England and ICBs in aggregate in the 2023-24 financial year. Specifically, I will set out whether the Government expect there to be an increase in expenditure by comparison with the previous financial year—2022-23—in relation to mental health, both in amount and proportion. It should be noted that, owing to the statutory requirement to lay this statement before Parliament ahead of the new financial year, the figures contained within this first annual statement will, in part, be based on projections.
In financial year 2023-24, the Government expect mental health spending to continue to increase as a proportion of the total recurrent expenditure incurred by NHS England and ICBs in aggregate. In financial year 2022-23, mental health spending made up 8.90% of all recurrent NHS spending. In the coming financial year we expect this to grow by 0.02 percentage points and account for 8.92% of total recurrent spend, as shown below.
This includes, at aggregate ICB level, baseline spend within scope of the mental health investment standard, which covers all spending on mental health from an ICB’s core allocations, and at NHS England level, service development fund spending and specialised commissioning spending on mental health.
These encouraging projections demonstrate the Government’s continuing commitment to expanding and transforming mental health services across England and to delivering sustained investment in this area across the country, and our ongoing commitment to parity of esteem for mental health.
[HCWS511]
NHS: Long-term Strategy
Steve Barclay Excerpts(1 year, 11 months ago)
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The Secretary of State for Health and Social Care (Steve Barclay)
I beg to move an amendment, to leave out from “House” to end and add:
“pays tribute to the work done by the National Health Service and recognises that there are pressures on health systems around the world; recognises that all parts of the UK are facing pressures; welcomes that the Government has committed to reduce waiting times in England as part of its strategy to strengthen the NHS and care system with up to £14.1 billion additional funding being made available by government over the next two years to improve urgent and emergency care and tackle the backlog—the highest spend on health and care in any government’s history; and regrets that the Scottish and Welsh governments have refused to make similar such commitments.”
I am grateful for the opportunity to update the House further to my statement on Monday, in which I recognised the very real pressures faced by the NHS, particularly in emergency departments and with ambulance handovers, and the fact that the experience had not been acceptable for some patients and staff in recent weeks. I set out a range of actions that we are taking in response to those pressures—pressures that are being experienced by healthcare systems throughout the United Kingdom, and in Europe and beyond.
Before I turn to the honourable Opposition’s flawed motion, I want to reflect on a few points that the hon. Member for Ilford North (Wes Streeting) did not cover. For a start, he hardly mentioned social care, although that was an issue raised on his own Benches. We have made £2.8 billion and £4.7 billion available for social care in each of the next two years, recognising that what happens in one part of the system impacts the other. He also failed to mention any of our life sciences success stories, such as our 10-year partnership with Moderna, our deal with BioNTech to give 10,000 people early access to cancer therapies, and how we were the first country in the world to have the bivalent vaccines. That kind of work will shift the dial on prevention.
Karin Smyth (Bristol South) (Lab)
Will the Secretary of State give way?
Steve Barclay
I will, and perhaps the hon. Lady will explain why none of her Welsh colleagues is here for the debate.
Karin Smyth
I speak for the people of Bristol South. Let me talk about social care: can the Secretary of State explain why he will not publish information about the trailblazers on social care? The Government made a huge commitment to people in this country that they would fix social care, but they have reneged on that promise. They spent £2.9 million on trailblazers. I have asked written parliamentary questions of the Secretary of State and have been told that they are not publishing information. We do not know what has happened to that money. We do not know the outcome of that trailblazers report. If we are to learn from the disaster of the last year in which the Government marched us up the hill and back down again, we need to understand the outcomes. Will he commit to publish the evidence that we have had thus far?
Steve Barclay
I support transparency, so I will take away the issue of trailblazers that she raises. [Interruption.] The hon. Member for Wallasey (Dame Angela Eagle) chunters from a sedentary position, but I am agreeing to look at the point that the hon. Member for Bristol South (Karin Smyth) raises. She and I have debated in the past, not least when I was a Minister of State and she raised the issue of NHS property. She knows that I was a supporter then of transparency. She raises an interesting point that has not been raised with me previously.
I am very happy to take that away and look at how we get some transparency on that, because it is important that the House is able to see the evaluation of innovation and where pilots are done. Secondly, one of the challenges that the NHS faces is that it does not adopt that innovation at scale. The substance of the hon. Lady’s point is fair and I will happily take it away. On why I mentioned Welsh MPs, given Bristol’s proximity I thought she may be able to shine a light on the strange absence of any Welsh MPs, unlike the Secretary of State for Wales who is taking a keen interest in this debate.
I turn to the motion moved by the shadow Secretary of State, which seems, incidentally, to have been written before my statement on Monday. I might have thought that he would change it. We set out a further £250 million to support emergency departments and to get those patients out of hospital who are medically fit to be discharged. Across the House, people recognise that the pandemic has had a significant impact on that. It effects flow in hospitals and it is an area of common ground between the shadow Secretary of State and me: the issue of delayed discharge is a big factor in the compression in emergency departments.
Dean Russell (Watford) (Con)
My right hon. Friend’s visit to Watford just last week highlighted the incredible innovation there in virtual hospitals and the power of people being looked after at home. I know the work area that he looked at; I would like his opinion on that fantastic visit and on how we can roll that out across the country.
Steve Barclay
My hon. Friend highlights an extremely important area of innovation that speaks to the point about how to adopt that at scale. I will come on to the issue of virtual wards. At Watford, they told me that it was saving the equivalent of another ward of the hospital by enabling people to be discharged to recover in their homes where it was more comfortable. Patient satisfaction was extremely high—over 90% in the programme in Watford. Not only that; the clinical wraparound support means that if they need to return to hospital, they are able to do so.
Daisy Cooper (St Albans) (LD)
I, too, have seen the virtual ward at Watford General Hospital, which serves my constituents. We are very proud in west Hertfordshire that we were the first hospital trust to have that virtual ward, but he will know from his visit that the No. 1 priority of every member of clinical staff in that hospital is to have funding from the new hospitals programme to improve our hospitals in Watford, Hemel and St Albans. Could the Secretary of State please pledge to write to me within the next seven days to report on his meeting with the hospital trust and tell us whether and when we will finally get some funding, after being overlooked for decades?
Steve Barclay
It was extremely helpful to discuss the priorities for the new hospital build with the clinical team and the leadership team at Watford. I could see that for myself, and we are committed to it. This is an issue that my hon. Friend the Member for Watford (Dean Russell) champions assiduously on behalf of the people of Watford, but I know that it matters to a wider cohort there and I am happy to write further to the hon. Lady as she requests.
The virtual ward at Watford—it is great to have cross-party support for that innovation—is further facilitated by the funding we announced in the autumn statement: the further £500 million this year, £600 million next year and £1 billion the year after. The Opposition say we are “failing to recognise” the scale of the current challenges in the NHS, yet when I set out in the statement the additional actions that we are taking, it was both to respond to the pressures from flu—the sevenfold increase we have seen, with 100 times the number of patients in hospital with flu compared with last year—and to facilitate the innovation that they highlight in programmes such as virtual wards.
Debbie Abrahams (Oldham East and Saddleworth) (Lab)
The Health Secretary will be aware that our hospital bed numbers are approximately half the OECD average, at fewer than 2.5 per 1,000 compared with 5 per 1,000 in the OECD. He will also have read reports in The Observer about the facility that was made available in the Health and Social Care Act 2012 that allows hospitals to allocate up to 49% of their hospital beds to private patients. Does he regret that?
Steve Barclay
The issue of bed capacity does indeed matter. I made the point a few moments ago that flow in hospitals is obviously constrained when bed numbers are high. That is exactly why, in the statement on Monday, I highlighted the importance of discharge, and of things like discharge lounges so that we can better facilitate those patients that are free to leave. But this is not simply about hospital bed capacity; it is about step-down intermediate care capacity and also, as we heard a moment ago, about the innovation that means we are better able to facilitate those patients who want to recover at home but want the safety net of some clinical support when they are doing so. It is about looking at the capacity in the whole of the system, not simply in the hospital; otherwise, the hospital itself becomes a magnet.
Dame Angela Eagle (Wallasey) (Lab)
The crisis this winter was predictable and building long before we arrived here. Normally, the NHS and the Department plan for winter crises in the summer months, but this year something else was going on in the summer months, wasn’t it? The Tory leadership election. Does the Secretary of State regret what the distraction of the Tories’ internal faction fighting has led to, which is the inability of this Government to plan ahead and do the day job, and the fall below minimum standards of the Government service?
Steve Barclay
I do not think those are factors that affected what happened in Scotland, where the First Minister warned on Monday that the hospitals were almost completely full. Indeed, the Scottish Government are taking emergency measures, including cancelling some non-essential operations. I do not think that was a factor in France, where the French Health Ministry is saying that intensive care beds are at saturation point. I do not think that was a factor in Wales, where more than 54,000 patients are waiting more than two years for an operation. I am glad that the hon. Lady highlights the summer, because it was in the summer that we hit the first of our elective recovery targets in terms of the two-year wait, getting those below 2,000, in stark contrast to what we saw in Wales. The surge in flu has happened across the United Kingdom, not just in England, and it has also affected France, Germany and other countries in Europe.
John Redwood (Wokingham) (Con)
I am very conscious that this Government have put a lot of extra money into the health service, and that Ministers have consistently wanted to get waiting lists down so that we have the extra capacity we need. Will the Secretary of State share a little of the thinking of senior management, who run the NHS day to day, in not using more of that resource for extra beds and extra staff to back them up?
Steve Barclay
As so often, my right hon. Friend raises an extremely important point about how we best use the resources and significant investment being put into the NHS. He will recognise that a key part of delivering value for money is looking at the interfaces on the patient pathway through the healthcare system. Handover points are often when we have the most difficulty.
I am sure my right hon. Friend will welcome that I recently visited Maidstone to see how we track the patient journey through a hospital and into care—residential care or domiciliary care. We are putting control centres in place through the 42 ICBs, and our reforms are bringing health and social care closer together. An area of common ground across the House is on the need to bring social care and healthcare closer together, and the ICBs, which were operationalised from July 2022, are a key part of that.
I suspect that one issue on which my right hon. Friend and I strongly agree is that it has to be underscored by data, so that we can see where the blockages are and prioritise the use of technology, such as machine learning, artificial intelligence, virtual wards and other innovations.
Clive Efford (Eltham) (Lab)
Will the Secretary of State give way?
Steve Barclay
I am being pretty reasonable on interventions, so if the hon. Gentleman will give me a moment.
Steve Barclay
The Opposition want to hear what the Government are doing, and then they tell me that they do not want to hear.
Clive Efford
The Association of Directors of Adult Social Services surveyed English local authorities back in 2019, and it found that they had endured cuts of £6.3 billion in adult social care, resulting in a drop since 2014 of 425,000 beds. How much does the Secretary of State think that has contributed to today’s crisis?
Steve Barclay
I am delighted that the hon. Gentleman raises the additional funding that the Government are putting into social care. In his autumn statement, the Chancellor made the biggest social care spending increase of any Government in history: an extra £2.8 billion next year and £4.7 billion the year after. That is £7.5 billion over two years, on top of the £6.6 billion he put into the NHS over two years. At a time when, as a consequence of the pandemic and the war in Ukraine, inflation is extremely high and there are acute cost of living pressures for constituents across the country, the Chancellor prioritised spending not just on health but, as the hon. Member for Eltham (Clive Efford) helpfully highlighted, on social care. Bringing health and social care together is exactly what I set out in my statement to the House on Monday.
Imran Hussain (Bradford East) (Lab)
Will the Secretary of State give way?
Steve Barclay
I will take one further intervention, and then I will make some progress.
Imran Hussain
The Secretary of State refers to significant challenges, as though this crisis started a few weeks ago. This crisis has been ongoing for more than a decade, and it is worsening year on year, but Ministers come here blaming it on anything other than, frankly, their incompetence and negligence over the last decade. When will they wake up, move away from their ivory tower and accept that it is on their watch that their incompetence and negligence have resulted in our constituents suffering today?
Steve Barclay
The data shows very clearly the profound impact of the pandemic, and the data shows that the impact is not constrained to England. It is acute in—[Interruption.] The hon. Member for Bradford East (Imran Hussain) has just had his intervention. If he wants to hear the answer, the reality is that the pandemic has had a profound impact on the NHS in Wales and Scotland, just as it has across Europe. That is what he is ignoring. He does not like the facts, but the facts are clear.
Steve Barclay
I will answer the hon. Gentleman’s first question. I will then give him a second go, as he is chuntering. Hospital flu admissions went up sevenfold in a month. The figure is 100 times higher this year than last year, and that comes on top of the severe pressure from the pandemic—9,000 cases. Perhaps he wants to explain the situation in Wales and why he feels the pandemic has not had an effect.
Imran Hussain
Of course, the Minister did not answer my question. I ask him about two things. First, every time this Government are put on the spot, they refer to what has become the Welsh defence; they would much rather not talk about their own incompetence. Secondly, how does he explain that in at least seven of the past 12 years they have missed their target overwhelmingly? That suggests we were in a crisis a long time ago.
Steve Barclay
Again, I can understand why the hon. Gentleman does not want to talk about the performance of the Welsh Government, but I was talking about the Scottish, French and German Governments, and about the fact that the pandemic has had a severe impact across the UK and across Europe.
Steve Barclay
I know that the hon. Gentleman has been keen to get in, so I will give way, but then I must make some progress.
Grahame Morris
I am grateful to the Health Secretary for that. On the point about relative performance, I want to touch on cancer treatment capacity. Our performance as a nation is lamentable on the seven most common forms of cancer. If the buzzword is innovation, surely we have a tremendous opportunity to roll out advanced radiotherapy. About one fifth of the machines we have in our hospitals are more than the recommended limit of 10 years old. Surely that is a perfect example of a cost-effective means by which we could apply artificial intelligence and diagnostics in parallel, and we could treat many more patients and improve outcomes. Is he open to that idea?
Steve Barclay
I am very open to that idea. For all the sound and fury that there sometimes is within the political debate, I know that there are certain topics within health on which people across the House are keen to work. Cancer is one issue that affects all families and all constituencies, and there is often scope to work extremely closely together on it. Knowing the hon. Gentleman well, I am happy to work with him moving forward.
Steve Barclay
May I just answer the last point, as the hon. Member for Easington (Grahame Morris) raised an important issue, and one that matters to many families? On the substance of his point about equipment, tech and innovation, we are looking at how we innovate. GP direct access is part of that, as it provides direct access to diagnostics. More patients are having their first cancer consultation following an urgent GP appointment. If we take the cohort of more than 810,000 who have started treatment for cancer since March 2020, the statistics show that 94% did so within their first month.
Given the seniority of the hon. Member for Westmorland and Lonsdale (Tim Farron), I will take his intervention, but then I must make some progress.
Tim Farron
I wanted to seize the moment, based on the excellent question from the hon. Member for Easington (Grahame Morris). The inquiry by the all-party group for radiotherapy is on 18 January, but we have not had a response to our request for the Secretary of State, or indeed any of his ministerial team, to attend. Will at least one of them do so?
Steve Barclay
Let me check the diaries with the Department. These things are always dangerous because we need to know what the travel plans and various commitments are, but I hear the hon. Gentleman and the hon. Member for Easington, and we will absolutely look at what can be done.
Vicky Ford
As a declaration of interest, let me say that I am the daughter of two NHS doctors, the sister of a geriatrician and the wife of an oncologist. I hope that the shadow Secretary of State shows a bit more respect in the future for those of us who come from medical families. I thank my right hon. Friend the Secretary of State for giving way, given that the Opposition were not allowing me to ask my question.
We know that it takes a long time to train doctors. Before the last interventions, the Secretary of State mentioned the Chancellor. One excellent thing the Chancellor did when he was Health Secretary was to announce 10 new medical schools. We have always had a shortage of doctors in Essex and difficulty recruiting them, because we had never trained doctors there. The medical school in Chelmsford is brilliant. Its attrition rate is less than half the national average. The first students will qualify this year, and it is fantastic. Those students want to stay locally. This is a symbol of the Conservative party investing in the long-term future of the NHS where it is needed. Will the Secretary of State consider expanding these excellent medical schools?
Steve Barclay
My right hon. Friend raises an extremely important matter. I was in the Department when the current Chancellor was Secretary of State and when we made that commitment to a 25% expansion in medical undergraduate places. She is absolutely right in saying that it takes time for those cohorts to come through. She is also right that Chelmsford has been a huge success. I am sure that, in the context of the workforce strategy that NHS England colleagues are bringing forward, she will make the case for where any additional capacity should go, but we will, of course, look to that workforce strategy to map out what is needed.
Let me turn to elective care backlogs. A number of Members across the House have raised the issue of the 7.2 million people on the waiting list. I think that it is worth breaking that figure down between the 1 million who require surgery and the 6 million who are waiting for outpatient appointments—either for their first appointment or for their follow-up. The NHS is doing more than 94 million outpatient appointments a year, of which 30 million are for new patients and 64 million are follow-ups. The “did not attend” rate is about 6.5%. This relates to the question of my right hon. Friend the Member for Wokingham (John Redwood) about value for money and how we deliver the reform of which he spoke. If we halved the “did not attend” rate of about 6.5%, it would free up almost 4 million slots. I am very interested in looking at the data and at how we prioritise within that data the wider challenge around the elective care backlog. I hope that that provides him with some reassurance.
Margaret Greenwood (Wirral West) (Lab)
Will the Secretary of State give way?
Mr Deputy Speaker (Mr Nigel Evans)
Before the intervention is taken, I advise Members that there is a lot of interest in this debate, and each intervention is cutting into the contributions that can be made. We will be down to a three-minute limit very quickly, and some people still may not get in.
Margaret Greenwood
I wish to bring the Secretary of State back to the point raised by my hon. Friend the Member for Oldham East and Saddleworth (Debbie Abrahams), who pointed out that in the Health and Social Care Act 2012, the coalition Government legislated to allow NHS hospitals to make up to 49% of their money from private patients. She asked whether he regretted that, but we did not get a response, so I would like to hear the Secretary of State’s response. Will he also tell us what assessment he has made of the impact on waiting lists of non-NHS patients taking the place of NHS patients in our hospitals?
Steve Barclay
It is a good thing to be bringing more funding into healthcare rather than turning it away. However, conscious of your edict, Mr Deputy Speaker, I will truncate some of the areas that I was going to cover, because I am sure that right hon. and hon. Members will bring out some of those points in the wider debate.
Labour’s motion ignores the statement that I gave to the House on Monday. It ignores the extra funding that we provided in the autumn statement and the commitment reflected in the Downing Street summit on Saturday to publish recovery plans for urgent and emergency care and for primary care, which we will do in the weeks ahead. The motion ignores the very real health challenges being experienced across the United Kingdom in Wales, Scotland and Northern Ireland, which all face pressures. It ignores the fact that France, Germany and elsewhere in Europe also face significant pressure.
The Government recognise, as I set out to the House on Monday, that there are real challenges in the NHS and social care. That is why we set out a three-phase approach: first, taking immediate steps to reintroduce flow to relieve pressure in the emergency department and across the hospital estate; secondly, putting in more capacity to build greater resilience over the course of the year, mindful of the fact that summer is increasingly a busy period—more so than was traditionally the case; and thirdly, making investments in our life science industry, such as the deals with Moderna and BioNTech, to ensure that patients in the UK get the most innovative drugs at the earliest date. That shows the Government’s commitment to backing the NHS now and in the future, which is why I commend the amendment to the motion to the House.
Several hon. Members rose—
NHS Winter Pressures
Steve Barclay Excerpts(1 year, 11 months ago)
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The Secretary of State for Health and Social Care (Steve Barclay)
Mr Speaker, I wish to take this first opportunity to update the House on the severe pressures faced by the NHS since the House last met. I and the Government regret that the experience for some patients and staff in emergency care has not been acceptable in recent weeks. I am sure that the whole House will join me in thanking staff in the NHS and social care who have worked tirelessly throughout this intense period, including clinicians in this House who have worked on wards over Christmas. They include my hon. Friend the Member for Lewes (Maria Caulfield), the Minister for mental health, and the hon. Member for Tooting (Dr Allin-Khan), the shadow Minister for mental health.
There is no question but that it has been an extraordinarily difficult time for everyone in health and care. Flu has made this winter particularly tough: first, because we are facing the worst flu season for 10 years—the number of people in hospital with flu this time last year was 50; this year, it is over 5,100. Secondly, it came early and quickly, increasing sevenfold between November and December. It also came when GPs and primary and community care were at their most constrained. When flu affects the population, it affects the workforce too, leading to staff sickness absence that constrains supply just as it also increases demand.
These flu pressures came on top of covid. Over 9,000 people are in hospitals with covid, while exceptional levels of scarlet fever activity and an increase in strep A have created further pressure on A&E. All that comes on top of a historically high starting point. We did not have a quiet summer, with significant levels of covid, and delayed discharges were more than double what they were during the pandemic. I put that in context for the House: in June 2020, there were just 6,000 cases per day of delayed discharge—patients medically fit and ready to leave hospital—whereas throughout last year the figure was between 12,000 and 13,000 per day. The scale, speed and timing of our flu season have combined with ongoing high levels of covid admissions in hospital and the pandemic legacy of high delayed discharge to put real strain on frontline services.
Since the NHS began preparing for this winter, there was a recognition that this year had the potential to be the hardest ever. That is why there was a specific focus on vaccination. There were 9 million flu shots and 17 million autumn covid boosters. We extended eligibility more widely than in the past, to cover the over-50s, and became the first place in the world to have the bivalent covid vaccine, which tackles both the omicron and the original covid strain.
NHS England also put in place plans for the equivalent of 7,000 additional beds, including the introduction of virtual wards of a sort that one can see at Watford General Hospital. That innovation is still at an early stage of development, but has the potential to be significant in reducing pressure on bed occupancy in hospitals; in Watford alone, it has saved the equivalent of an extra hospital ward of patients. In addition, our plan for patients put £500 million specifically into delayed discharge, with a further £600 million next year and £1 billion the year after. Although the funds are already starting to make a difference, efforts have taken time to ramp up operationally with local authorities and the local NHS.
In addition, our 42 integrated care boards, recognising how bed occupancy in hospitals and social care are connected, will fully integrate health and care in the years to come. But likewise, they are at an early stage of maturity, with ICBs having become fully operationalised only in July 2022, less than six months ago.
Our plans involving the integration of hospital care and social care, additional funding for discharge, increased step-down capacity, the equivalent of 7,000 additional hospital beds and a vaccination programme at scale have provided the groundwork for the Government response, but it is clear we need to do more right now in light of the level of flu and covid rates and given that hospital occupancy remains far too high and emergency departments are too congested. Recognising that, we launched the elective recovery taskforce on 7 December, and in the coming weeks, we will publish our urgent and emergency care recovery plans. NHS England and the Department of Health and Social Care have been working intensively over Christmas on these plans, which were reviewed with health and care leaders at an NHS recovery forum in Downing Street on Saturday.
The recovery falls into three main areas of work: first, steps to support the system now, given the immediate pressures we face this winter; secondly, steps to support a whole-of-system response this year to give better resilience during the summer and autumn—as we have seen with the heatwave this summer and with the levels of covid, pressure is now sustained throughout the year, not just, as in the past, during autumn and winter; and, thirdly, our work alongside those two areas on prevention, on maximising the step change potential of proven technologies, such as virtual wards, and on the wider adoption of innovations such as operational control centres and machine reading software to treat more conditions in the community, away from someone reaching an emergency department in the first place.
Let me first set out the measures I can announce today to provide support to the NHS and local authorities now. First, we will block-book beds in residential homes to enable some 2,500 people to be released from hospitals when they are medically fit to be discharged. When that is combined with the ramping up of the £500 million discharge funding, which will unblock an estimated 1,000 to 2,000 delayed discharge cases, capacity on wards will be freed up, which will in turn enable patients admitted by emergency departments to move to wards, which in turn unblocks ambulance delays. It is important, however, that we learn from the deployment of a similar approach during the pandemic by ensuring that the right wraparound care is provided for patients released to residential care. I have asked NHS England to particularly focus on that, so that it is the shortest possible stay on patients’ journey home and into domiciliary care, and indeed it is in the NHS’s own interests for those stays to be as short as possible. Taken together, this is a £200 million investment over the next three months.
Next, our A&Es are also under particular strain. From my visits across the country I have seen and heard how they often need more space to enable same-day emergency care and short stays post emergency care. Our second investment is in more physical capacity in and around emergency departments. By using modular units, this capacity will be available in weeks, not months, and our £50 million investment will focus on modular support this year. We will apply funding from next year’s allocation to significantly expand the programme ahead of the summer. We are giving trusts discretion on how best to use these units to decompress their emergency departments. It might be for spaces for short stays post A&E care, where there is no need for a patient to go to a ward for further observation, or for discharge lounges that previously have not been able to take a patients in a bed—many of those are often simply chairs—or for additional capacity alongside the emergency department at the front end of the hospital.
The third action we are taking to support the system right now is to free up frontline staff from being diverted by Care Quality Commission inspections over the coming weeks, and the CQC has agreed to reduce inspections and to focus on high-risk providers in other settings, such as mental health. Those are the actions we are taking that will have an immediate effect.
I turn to the measures we are taking now that will give greater resilience into the summer and next winter. We now have 42 NHS system control centres in operation across England, staffed 24 hours a day, seven days a week, tracking patients on their journey through hospitals, helping us to identify blockages earlier and getting flow through the system. Where we have implemented these systems, such as the one I saw in operation in Maidstone, they have had a clear impact. We will therefore allocate funding in next year’s settlement to apply these systems more widely.
Similarly, we have also seen how the use of artificial intelligence and data can demonstrably reduce demand and release patients sooner. NHS England has been tasked with clarifying and simplifying the procurement landscape, taking on board best international practice, so that a small number of scalable interventions are taken forward where international experience shows they can deliver meaningful benefits to patients.
Next, we will capitalise on the incredible potential of virtual wards. Last week at Watford General Hospital, I saw how patients who would have been in hospital beds were treated at home through a combination of technology and wraparound care. Patients released sooner are often much happier, knowing that they are receiving clinical supervision and always have the safety net of being able to quickly return to hospital should their condition deteriorate. There is scope to expand these measures to many more conditions and many more hospitals in the months ahead.
We are also opening up more routes for NHS patients to get free treatment in the independent sector and offering even greater patient choice. The elective recovery taskforce is helping us to find spare operating theatres, hospital beds and out-patient capacity.
We must also take steps in primary care. We are clear that our community pharmacists can support many more things to ease pressure on general practice. From the end of March, community pharmacists will take referrals from urgent and emergency care settings; later this year, they will also start offering oral contraception services. But I want to do even more, as they do in Scotland, and work with community pharmacists to tackle barriers to offering more services, including how to better use digital services. The primary care recovery plan will set out a range of additional services that pharmacists can deliver.
Finally, notwithstanding very severe pressures, we know that to break the cycle of the NHS repeatedly coming under severe pressure, the best way to reduce the numbers coming through our front doors is to address problems away from the emergency department. On Friday, we signed a memorandum of understanding with BioNTech —a global leader in mRNA technology—to bring vaccine research to this country, which will give as many as 10,000 UK patients early access to trials for personalised cancer therapies by 2030. This builds on the 10-year partnership we struck with Moderna in December to also invest in mRNA research and development in the UK and build state-of-the-art vaccine manufacturing here.
We are also reviewing our wider care for frail, elderly patients in care homes long before they ever get to A&E or our hospitals. Take the brilliant work being done in Tees valley, where community teams are being used to help with falls to prevent unnecessary ambulance trips to hospitals. We have looked at what more support we can offer elderly patients further upstream. With an ageing population, and many more people with more than one condition, it is clear that we have to treat patients earlier in the community and go beyond individual specialties to better reflect patients with multiple conditions to give the right support to people where they are, which is often at home or in residential homes.
Today’s announcement provides a further £250 million of funding, which recognises the spike in flu on top of covid admissions and high delayed discharge numbers from the pandemic. The funding will provide immediate support to reduce hospital bed occupancy and decompress A&E pressures, and, in turn, unlock much-needed ambulance handovers. This funding builds on the £500 million announced in the autumn statement specifically for discharge, which is ramping up, and the additional funding for next year.
All this work ultimately builds on the much-needed greater integration of health and social care through the 42 integrated care boards, which we will strengthen through the Hewitt review, and through a step change in capability, including operational control centres.
This immediate and near-term action sits in parallel with our wider life science investment, such as the deals with BioNTech and Moderna, and underscores our commitment to recognising the immediate pressures on the NHS and investing in the science that will shift the dial on earlier, upstream treatment at scale, particularly for the frail elderly, long before a patient reaches an emergency department. This is a comprehensive package of measures, and I commend this statement to the House.
Wes Streeting (Ilford North) (Lab)
Happy new year to you, Mr Speaker, and to the rest of the House. I thank the Secretary of State for Health and Social Care for advance sight of his statement.
This winter has seen patients waiting hours on end for an ambulance, A&E departments overflowing with patients, and dedicated NHS staff driven to industrial action—in the case of nurses, for the first time in their history—because the Government have failed to listen and to lead. I notice that the Secretary of State did not talk about the abysmal failure of his talks with nurses and paramedic representatives today. Let me say to him: every cancelled operation and delayed appointment, and the ambulance disruption due to strikes, could have been avoided if he had just agreed to talk to NHS staff about pay. Today, he could have opened serious talks to avert further strikes. Instead, he offered nurses and paramedics 45 minutes of lip service. If patients suffer further strike action, they will know exactly who to blame.
Of course, the Prime Minister has already shown that he is not interested in solving problems; he resorts to the smokescreen of parliamentary game playing by bringing in legislation to sack NHS staff for going on strike. I ask the Secretary of State, in his sacking NHS staff Bill, how many nurses is he planning to sack? How many paramedics will he sack? How many junior doctors will he sack? The Government have the audacity to ask NHS staff for minimum service levels, but when will we see minimum service levels from Government Ministers and the entire Government?
After arriving at the Derriford Hospital in Plymouth, an 83-year-old dementia patient waited in the back of an ambulance outside A&E for 26 hours before being admitted. That was on 23 December, when no strikes were taking place; the Secretary of State should listen. The patient’s family found him in urine-soaked sheets, and since arriving in hospital, he has contracted flu. His daughter said of the hospital staff:
“They’re polite, they’re caring, and they are trying their best. It’s just impossible for them to do the work they want to do.”
Let me say what the Health Secretary and Prime Minister refuse to admit: the NHS is in crisis—the biggest crisis in its history. That is clear to the staff who have been slogging their guts out over Christmas and to everyone who uses it as a patient; the only people who cannot see it are the Government.
What has been announced today is yet another sticking plaster when the NHS needs fundamental reform. The front door to the NHS is blocked, the exit door is blocked, and there are simply not enough staff. Where is the Conservatives’ plan to fix primary care, so that patients can see the GP they want in the manner they choose? After 13 years of Conservative government, they do not have one. Where is the plan to recruit the care workers needed to care for patients once they have been discharged from hospitals, and to pay them fairly so that we do not lose them to other employers? After 13 years of Conservative government, they do not have one. Where is the plan to train the doctors, nurses and health professionals the NHS needs? After 13 years of Conservative government, they do not have one.
Well, we do. The Secretary of State is welcome to nick Labour’s plan to abolish non-dom tax status and train 7,500 more doctors and 10,000 more nurses and midwives every year; to double the number of district nurses; and to provide 5,000 more health visitors—a plan so good that the Chancellor admitted that the Conservative Government should nick it. After 13 years of mismanagement, underfunding and costly top-down reorganisations, however, all the Conservatives have to offer the NHS is a meeting and a photo op in Downing Street.
The collapse of the health service this winter could be seen coming a mile away—health and social care leaders were warning about it last summer—so why is the Secretary of State announcing these measures in the middle of January? Why have care homes and local authorities been made to wait until this month for the delayed discharge fund to reach them? It is simply too little, too late for many patients.
In fact, this Government are so last minute that, after announcing this plan last night, they found an extra £50 million and sent out another press release. I know most of us are happy to find a spare fiver lying around the house that we did not know was there, but this Prime Minister seems to have 50 million quid stuck down the back of the sofa. What on earth is going on? No wonder they cannot get money to the frontline: the left hand does not know what the right hand is doing.
It is intolerable that patients who are fit and ready to leave hospital are then stuck there for months because the care they need is not available in the community. They are not bed blockers, and they are not an inconvenience to be dropped off at a hotel and forgotten about. They need rehabilitation at home, rather than a bed in a care facility. Vulnerable patients deserve proper support suited to their needs, or they will fall ill again and go back to hospital. What about all these beds the NHS is procuring, and what about the capacity that families need? I will tell hon. Members what will happen: they will not get the care, and they will be coming right back through the front door of A&E, with the cycle of broken systems repeating itself again and again. Where is the choice and control for patients and their families who may not want to be discharged to a hotel?
I am afraid that, after 13 years, this just is not good enough. The Prime Minister might not rely on the NHS, but millions of ordinary people do. They are sick and they are tired of waiting. There have been 13 years of Conservative Government now—13 years—and look at what they have done to the NHS. Did the Health Secretary listen to himself as he described the situation in hospitals of people waiting on chairs for discharge, the trolleys in the corridors and people waiting longer than ever? Whose fault is it? It is not that of the NHS staff he is threatening to sack, but of the Conservative Ministers who have made disaster after disaster. After 13 years of Conservative Government it is clear that the longer they are in power, the longer patients will wait. Only Labour can give the NHS the fresh start and fresh ideas it needs.
Steve Barclay
The hon. Member talks about a fresh start, but even his own shadow Cabinet colleagues do not seem to agree with his plans. His own deputy leader seemed to distance herself from his plans to use the private sector, and his own shadow Chancellor seems to have distanced herself from his plans for GPs. Perhaps he can share with the House exactly how much his unfunded plans for GPs will cost, because the chief executive of the Nuffield Trust has said:
“It will cost a fortune”,
and is
“based on an out of date view”.
The point is that he has no plans that his deputy and his own colleagues support, and he has not set out how he would fund those plans in a way that does not divert resource from other parts of the NHS.
The hon. Member talked about pressure, yet there was no mention of the fact that the NHS in Wales, the NHS in Scotland and, indeed, health systems across the globe have faced significant pressure as a result of the combination of covid spikes and flu spikes, particularly in recent weeks. This is not a phenomenon limited to England and the NHS; this is a pressure that has been reflected internationally, including for the NHS in Wales.
The hon. Member refers to talks with the trade unions, and it is right that we are engaging with the trade unions. I was pleased to meet the staff council of the NHS today. Indeed, the chair of the NHS staff council, Sara Gorton, said the discussions had made “progress”, notwithstanding one trade union leader who was not in the talks giving an interview outside the Department to comment on what had and had not been said in those talks. We want to work constructively with the trade unions on that.
The hon. Member says that we are only announcing measures today, but again, he seems to have written those comments before he got a copy of the statement. The integrated care boards took operational effect in July last year—[Interruption.] Because they are scaling up, we are putting control centres in place and we are integrating health and social care. In the autumn statement, we announced £500 million for discharge, a further £600 million next year and £1 billion the year after, recognising that there is significant pressure, and that is ramping up. NHS England set out its operational plans in the summer, including the 100-day discharge sprint. That, for example, set out the greater use of virtual wards, which is new technology being rolled out at scale. It also announced the extra 7,000 community beds. Indeed, we also set out the additional measures in our plan for patients.
What is clear when we have a sevenfold increase in flu in a month—50 cases admitted last year compared with 5,100 this year—is that there is a combination of a surge in demand on top of the existing high-level position, and the surge in demand corresponds with a constraint on supply as staff absences also increase because of flu, so during the Christmas period community services are more constrained. Those two things together have created significant pressure on our emergency departments. That is why in the engagement I have had with health leaders the two key messages they gave to me were the importance of getting flow into hospitals, which is constrained by the high bed occupancy—that is why getting people out of hospital is so central to relieving pressure—and, within the emergency departments specifically, the need to decompress those services with same-day emergency treatment and having short stay post-emergency departments. That is a better way to decompress those emergency departments—through the triaging and bringing other clinical specialties closer to the front door. We have listened to the NHS frontline and those were the two key requests made to me, alongside other issues such as care quality inspections and how to make them more flexible. However, alongside those immediate pressures, we need to recognise that we had pressures last summer during the heatwave and we had pressures in the autumn, which is why we have announced a wider set of measures today.
So we have listened and we have acted; we have taken measures to deal with the immediate pressure, but we have also set out how we will build further capacity that will go through into the autumn. Alongside that, we have signed deals, for example with Moderna and BioNTech, and we are bringing forward the life science investment so that that has a better impact on pressures on the frontline.
Steve Brine (Winchester) (Con)
There is no doubt that, in some places more than others, patient flow in acute hospitals is the issue gumming up the system, and the Secretary of State is right to say that demand far outstrips supply, in part because of the very high flu numbers. Today’s injection of funding is very welcome as is the additional surge capacity the Secretary of State spoke about in his statement. His mention of prevention is especially welcomed by me; let us do so much more on this. Another £250 million is a lot of the public’s money. What real-time oversight does he have to ensure that NHS England spends it wisely, and may I make a plea that domiciliary care is not overlooked, because the lack of care in people’s homes is every bit as much the enemy of patient flow as the lack of care home places that he has identified today?
Steve Barclay
My hon. Friend raises an important issue about getting flow into the system, not least because delays in ambulance handovers lead to the highest risk in what is a whole-of-system issue where the patient is not seen and treatment is delayed. That is why flow through discharge is so important, because, while that often concerns the back door of the hospital, it is actually the pressure at the front door that is most acute. The Government recognised that in the autumn statement and that is why there was additional funding with the £500 million for delayed discharge. That has taken some time to ramp up, but we recognise that because of the flu there is an immediacy in the pressure on A&E that we need to address.
My hon. Friend’s point speaks to one of the key lessons from the covid period. It is not simply about releasing patients from hospitals who are fit to discharge; it is also about the wraparound services provided for those patients so that they do not get stuck in residential care for longer, and they are still able to go home and get the domiciliary care packages. NHS England is focused on that so that they have the wraparound services alongside that discharge.
Dame Meg Hillier (Hackney South and Shoreditch) (Lab/Co-op)
We have seen this year in, year out: money thrown into the NHS at a winter crisis point, too late to spend it sensibly, yet this Government have been in power for nearly 13 years. I could not identify anything new in the Secretary of State’s speech. We have talked about discharge before, and picking up on the point made by the Select Committee Chair the hon. Member for Winchester (Steve Brine), without proper funding for local councils for domiciliary care and for funding care homes, this will never work.
Steve Barclay
In terms of what is different, there is the block booking that will enable residential care to put the workforce in place and release the delayed discharge of the 13,000 patients who are in hospital but medically fit to be discharged. The accelerated release of those patients will help those at the front door, where the spike in flu is so acute. That is what we are doing; we are responding to what health leaders have said is the key intervention we can take. Of course, that is not being done in isolation. The point is that that is coming on top of the £500 million announced during the autumn statement and is to provide further capacity, recognising the significant pressure that the system is under.
Chris Grayling (Epsom and Ewell) (Con)
My right hon. Friend is absolutely right to highlight the fact that this is not purely an English issue but one affecting whole systems across the western world. I welcome many aspects of what he said, and I am grateful to staff at Epsom Hospital and those in the ambulance service in my constituency. So much of the time of those paramedics is spent taking frail elderly people from care homes to A&E where, frankly, they probably should not be. What steps can he take to divert some of those frail and elderly people from A&E to take some of the pressure off and get them to an environment where they will be much better looked after?
Steve Barclay
My right hon. Friend is absolutely right. That is where virtual wards have potential significant benefits in both demand management—avoiding elderly, frail patients coming to emergency departments in the first place—and releasing capacity in hospitals. The virtual ward at Watford General Hospital, equivalent to an additional ward of the hospital, is able to release patients with the comfort of knowing that they are still under supervision. Their medical information is being tracked and monitored and they get a daily phone call from a nurse. They also know that, if they need to come back to the hospital, they can do so much more quickly. That gives patients the comfort and confidence to recover at home, which is often where they want to be. Indeed, patient satisfaction from that trial at Watford was over 90%.
Mr Ben Bradshaw (Exeter) (Lab)
Given that there are currently 165,000 vacancies in social care—a 51% increase in just a year—where will the Secretary of State magic up the people to look after those he wants to put in hotels?
Steve Barclay
The whole purpose of the £500 million is to put more support into local authorities’ funding for social care. About a quarter of that funding is going specifically on workforce interventions, but we are also using other measures. One of the other things we have been doing is boosting workforce recruitment through international recruitment, with care sector staff on the shortage occupation list.
James Morris (Halesowen and Rowley Regis) (Con)
I welcome the Secretary of State’s statement and in particular the additional money for discharge. Does he agree that, in regard to integrated care systems, we really need to accelerate the integration between health and social care? Notwithstanding what he said about maturity, that is the key to the future integration of health and social care, and that will solve many of the problems that we face at the moment.
Steve Barclay
My hon. Friend is right. That is why, in the run-up to Christmas, one of the ministerial priorities was to have a whole series of ministerial meetings with the chairs and chief executives of the integrated care boards, because, as the Government have recognised, it is through the integration of those 42 ICBs that we will bring health and social care together. The ICBs have been operationally in place since July and are ramping up at pace. One thing that is making a real difference to them is having control centres that allow patient flow to be tracked through the system—Maidstone is a good example—with the data allowing blockages, as a whole-of-system problem, to be gripped at a much earlier stage.
Rachael Maskell (York Central) (Lab/Co-op)
Staff retention in both the health sector and the social care sector is at the heart of this crisis, but staff cannot be retained if they are not paid and, if they are not paid this year, the issues will not be addressed. Will the Secretary of State recognise that when he set the remit for the pay review body, inflation was not where it is and we did not have a war in Ukraine, so factors have changed and the remit for pay must therefore change this year so that we can retain the staff to deliver what he proposes?
Steve Barclay
On delayed discharge, the key is having domiciliary care support. That is not about the NHS Agenda for Change contract; it is about funding for those in the social care sector. Around a quarter of delayed discharges are due to delays in what is known as pathway 1, the domiciliary care side. That is what the £500 million in particular recognised. We are putting in more money, but that is about the social care sector so we can get flow through delayed discharge.
Priti Patel (Witham) (Con)
The Secretary of State speaks about getting more people treated in the community, and I think we all support that. He will know that in my constituency we have a higher than national average patient-to-GP ratio. It is a major problem for us and has been for a long time. We are short of diagnostic facilities and Essex County Council needs more resources to deal with adult social care for the very reasons he has spoken about. Will he please write to me—he will not be able to do it from the Dispatch Box today—with specific details of when, on all three of those areas, the money he has announced today will come to the frontline in Essex? Our doctors and nurses need the money and resources to do what they joined the profession for: to provide the care they really believe in to members of the public.
Steve Barclay
First, I am very happy to write to my right hon. Friend with further details. For the benefit of the House, in relation to the £500 million announced in the autumn statement, local authorities gave the Department and NHS England their data returns on Friday. We will have that data, which I will be able to share more specifically in relation to the £500 million. The £250 million for NHS England announced today is for very urgent delivery into systems and that will be going out extremely quickly.
Daisy Cooper (St Albans) (LD)
NHS leaders have today told the Health Services Journal that the Government have just seven to 10 days to get the additional funding to discharge hospital patients to the frontline for it to make any difference whatever. The NHS Confederation has said that the next three months in the NHS will likely be defined by critical incidents being declared. Will the Secretary of State promise that the extra funding will reach the frontline in the next seven to 10 days? Will he please finally declare a national critical incident, so that we can mobilise every single bit of our NHS to save lives and save the NHS?
Steve Barclay
The very purpose of today’s announcement—I have made it on the first day that Parliament is back—is to give that urgent uplift in funding to local authorities and ICBs so that they can act now, knowing that that funding is available. They have the additional £500 million, which is ramping up as well. That is part of a wider package of measures—NHS England putting in community support with 7,000 more beds—but the purpose is to recognise the very real immediate pressure the frontline has been under. It also needs to be viewed as something that other healthcare systems across the globe have faced: a very sudden and very significant spike in flu seven times higher than last month and 100 times what it was last year.
Sir Edward Leigh (Gainsborough) (Con)
Yes, but they also have covid and flu in France, Germany, Italy, Sweden and Holland. Winter after winter, they cope far better because they have much more integrated social insurance systems. Some people like me have been banging on about this for years, but now the former Health Secretary, my right hon. Friend the Member for Bromsgrove (Sajid Javid), is suggesting a social insurance system, as is newspaper editorial after newspaper editorial. What is our long-term plan? We cannot leave the Labour party to have a long-term plan while we do not. How are we going to reform this centrally controlled construct? People of my age have paid taxes all their life and their only right is to enjoy the back of a two-year queue! What is the Secretary of State’s plan?
Steve Barclay
First, integrating health and social care through the integrated care boards. That is what we put in place from July, recognising that actually the pressures on the NHS are often as much about pressure on social care as they are about pressures in the NHS itself. In particular, if we look at ambulances, we see that often it is the delay in domiciliary care that is driving the blockage on the wards, which in turn applies there. Secondly, it is recognising that there are workforce pressures, which is why NHS England has been working on the workforce plan that has been set up.
Thirdly, we have already set out our elective recovery plan. Over the summer, the longest waits—those of over two years—were largely cleared. [Interruption.] Opposition Front Benchers chunter, “How’s it going?” Let us look at how it is going, compared with the Labour Government’s two-year clearance in Wales. Before Christmas, there were about 60,000 people in Wales who had been waiting for more than two years; in England there were fewer than 2,000. We are making progress on the longest waits through the work of Jim Mackey, Professor Tim Briggs and Getting It Right First Time. We are innovating with the surgical hubs and the community diagnostic centres. That, in turn, gives greater resilience to the electives that used to be cancelled when there was winter pressure. With hot and cold sites, they are much more resilient.
Finally, I must take issue with what my right hon. Friend says. In France, Germany, Canada and many other countries, the massive spike in flu and covid pressure, combined with pressures from the pandemic, has placed similar strains on healthcare systems. It is simply not the case that the issue affects England alone.
Dame Diana Johnson (Kingston upon Hull North) (Lab)
I am really not clear how, despite all the warnings, the Government have got themselves into this position after the biggest crisis in the NHS. We all know that it is a no-brainer to invest in social care to reduce bed blocking, so what exactly is the purpose of the pilot that has been announced for Hull and the Humber? It will tell us what we already know: that what we need is investment in social care and reform of social care.
Steve Barclay
We recognised very early—in fact, NHS England recognised it in the summer—that this winter was likely to be extremely hard, both because population resilience to flu would be lower as a consequence of the pandemic and because of the combination of pandemic backlogs with the ongoing level of covid admissions. As I have said, we have more than 9,000 patients in hospital with covid and a further 5,000 with flu; that comes on top of the other strains from the pandemic that we have seen. The measures taken, such as boosting the vaccination programme, extending it to the over-50s and being the first place to have the bivalent vaccine, were part of the package in NHS England’s operational plan.
We also recognised—this point goes to the heart of the right hon. Lady’s question—that social care is central. That is why, notwithstanding the other economic pressures that the Government faced, health and education were prioritised in the autumn statement, with an extra £6.6 billion in funding for the NHS over the next two years and an extra £7.5 billion in funding for social care. That was recognised with a clear prioritisation in the autumn statement. The reality is that we have had a massive spike in flu cases, meaning that there have been 100 times as many hospital admissions for flu as there were last year.
Holly Mumby-Croft (Scunthorpe) (Con)
I welcome the measures that my right hon. Friend has set out for us today; it is absolutely right that we consider a wide suite of measures. With that in mind, may I draw his attention to my region? We have, I think, the second biggest ICB area by geography, but without the population to match. Will he consider giving us an additional community diagnostic hub? For everyone in the area to have access, we need two, not one. Will he look at that, please?
Steve Barclay
My hon. Friend is absolutely right to highlight the importance of diagnostic centres, which we have particularly prioritised. As she knows, I am extremely keen to accelerate the programme so that where we award community diagnostic centres, they open in 2023. In my view, too many plans were for 2024, so that is a particular challenge that I have been posing. My hon. Friend has campaigned strongly on behalf of her constituents; I know that the Minister of State, my hon. Friend the Member for Colchester (Will Quince), is looking at the proposal that she has shared and will be happy to discuss it with her in the days ahead.
Maria Eagle (Garston and Halewood) (Lab)
Hospitals used by my constituents in Liverpool and Knowsley have had queues at A&E of 33 hours, 41 hours and 30-plus hours. They have had dozens of ambulances queuing up outside for entire shifts, unable to transfer even one patient. These problems were predictable and—as the Secretary of State has just said—predicted, yet he disappeared over Christmas and the new year when they were going on, only emerging last week to blame them on flu and covid. When will he acknowledge that leaving it until January to deal with winter pressures is too little, too late? When will he take responsibility and apologise for the lamentable situation in which he has left my constituents and many others across this country? The fear, the pain, the worry—when will he say sorry for it?
Steve Barclay
That simply is not accurate. Let me give the hon. Lady some specific examples. Under the auxiliary contract with St John Ambulance, we invested an extra £150 million in the ambulance service, and we invested a further £50 million in additional capacity for call centres. Taxpayers spent £800 million on the new Royal Liverpool Hospital, and during 2018-19 a brand-new hospital was built at Aintree. However, this is not simply about investing in new hospitals; it is also about looking at the integration between health and care, and that was recognised in the autumn statement, which provided an additional £500 million. It is simply inaccurate to say that there were no measures in the summer. The St John Ambulance contract and the community first responders, and the service for frail and elderly people, will help with demand management and prevent people from going to emergency departments in the first place.
Sir Julian Lewis (New Forest East) (Con)
Do the Government recognise the danger of a major increase in pressure on the NHS as a result of any new variant of covid that may be imported from China? How quickly would we be able to identify such a variant and prepare a vaccine against it?
Steve Barclay
Let me first congratulate my right hon. Friend—along with the whole House, I am sure—on the knighthood that he received from His Majesty.
According to the analysis we have received, the variant in China is the same as the one in the United Kingdom. On the other hand, the data shared by China is often not as clear as we would like. That is why, over the Christmas period, my right hon. Friends the Prime Minister and the Secretary of State for Transport announced proportionate measures involving covid tests for travellers and, in particular, sequence variant testing for those coming into the UK, in order to identify any new variant quickly.
Liz Saville Roberts (Dwyfor Meirionnydd) (PC)
Strikes by nurses and ambulance workers are a last resort for overworked staff, who fear that patient safety is suffering as a result of increased demand and staff shortages. Instead of providing proper pay increases, the Labour Welsh Government have responded by offering Welsh health service staff tokenistic one-off payments, and, reportedly, the right hon. Gentleman’s Government are considering doing the same in England. Can he guarantee that if that approach is taken, one-off payments will be recognised as support with the cost of living crisis rather than proper pay increases, and will be treated as such for tax and benefit purposes?
Steve Barclay
As we have said previously, we have a process, through the independent pay review body, to look at these issues in the round and, when it comes to the needs of our NHS—my focus, obviously, is on the NHS in England; it is for the Welsh Government to conduct negotiation in Wales—to balance what constitutes the right level of funding for retention and recruitment against the wider issues of affordability for the economy as a whole. However, we are keen to engage with the trade unions, and we had a good discussion with them today. I am pleased that they recognised the progress made in that discussion, and I look forward to further discussions with them.
Siobhan Baillie (Stroud) (Con)
In recent weeks I have seen a few of my constituents in tears because they have been with loved ones in A&E and seen elderly residents stuck on trolleys. No Member of Parliament wants to deal with that. I know that my right hon. Friend is working hard, and I welcome his announcements, but the public are watching more and more money going into the NHS, and I think we need to hear, very clearly, his assessment of when the further money that has now been announced will lead to meaningful change in Gloucestershire’s A&E departments and elsewhere.
Steve Barclay
That is a fair challenge. Let me divide it into three sections. First, there is a recognition that the combination of the legacy from the pandemic, the ongoing covid issues and, in particular, the massive spike in flu create an immediate pressure in our A&E departments. The package announced today shows that we have listened to those on the frontline, and have responded.
Secondly, there is a recognition—this is relevant to some of the questions asked today—that the system has been under pressure for some time. Therefore, the second phase looks at innovation, technology, artificial intelligence, virtual wards and ways of doing things differently. To take the example of the frail and elderly, that will address their needs upstream in the care home before they get to the emergency department or release them from hospital quicker, provided they have the safety net of being part of a virtual ward, where they are subject to ongoing clinical supervision. If they need to come back to hospital, they can do so much more easily than would otherwise be the case. That stops the boomerang of patients being released early and then coming back. That second phase includes the modular capacity, because space is needed to streamline and to triage. That compression within the emergency department also drives inefficiency and poor care.
Thirdly, the Government have invested in the life sciences industry. R&D investment of £15 billion to £20 billion is a big marker of that. One of the priorities is to say that we can do certain things at scale with companies such as Moderna that will shift the dial in healthcare. That is a third but significant part of this, particularly in respect of the prevention work that we can do.
Emma Hardy (Kingston upon Hull West and Hessle) (Lab)
The failure to fix social care is having an impact on not only the acute service but the mental health service. I have raised directly with the Secretary of State the problems facing the Humber NHS trust, where 42% of adult learning difficulty beds have been taken by patients with delayed discharge and where 17% of adult mental health beds and 22% of child and adolescent mental health beds have been taken by patients waiting for discharge. What investment and support will be given to provide the right social care and support services, to enable beds to be freed up not just in the acute service but in the desperately needed mental health services?
Steve Barclay
The hon. Lady is right to highlight mental health, which is an extremely important part of the wider health landscape. That is why the Government are increasing funding for mental health by £2.3 billion. We must also consider how we get better value for money from that spending. The reform of the Mental Health Act 1983 that the Minister for mental health, my hon. Friend the Member for Lewes (Maria Caulfield), is taking forward will help us better target that funding in ways that deliver value for money.
Richard Graham (Gloucester) (Con)
I join the Secretary of State for Health and Social Care in paying tribute to those working in hospitals, such as the Gloucestershire Royal Hospital in my constituency, so intensely and under such heavy pressure. I welcome the changes that he has announced, but will he confirm what progress his Department has made with the Home Office to prioritise tier 2 health visas and to provide a grace period for international GP trainees? Lastly, will my right hon. Friend consider helping staff with parking and out-of-hours food this winter, which has been described by so many as a perfect storm?
Steve Barclay
As I said at the outset, today’s announcement is part of the wider recovery programme that we discussed with health leaders at No. 10 on Saturday. That will have a number of components, one of which is the urgent and emergency care recovery. Work is ongoing with Home Office colleagues on the visa component. My hon. Friend raises an extremely important point that a number of clinicians on the frontline have raised with me, and I am discussing it with my right hon. and learned Friend the Home Secretary.
Stephanie Peacock (Barnsley East) (Lab)
More than 5,000 operations have been cancelled at Barnsley Hospital in the last year. What are the Government doing to reassure those in Barnsley who are waiting in pain for delayed operations? Will they ensure that any new staff are deployed first to the areas that need them most?
Steve Barclay
I share the hon. Lady’s desire to reduce the backlog in the electives programme, which is why the Government have invested a further £8 billion. To ensure that it delivers value for money, the key focus is on building greater resilience into that elective programme through surgical hubs and the better use of community diagnostic centres, in particular by having a distinction between hot and cold sites.
Too often in the past, as winter pressures have surged, elective operations have been cancelled to free up bed capacity. Having the surgical hubs and the hot and cold sites builds greater resilience. I pay tribute to the work of the Getting It Right First Time team, and to Professor Tim Briggs and Jim Mackey, who are leading that programme. We saw the progress that was made in the summer and we are very focused on the next stage, which is 78-week waits. We are working very actively on that.
Jason McCartney (Colne Valley) (Con)
Maple ward at Holme Valley Memorial Hospital used to provide much-needed community intermediate care for those leaving Huddersfield Royal Infirmary. Unfortunately, it closed temporarily around six years ago. Does the Secretary of State agree that this is exactly the kind of facility that we now need in the community, not only to give great intermediate care but to free up capacity in our main hospitals?
Steve Barclay
My hon. Friend makes an important point. Often the debate is about beds, but in reality it is as much the workforce that go with those beds that we need to consider. The point about step-down care is that it has a lighter patient-staff ratio compared with what is necessary for more serious patients at the acute stage. It is important that we look at the end-to-end capacity, and that includes step-down care. That is why NHS England set out 7,000 additional beds in its summer plans. We are also doing things differently using technology. Virtual wards allow some patients to be at home, which many patients prefer, but with wraparound clinical support. Virtual wards and step-down care in the community are part of that wider landscape.
Zarah Sultana (Coventry South) (Lab)
Iqbal fell seriously ill on Christmas eve. His family rang for an ambulance, calling 999 three times and pleading for help. They waited for three hours, but by the time an ambulance arrived, it was too late. Paramedics tried desperately to save his life, but the 58-year-old father tragically passed away. His daughter Minnie was clear about who was to blame, saying that it was not NHS staff but Tory Governments who have left the NHS in what she called a “disastrous state”. Will the Health Secretary heed Minnie’s words and undo 13 years of running down our NHS by giving NHS workers a proper pay rise, ending all forms of privatisation and giving the NHS the funding it desperately needs?
Steve Barclay
As I said in my opening remarks, I regret the fact that some patients in emergency care did not receive acceptable care in recent weeks, but I gently remind the hon. Lady that the pressure, particularly around flu and covid rates, is something that has put huge pressure on the NHS in Wales and Scotland, as well as across Europe and across the globe.
Andrew Jones (Harrogate and Knaresborough) (Con)
I thank my right hon. Friend for his statement and I welcome North Yorkshire’s involvement in the trials he has announced today. He has highlighted the increased bed occupancy that has come from the flu surge. NHS North Yorkshire briefed me earlier that flu vaccination take-up in North Yorkshire was 64%. That means that one in three people is not vaccinated. Does my right hon. Friend agree that putting more focus on encouraging vaccination take-up is one way in which we can all help to alleviate this crisis and reduce demand in our hospitals?
Steve Barclay
I very much agree with my hon. Friend about encouraging greater vaccine take-up. I think we can agree across the House that that is to be encouraged, and I hope all Members will reinforce the UK Health Security Agency’s messages on the take-up of the vaccine. We have expanded the scope to include over-50s, and we have the world-leading bivalent vaccine that targets both omicron and the original strain of covid, but it is important that as many people as possible get their flu jab as well, and I encourage all Members to support that.
Caroline Lucas (Brighton, Pavilion) (Green)
The NHS and social care are in unprecedented crisis, even if that is a word that the Secretary of State and the Prime Minister refuse to use. We know that resilience was stripped out of our NHS years before the covid pandemic, and I come back to the level of vacancies: there are 133,000 in our NHS and 165,000 in social care. Will the Minister admit that, as well as growing the workforce, we urgently need to keep the workforce that we have? If so, why are the Government not at least meeting the nurses halfway on pay, as the Royal College of Nursing has offered to do, and why, after 13 years of Tory Government, is the average care worker’s pay less than the pay at McDonald’s or Amazon?
Steve Barclay
It would have been welcome if, within that list, the hon. Lady had recognised the Government’s significant investment in Brighton’s new hospital. There are also more doctors and nurses in the NHS this year than there were last year.
The Chancellor announced the £500 million in his autumn statement partly in recognition of the pressure on the social care workforce, which is why the funding was prioritised, and Home Office colleagues have put social care workers on the shortage occupation list to enable us better to attract international talent.
Mr Robin Walker (Worcester) (Con)
My right hon. Friend made many sensible points in his statement, but he will forgive me for focusing on the local pressures in Worcestershire, which remain acute. Our two A&Es saw 14,000 attendances in December, up from 12,500 in December 2021 and 10,600 in December 2020. The hospital trust tells me that, on any given day in December, around 100 patients in hospital beds could have been cared for somewhere else.
Today, I read my right hon. Friend’s press release on extra funding for neighbouring Warwickshire. Will he ensure that a significant amount of this £200-million funding package reaches Worcestershire hospitals? There is an acute need to upgrade our A&Es, which I understand is due to happen this year.
Steve Barclay
As my hon. Friend knows, I signed off those A&E upgrade plans when I was Chief Secretary to the Treasury, but they have been delayed by contractual disputes on the ground. I share his desire to see them expedited. The Government made that investment, and we want to see a consequent improvement in operational performance.
My hon. Friend is right that today’s announcement will enable ICBs, including those in his area, to accelerate their discharge plans. Plans were already in place because of the funding in the autumn statement, but today’s announcement allows ICBs to go further and quicker in releasing patients, which will in turn take pressure off A&E departments.
Barbara Keeley (Worsley and Eccles South) (Lab)
It is one thing to talk about blocked beds but, as many Opposition Members have said, care is also about staff. How does the Secretary of State expect care homes to cope with this increased pressure when one in 10 social care posts remains empty and when staff feel overworked, underpaid and exhausted?
Last year, a report commissioned by the Department of Health and Social Care found that the rapid discharge of people from hospital to care homes during the first wave of the pandemic, without adequate covid testing, was “highly likely” to have caused some outbreaks. How will the Health Secretary avoid the fatal mistakes of the past by militating against the seeding of more infections in care homes and, as my hon. Friend the Member for Ilford North (Wes Streeting) said, the danger of unsuitable care leading to hospital readmissions?
Steve Barclay
The hon. Lady makes a good point about the risk of introducing infections into care homes, as happened in the past. It is worth the House reflecting on the fact that we are in a very different position from the start of the pandemic. First, we now have vaccines in place for care home residents and staff. Secondly, we now have antivirals. Thirdly, we now have huge knowledge about covid. From an infection point of view, the risk of releasing people into care homes is now in a very different place.
On the wider workforce, part of the reason for the £500 million announced in the autumn statement is to support measures for the workforce, but we are also looking to boost numbers through international recruitment.
Sir Robert Syms (Poole) (Con)
I welcome what the Secretary of State says about community pharmacists, who have always wanted to do more. They can take a lot of the burden off GPs and, if access to GPs were improved, fewer people would turn up at A&E. It seems to be a win-win-win situation, so let’s do it.
Steve Barclay
I could not agree more. There is a huge opportunity for pharmacists to do more, and I have asked the Department and NHS England to explore that at pace. I expect to say more on that when I announce our recovery plan at the end of the month.
I think we can go even further because, alongside pharmacists, there is much more scope to work with employers. Staff absences due to cardiovascular conditions are a significant cost to employers, so it is in their interest to work with us on prevention measures.
Much more can also be done through home testing. One of the lessons from covid is that the public will test at home. In looking at the challenge of excess deaths, there is a significant opportunity to do more home testing, employer testing and work in the community, particularly through pharmacists.
Wera Hobhouse (Bath) (LD)
When a constituent of mine fell seriously ill recently, his wife rang 999. It was a category 2 emergency that then escalated to category 1, but it still took the ambulance nearly two hours to arrive and, despite the paramedics’ heroic efforts, my constituent sadly died. There are now up to 500 avoidable deaths per week because of A&E delays, according to the Royal College of Emergency Medicine. Will the Government support the Ambulance Waiting Times (Local Reporting) Bill, introduced by my hon. Friend the Member for St Albans (Daisy Cooper), to identify hotspots with the largest waiting times and put support to where it is most needed?
Steve Barclay
I have seen a lot of speculation in the media about the excess mortality to which the hon. Lady refers. I have discussed the issue in detail with both the chief medical officer and the medical director for NHS England. The point to note is, first, that this is something that has happened internationally. It cannot be ascribed just to one issue, as is so often the case. Some of the excess mortality will be due directly to covid, albeit that that will be a diminishing proportion, and some of the non-covid excess mortality will also be driven by quite a wide combination of factors, so we have to be cautious when those sorts of numbers are bandied around.
Amanda Milling (Cannock Chase) (Con)
I have recently had alarming reports from constituents who have had to wait for more than 20 hours for an ambulance, so will my right hon. Friend set out in further detail how the measures outlined today will also support ambulances to reach patients more quickly?
Steve Barclay
The measures announced today speak to the heart of that issue: by putting in more capacity to decompress emergency departments, we allow, in particular, more same-day emergency care, where patients can be rapidly assessed, diagnosed and treated without being admitted to a ward. By unblocking capacity on wards, we enable emergency departments to release patients, which in turn creates the capacity for ambulances to hand over patients. The delay in handovers from ambulances is caused where the emergency department is already at capacity and there is an understandable reluctance from clinicians for additional patients to come in. Freeing up capacity within the emergency department is therefore about the operation of same-day emergency care at the front door of the hospital as well as what is happening at the back door with delayed discharge.
Paula Barker (Liverpool, Wavertree) (Lab)
The Secretary of State has said that the Government will now block-book residential homes for hospital discharges, but social care is in crisis and has been for many, many years. Care workers are leaving the profession in droves, because of low pay and poor conditions. To prevent care workers from leaving to work for supermarkets or Amazon, what will he do to recognise their incredibly highly skilled work and pay them what they deserve? Unless we retain existing staff, the international recruitment drive is meaningless.
Steve Barclay
We need to both maximise international recruitment and retain existing staff. That is why the Chancellor, in the autumn statement, with all the other competing pressures that he faced, prioritised putting £7.5 billion into social care over the next two years—the biggest ever increase, under any Government. Alongside the announcement of a further £6.6 billion investment in the NHS over the next two years, that was about recognising the centrality of social care in the wider pressures on the NHS.
Mark Pawsey (Rugby) (Con)
Does the Secretary of State agree that many of those who will need to be admitted to hospital in the coming weeks will have reason to welcome the fact that this Government, unlike the Labour party, do not have a prejudice against making use of facilities from within the independent sector?
Steve Barclay
I agree; I think that it is important that we maximise capacity in the independent sector. That is what we are committed to doing, and I very much agree with my hon. Friend.
Jonathan Edwards (Carmarthen East and Dinefwr) (Ind)
Over recent years, I have received sporadic correspondence from consultants based in my constituency complaining about the tax liabilities that they face as a result of their pension contributions, which force them to reduce their hours or to leave public health altogether. I understand that the Government are consulting on this issue and that this is probably a matter for the Treasury, but how close does the Secretary of State think we are to an innovative solution?
Steve Barclay
The hon. Gentleman mentions a matter that is raised with him. As he can imagine, it is also raised with me by many senior clinicians. He is right that it is a question for the Chancellor, because, as he knows, tax is a Treasury matter. I am happy to share that point though, as I know that it is under consideration by my right hon. Friend the Chancellor.
Jack Brereton (Stoke-on-Trent South) (Con)
As the Secretary of State knows, there are serious pressures within the NHS in North Staffordshire. The chief executive of the Royal Stoke University Hospital said on Radio Stoke last week that the key issue to addressing these pressures is dealing with social care. Will my right hon. Friend assure me that the measures will deliver more social care places across North Staffordshire?
Steve Barclay
I am very happy to give that assurance to my hon. Friend, but it is important to see the measures in the context of the autumn statement and the announcements that were made earlier by the Government around integrating health and social care through the integrated care boards. That will not only provide additional funding, but improve significantly the data, which will address some of our interface challenges in relation to those patients who are medically fit to be discharged from hospital, so that we can better ensure that the different pathways—whether it be domiciliary care, intermediate care or residential care, pathways one, two and three—are operating in a better way.
Janet Daby (Lewisham East) (Lab)
During this winter period, my constituents took their two-year-old child with severe breathing difficulties to A&E. It soon became apparent that the child needed to be hospitalised, but no beds were made available. After some 34 hours spent in A&E, a bed was found. I am sure that hon. Members from across the House can imagine how scary and exhausting that experience was for the whole family. Does the Minister view this experience as acceptable, and is this the new norm that the public should now expect from our national health service under a Conservative Government?
Steve Barclay
I recognised the hon. Lady’s second point at the start of my statement. On the wider point around those specific very troubling cases, one purpose behind integrated care systems having control centres is to get much earlier sight of the issues and much clearer escalation, with the result that these issues will get more scrutiny than is currently the case.
Rob Butler (Aylesbury) (Con)
In addition to the substantial increase in the number of cases of flu that my right hon. Friend mentioned, the intense cold snap shortly before Christmas put further unforeseeable pressure on hospitals. Stoke Mandeville Hospital in my own constituency saw four times as many broken hips as it normally would in that period, so I pay tribute to all the staff at Buckinghamshire Healthcare NHS Trust for treating those additional patients. I warmly welcome the Health and Social Care Secretary’s announcement on freeing up thousands of beds. Does he agree that putting a real, great focus on intermediate care and intermediate step-down beds is key, so it will be very important for integrated care boards, including the one covering Buckinghamshire, to put an intense concentration on that and on working constructively and effectively with the local authority and the local NHS trust?
Steve Barclay
My hon. Friend raises an extremely important point, which is the role of step-down care in freeing up capacity in hospital. I was keen to emphasise, in my opening remarks, the right wrap-around support and care for patients when they are discharged from hospital. Over the next few weeks, it will not simply be a question of discharging those patients; there needs to be the wrap-around care as well. He is also right to point to the fact that there have been significant increases in demand—the fourfold increase that he highlights—which, combined with flu, covid and the pandemic legacy, resulted in very significant pressures. That demand pressure combined with an impact on supply—for example, from flu—also exacerbated staff absences during the Christmas period.
Mr Deputy Speaker
My apologies to the Secretary of State. I now call Clive Efford.
Clive Efford (Eltham) (Lab)
Thank you, Mr Deputy Speaker; I was as enthusiastic to make a contribution as you were for me to make it. What contingency did the Secretary of State put in place for a spike in flu cases? He speaks as if it took the Department by surprise, but it was widely predicted that there would be a spike in flu cases following on from the lockdowns during covid. He has announced 4,500 places to ease pressure, but in his statement he said that in 2020 there were just 6,000 cases of delayed discharge per day—“just” 6,000, as if that is not significant—whereas last year it was between 12,000 and 13,000 cases per day. What he has announced is roughly one third of what he said was the average per day for the last year. Is this not just too little, too late?
Steve Barclay
First, the central announcement at the autumn statement was the additional capacity to deal with domiciliary care and further support for social care. That £500 million announcement was part of the £2.8 billion next year and the £4.7 billion the year after. The autumn statement recognised the fact—I would have to go back and check the transcript, but there were many comments around that period pointing to it—that this was likely to be the worst-ever winter because of the combination of pandemic pressure, covid admissions and the risk of flu, which has transpired to be the worst for 10 years. That is why, for example, we expanded the cohort eligible for the flu and covid vaccine to the over-50s and invested in the bivalent vaccine. It is why NHS England put in place an additional 7,000 beds. It is why we have been rolling out virtual wards of the sort used at Watford General Hospital, which is able to address the equivalent of an extra ward. Additional measures have been taken but, over the Christmas period, in line with what happened in Wales, in Scotland and internationally, we saw a rapid spike in flu, with a sevenfold increase in cases over a short period, on top of the pressures already in the system.
Ruth Edwards (Rushcliffe) (Con)
I welcome the Secretary of State’s statement and the new funding announced. In Nottinghamshire, the Nottingham University Hospitals NHS trust had to declare a critical incident between 29 December and 6 January. It needs this new funding to help to discharge more patients now. Can the Secretary of State confirm when the money will arrive and start making a difference to my constituents in Nottinghamshire, and what his Department is doing not only to attract new people to work in social care, but to try to win back some of those who have recently left?
Steve Barclay
To address my hon. Friend’s two points, first, the NHS will take immediate action to start arranging additional step-down care; that is a clear message that she can take to her constituents to show that the Government have listened and acted on the very real pressures we have seen. On the wider social care system, an example from Hull—the hon. Member for Kingston upon Hull West and Hessle (Emma Hardy) is not in her place now—is the Jean Bishop Integrated Care Centre, which co-locates social care and NHS staff. The feedback I received from those staff was that that integrated model is extremely rewarding for staff and a much better way of operating than working in silos. The workforce themselves have said that that co-location and greater integration between social care and health is extremely beneficial.
Tim Farron (Westmorland and Lonsdale) (LD)
Patients living with cancer, their families and the outstanding cancer workforce will be staggered—as am I—that we have just had a statement on NHS pressures that put forward no serious plan to tackle the deadly cancer backlog. Some 17,000 cancer patients in the last three months have had their targets for cancer treatment delayed or missed; 43% of people diagnosed with cancer in south Cumbria waited more than two months for their first lifesaving treatment, and in north Cumbria that figure was 63%. Where is the urgent plan to tackle the cancer backlog? On a practical, cross-party level, will the Secretary of State or one of his Ministers attend the all-party parliamentary group for radiotherapy’s inquiry on 18 January, so that we can work together to come up with some quick technical solutions that will save lives?
Steve Barclay
It is worth pointing out to the House that 92% of new patients are starting their cancer treatment within four weeks. On the substance of the hon. Gentleman’s point, however, we are rolling out the programme of community diagnostic centres and the surgical hubs programme precisely in order to prioritise cancer treatments. Also, given that it was a central part of the statement, it is rather surprising that the major investment in bringing out the potential of world-leading cancer vaccines from our life sciences strategy, which could be absolutely transformational for cancer patients, was not even referred to by the hon. Gentleman. I hope that he supports it, because it has the potential to be game-changing.
Andrew Percy (Brigg and Goole) (Con)
The Secretary of State is absolutely right: nothing about this situation is unique to the UK. There have been record delays at Canadian hospitals, Canadian emergency rooms have been closed because of staff shortages, and some Canadian citizens have had no ambulance cover at certain times, so the role of paramedics has been expanded there to enable them to do more diagnostics and to prescribe.
As somebody who works in this service, I say that it is not just about the delays in getting into hospitals; the demand on the ambulance service is equally driven by the fact that we have more people living for longer with more conditions that sometimes require care at 1 or 2 in the morning, and the only NHS service that will turn up is the ambulance service. What is my right hon. Friend’s vision for the future of community paramedicine? How can we expand paramedic roles, employ more advanced paramedics and, of course, put the proper resources into that service?
Steve Barclay
My hon. Friend raises a brilliant point—one that I completely agree with—about how we upskill the existing workforce and get more people operating at what is referred to as the top of their licence. One of the key areas in the discussions we had at No. 10 on Saturday was how we can better utilise the existing workforce and their roles, and what regulatory changes we need to maximise that.
I pay tribute to my hon. Friend for the work that he did over the Christmas period as a community first responder. He is absolutely right: looking at how we better integrate the data available to paramedics, for example, and therefore enabling them to do more, is exactly the direction of travel that we want to take. I look forward to discussing that further with him.
Kerry McCarthy (Bristol East) (Lab)
Last month, I asked the Prime Minister about a constituent with dementia who waited three hours for an ambulance and then spent 10 hours in the back of the ambulance in the car park at A&E. We have heard much worse examples today. I have now been contacted by another constituent, who went into cardiac arrest at his GP’s surgery. He waited two hours for an ambulance, and the GP eventually ended up driving him to hospital and probably saved his life. Can the Secretary of State give us some confidence that everything he is talking about today will filter through quickly to ambulance response times? At the moment, my constituents are terrified that if they call for an ambulance, it will not come.
Steve Barclay
Looking at the media coverage, the hon. Lady raises a very fair challenge. To give her a sense of what underscores our approach, 15 trusts are responsible for 56% of ambulance handover delays, so the targeting of additional capacity—particularly how we target what we have announced on the areas where delays are most acute—is obviously one of the central things that we are doing at pace, and there is a significant concentration of that.
There are also opportunities to look at the variation in performance and what is working effectively in other trusts. That combination of control centres and better upstream demand management is absolutely core, particularly for cohorts such as dementia patients. There are significant opportunities to target interventions better—NHS England has been doing a lot of work on that as part of its 100-day sprint exercise—but we can do more and the funding announced today speaks to that.
Jonathan Gullis (Stoke-on-Trent North) (Con)
I put on the record my thanks to the incredible staff at the Royal Stoke University Hospital and the Haywood walk-in centre, who have faced unprecedented pressures. Tracy Bullock and Neil Carr deserve our full respect.
We have two problems in Staffordshire. One is that community first responders do not have blue-light ability, which was taken away by the West Midlands Ambulance Service. When will it be reinstated? The second is that community pharmacies can do more—I am delighted that we will see them do more—but their core funding needs to be increased, which it has not been since 2014. How will that be rectified?
Steve Barclay
On the blue-light ability, I am very happy to take that away and look at it. As is often the case, these things are slightly more nuanced, as I discovered when we were looking at Ministry of Defence ambulance drivers and their interaction with blue lights. I am very happy to look at that.
The Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Harborough (Neil O’Brien), is looking at community pharmacy and, in particular, how we better enable patients to get the right treatment in the right place. Given that community pharmacies are accessible and sometimes get higher numbers in more deprived communities, there are significant opportunities for us to do more with them, and I know that that is something the ministerial team is working on.
Justin Madders (Ellesmere Port and Neston) (Lab)
I listened with some incredulity to the Secretary of State’s explanation—that because the integrated care boards are only six months old they are still getting to grips with the link between health and social care. Who does he think was running health and social care before the ICBs were created? It was the very same people, who know exactly what the issues are; what they are lacking is a Government committed to dealing with the systemic issues facing both sectors.
As we have heard, one of those issues is workforce and social care. A quick internet search reveals that there are 200 social care vacancies within a 10-mile radius of Ellesmere Port; we have heard already that there are 165,000 social care vacancies nationwide. I have not heard anything from the Secretary of State today about what he is actually going to do to address those vacancies. In a year’s time, how many social care vacancies does he expect there to be across the country?
Steve Barclay
On the interaction between vacancies and workforce, NHS England is working on a workforce strategy, as has been said, and we will say more on that shortly.
In his wider point, the hon. Gentleman is ignoring examples such as the Jean Bishop Integrated Care Centre—the ability to bring health sector and social care staff to work together in a more integrated way. Yes, the integrated care boards were operational from July. That is a factual statement; I am slightly mystified about why he thinks that was in some way an unusual observation to make. It is just the factual position. The point is that when one looks at the issue, one sees opportunities, particularly around how the data are better integrated, to understand where the workforce pressures and bed capacity are.
One of the causes of delayed discharge is about the interfaces as well as what is domiciliary care, what is step down and what is residential. There are a number of issues. By bringing them together in more integrated way, integrated care boards will be one of the ways we improve the situation. Indeed, that is what the hon. Gentleman’s former colleague Patricia Hewitt is looking at through the Hewitt review.
Mr Peter Bone (Wellingborough) (Con)
I am grateful to the Secretary of State for getting to grips with delayed discharges. As he will know, only a third of such discharges are in social care; most are down to the fact that there needs to be an NHS medical discharge.
I have some good news for the Secretary of State. The bad news is that Spinneyfields in my constituency, a 51-bed social care step-down facility, is going to be closed. If the Secretary of State spent a small proportion of the £250 million, the NHS could take over Spinneyfields and tomorrow 51 beds would be released at the acute hospitals in Northampton and Kettering. Will he agree to that now?
Steve Barclay
One of the things that my hon. Friend agrees with is that more decisions should be devolved rather than every decision being made in Westminster. Part of the reason for integrated care boards is so that they can look at where best to allocate their funds locally. He raises an extremely important point. He is right that around a quarter of delayed discharges are on the social care side—a fifth actually, in the NHS; there are a number of factors within that, which we will need to disaggregate.
On my hon. Friend’s point about local capacity, the Government are allocating the funding to his local ICB. I am sure he will have a conversation with his ICB on where the spare capacity can be best identified and rolled out at pace.
Mr Toby Perkins (Chesterfield) (Lab)
Last week, I met Hal Spencer, the chief executive of Chesterfield Royal Hospital; the pressures that he and his staff had faced as the hospital went into a critical incident over Christmas were etched all over his face. He spoke about the pressures on A&E registrars, ambulance drivers and nurses and about coming face to face with people who had been waiting 24 hours in a corridor on a trolley or who had been waiting many hours for an ambulance to turn up.
Is not the reality that this is a system-wide failure 13 years in the making? Did the right hon. Member for Gainsborough (Sir Edward Leigh) not hit the nail on the head in saying that Labour has a long-term plan for our NHS and this Government do not?
Steve Barclay
On the hon. Gentleman’s first point, this is absolutely a system-wide challenge. That is why the use of innovations such as virtual wards in demand management upstream, in the care home or on the home, is important, just as discharge—getting patients to leave hospital who are fit to do so—is important. The focus has often been on ambulances being delayed at A&E or on the significant and real pressures in emergency departments themselves, but the challenge is much wider. That is what the funding in the autumn statement recognised.
In response to his second point about this being a longer-term issue in England specifically, I would just point him to the examples in Wales and the pressures in Scotland. This surge in flu combined with covid and the pandemic legacy that we have seen in England have created so much pressure over the festive period, and it is something with which many other health systems around the globe have also been grappling.
Anna Firth (Southend West) (Con)
I very much welcome this extra funding, and I look forward to hearing how much will be coming to Southend University Hospital, which has had to deal with not one but two critical incidents declared by the East of England Ambulance Service NHS Trust. It has already innovated with modular units and an active discharge lounge. These NHS workers deserve all our recognition, and what they need is £8 million of capital funding to reconfigure the hospital, which is fundamentally not big enough. In the short term, will the Secretary of State agree to encouraging care homes to take discharges after 5 pm? Every day, 15% of the people who need to be discharged cannot be discharged because the care homes will not take them after 5 pm. That is at least 70 people a week who could be out of hospital. This is an emergency—everyone must put their shoulder to the wheel.
Steve Barclay
My hon. Friend has raised the £8 million capital request with me previously, and it is something we are looking at. She is right about how capital needs to be looked at in the context of getting flow into a local system and of where triaging can be unlocked. In response to her point about 5 pm, there are two points. First, part of the reason for looking at discharge lounges is that if we have something that is 7 am to 7 pm, there is a cultural change for the patient in going into the discharge lounge in the morning and being off the ward. Looking at other health systems around the world, we see that that can be beneficial in accelerating discharge, rather than there being a point in the day after which suddenly it is easier to leave discharging the patient until the next day.
The second point on 5 pm is that we need to look at what support care homes need to have the confidence to take the patient. To be fair to them, it is not simply a question of whether they are refusing to take the patient after 5 pm; it is also about us looking at the wider wraparound care package, so that care homes are confident in taking that risk not just after 5 pm on weekdays, but at weekends, when there is often a significant drop in the number of patients taken.
Helen Morgan (North Shropshire) (LD)
One of the key issues in Shropshire is a shortage of staff across every discipline and at every level. It is one of the reasons for the horrifying ambulance wait times that I raised in this place on my first day, 5 January 2022—this is not a new issue for 2023. What is the Minister’s plan to improve staff retention, because staff recruitment on its own will not plug this gap? It has not plugged it in Shropshire, and there are no signs of it plugging the gap across the rest of the country either.
Steve Barclay
We are expanding staff numbers—that is why there are 3% more doctors and 2% more nurses than last year—but it is about more than simply looking at that. We also need to look at the fact that we have more elderly patients, who are presenting with multiple conditions, which in turn changes the demands from a system that has traditionally been more about individual specialties. Now we are looking at treating those patients with multiple conditions, and that then needs to be factored into the skills the workforce have. That is why the point from my hon. Friend the Member for Brigg and Goole (Andrew Percy) is so important. We need to think about what upskilling can be offered to particular roles and how they can take on a wider set of responsibilities. There is also the role of technology in that. For example, many nurses in hospitals currently take time looking for beds. Operational control centres with a different cohort of staff, as is already the case in some hospitals, not only automate much of that process, which is far quicker in getting beds back into use, but free up a lot of nursing time to be used for what nurses would prefer to be doing, which is focusing on the clinical side and taken away from some of those administrative roles.
James Wild (North West Norfolk) (Con)
Norfolk and Waveney has already received £11 million to tackle discharges, which is making a difference. However, today there are 128 patients in the Queen Elizabeth Hospital in King’s Lynn who do not need to be there. This additional funding is welcome, but do these pressures not also underline to the Treasury the long-term importance of investing in modern hospitals that are able to meet demand and the case for including the QEH in the new hospitals programme?
Steve Barclay
My hon. Friend skilfully combines the importance of discharge at King’s Lynn with the importance of addressing RAAC—reinforced autoclaved aerated concrete—hospitals, on which he has campaigned assiduously. As he will know from my speech at the NHS Providers conference, it is an issue that I very much recognise. I have visited the hospital and seen the challenges at first hand; indeed, my son was born in that hospital, so I know it very well. We are discussing that issue with the Treasury and I hope to be in a position to update the House shortly.
Richard Burgon (Leeds East) (Lab)
We will not solve the NHS crisis without solving the NHS staffing crisis, which means sorting out pay. However, in talks with the unions today, the Government refused to make a new offer on pay. The unions say that the Secretary of State is ludicrously calling for—demanding—efficiency savings from nurses and other NHS staff. Many nurses and NHS staff are already working 18-hour shifts. When will the Government get real? When will the Government get serious? When will the Government make a proper offer to NHS staff to avoid strikes?
Steve Barclay
The hon. Gentleman seems to be quoting Onay Kasab, the lead national officer of Unite, who spoke to Sky News outside the Department of Health and Social Care just a few minutes after my discussions with the trade unions. The slightly odd thing was that Mr Kasab was not actually in the meeting on which he was commenting.
Ben Bradley (Mansfield) (Con)
It is pleasing to hear from across the House a focus on capacity in domiciliary care, which is a huge priority. Ultimately, that is where we want people to end up: independent in their own homes, as far as possible. I wonder if the Secretary of State could reassure me about some elements of the plan for the NHS to procure care beds. Where does he envisage staff coming from? If it is from the NHS, how will we ensure that more people do not leave domiciliary care for what are often better-paid roles in the NHS? In the same vein, on capacity, how will we ensure that people are able to move on from residential care beds into domiciliary care when there is that shortage of capacity?
Steve Barclay
As befits the leader of his own county council, my hon. Friend rightly recognises the importance of the integration of health and care. I have pointed to examples where that is already being done extremely effectively in an integrated way. As I recognised in my remarks, the medical director of NHS England has said that helping people to leave hospital with the right support when they are ready to do so is not just clinically the best option for those individuals, but one of the safest options for expanding capacity for everyone who needs care. It is the right thing to do clinically, but his point—one that we are extremely focused on—is about how we then ensure that wraparound service for patients who are released into residential care so that they can move into domiciliary care.
Jim Shannon (Strangford) (DUP)
I know that the Secretary of State appreciates that the winter pressures are only exacerbated by the looming strikes. I joined the picket line at Newtownards hospital back in early December. Just before Christmas, I had the opportunity to meet Pat Cullen, the leader of the nurses’ union at St Thomas’s Hospital, just across Westminster bridge, as the protest was ongoing, and we heard in the news that she referred to a glimmer of hope over today’s talks between the Government and nurses. Does the Secretary of State believe that there can be real engagement with not only nurses and midwives, but junior doctors, who are also threatening strikes? Does he agree that it is about not just a pay increase, but an increase in the numbers of staff to secure safety and accountability on shifts in hospitals tonight and every night from today on?
Steve Barclay
I agree that a combination of pay and wider conditions have an impact on recruitment and retention. That is why we have been keen to engage constructively with the trade unions; we had a good discussion earlier today. We recognise that there is a range of factors. To take the example of paramedics, the feedback from my discussions with a number of paramedics was that their frustration about handover times and the delays that they were experiencing was more important to them than pay. It is important to have discussions through the independent pay review bodies about pay, what is affordable and what is the right balance, but a range of non-pay factors are also extremely important to staff.
Mr Philip Hollobone (Kettering) (Con)
The biggest flu outbreak in 10 years has seen Kettering General Hospital become the 28th busiest hospital in the country, with a bed occupancy rate of 96.5% in the week leading up to the new year. The Secretary of State was kind enough to visit it last year and stood in the busy and overcrowded A&E. He was also good enough to visit Thorndale care home, where he was briefed on the fact that the rate of increase in the number of over-80s in Northamptonshire gives it one of the fastest-growing elderly populations in the country. In thanking the Secretary of State for the measures that he has outlined today and the extra funding, I ask whether he will ensure that Northamptonshire, North Northamptonshire Council, the Northamptonshire ICB and, crucially, Kettering General Hospital get their fair share of the funding that he has announced, so that we can tackle these winter pressures quickly and successfully?
Steve Barclay
My hon. Friend is right to point to the real pressures at Kettering which, as he says, I have visited. Not only am I keen to see it get its fair share, but I know that he will absolutely champion it through his good offices to ensure that that is the case, as he always does. He also raises an important point that the pressure of an ageing population is not universally distributed but is more intense in certain areas than others. Again, in our scrutiny of the data, I am keen to look at how that plays out in the variation in performance between trusts because, as I said, 15 trusts account for 56% of ambulance handover delays and there is significant variation across the NHS. Understanding what is driving that, such as different ageing profiles between different areas, is a key part of our recovery plans.
Andy Carter (Warrington South) (Con)
I spent Friday morning at Warrington Hospital to see the challenges that A&E department staff are facing. One senior clinician said to me that it was the busiest he had seen it in 30 years. The entire hospital was full—there were no beds—and last Monday, 90 people were waiting in A&E to be admitted to a bed. The Secretary of State knows that I am waiting for an announcement on whether a new hospital can be funded in Warrington, and I am keen to hear when that announcement will come, but can he reassure my constituents that the funding announced today will support the staff in Warrington Hospital and the social care staff in Warrington and ensure that the pressures that they are facing will be addressed immediately?
Steve Barclay
Yes, I can; that is the whole purpose of the announcement. Although my hon. Friend campaigns assiduously for the new hospital, he will concede that, regardless of the decision, that would take time. To his point about the hospital being full, there is an immediate challenge about how we get additional capacity into the emergency department so that it can operate more effectively, because if there are too many people, that impedes an emergency department’s ability to operate effectively. There is also a challenge about how we address the wider occupancy in the hospital as a whole, because that is at the core of getting flow into the system. That is the essence of the feedback that we have listened to and taken on board from the clinical community —as he did on Friday—particularly within emergency departments. Today’s announcement speaks to the exact issue that he raises.
Mr Deputy Speaker (Sir Roger Gale)
Finally, with the prize for patience, I call Shaun Bailey.
Shaun Bailey (West Bromwich West) (Con)
Thank you, Mr Deputy Speaker—I am last but I hope I am certainly not least. Some 700 beds are due to come online thanks to the Midland Metropolitan University Hospital and there is a new primary care centre in Wednesbury, so when my right hon. Friend’s Department delivers, we see the benefit. Clearly, however, that means nothing if we cannot get the processes right. The most pressing issue for my constituents during the winter has still been access to their GPs, as I am sure hon. Members on both sides of the House will agree. I welcome what he has said about the use of technology to ensure that people are seen, but fundamentally, people still want face-to-face appointments, because if they are digitally disconnected, they cannot access that technology. It is as simple as that. I ask him to commit—just after he commits to come to Wednesbury to see our new primary care centre—to work through his good offices with GP practices where there is best practice, particularly in the Black Country ICB, to ensure that we enable people who are digitally disconnected to access GPs.
Steve Barclay
We are working actively with the primary care community. Indeed, that was a key focus of the Prime Minister’s summit in No. 10 on Saturday and it is part of the work that the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Harborough (Neil O’Brien) is leading through the primary care recovery plan. Last year’s GP patient survey suggested that continuity of care and face-to-face appointments were extremely important for two fifths of patients, but that suggests that for three fifths—often younger patients—speed of access is more pertinent. Continuity of care is important for those with multiple conditions, particularly elderly patients.
Alongside that, my hon. Friend is right to raise the Midland Metropolitan University Hospital. Four years ago, when I visited as a Minister of State in the Department, it was near completion. As he knows, it has taken a significant amount of time since then to get to its opening, which is why we need to look at doing things differently when it comes to value for money. Looking at the hospital estate programme, nine of the last 10 hospitals were built over time and over spec, so we need to look at modular design, modern methods of construction, and standardisation, which deliver a 35% unit-on-unit reduction in cost and much quicker operational performance, and would enable us to get hospitals up and running earlier.
It is important to do things differently and the new hospital building programme is part of that. We have listened to the concerns of those on the frontline and today’s statement addresses the immediate issue of bed occupancy in hospitals and the pressure on emergency departments.
Mr Deputy Speaker (Sir Roger Gale)
My thanks to all hon. Members—Front Benchers and others—who have taken part in an important discussion.
BioNTech Strategic Partnership
Steve Barclay Excerpts(1 year, 11 months ago)
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The Secretary of State for Health and Social Care (Steve Barclay)
The UK’s response to the covid-19 pandemic demonstrated the power of Government collaborating with industry to accelerate life sciences innovation. We want to take this innovative approach to tackling the other major healthcare challenges we face, such as cancer.
The Government have signed a Memorandum of Understanding with the Germany-based company BioNTech. This MoU aims to build a strategic partnership which will bring innovative immunotherapy research to the UK, with the potential to transform cancer patient outcomes and develop new vaccines for infectious diseases. This agreement will pave the way for a multi-year partnership between the Government and BioNTech, accelerating trials into the company’s ground-breaking pipeline of products targeted at major global diseases such as breast, lung and pancreatic cancer, malaria and tuberculosis.
BioNTech is a biopharmaceutical company developing a pipeline of cutting-edge immunotherapies—including mRNA-based vaccines and therapies. The company became a household name in 2020 after developing a covid-19 vaccine in partnership with Pfizer, which went on to become the world’s first licensed vaccine to use novel mRNA technology.
Through this partnership with BioNTech, the Government aim to ensure trials into further promising vaccines and therapies are accelerated, to reach our patients faster. The agreement means cancer patients will get early access to trials exploring personalised mRNA therapies, like cancer vaccines. No two cancers are the same and mRNA vaccines will contain a genetic blueprint to stimulate the immune system to attack cancer cells. The collaboration will aim to deliver 10,000 personalised therapies to UK patients by 2030 through a new research and development hub, creating at least 70 jobs and strengthening the UK’s positions as a leader in global life sciences.
BioNTech will also be the first industry partner in the new cancer vaccine launch pad which is being developed by NHS England and Genomics England. The launch pad will help to rapidly identify large numbers of cancer patients who could be eligible for trials and explore potential vaccine across multiple types of cancer. The partnership will aim to help patients with early and late-stage cancers.
If successfully developed, cancer vaccines could become part of the standard of care.
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Moderna Strategic Partnership
Steve Barclay Excerpts(1 year, 11 months ago)
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The Secretary of State for Health and Social Care (Steve Barclay)
The covid-19 pandemic has shown the importance of having the ability to develop and deploy vaccines rapidly to respond to a health emergency, as well as to mitigate the potential economic and health costs such an emergency can cause. It also demonstrated the need to establish resilience on UK shores to avoid supply chain disruptions which could have severe public health and economic consequences. While the future trajectory of the covid-19 virus is uncertain, delivering a consistent and resilient supply of covid-19 vaccines is critical in ensuring safe and effective vaccines are provided on at least an annual basis over the next decade, to protect those who are most vulnerable to covid-19.
With these challenges in mind, in June 2022 Ministers signed non-binding heads of terms and a single tender case for a strategic partnership between HMG and Moderna. Since then, the Vaccine Taskforce and the UK Health Security Agency (UKHSA), has worked to negotiate a definitive agreement with Moderna. The execution of our contractual agreement for a 10-year partnership with Moderna was announced on 22 December 2022. The partnership will bring vaccine development onto UK shores, boosting our messenger RNA (mRNA) capability, strengthen our ability to scale up production rapidly in the event of a health emergency, and better equip the UK to respond to covid-19 and future health emergencies.
Through this deal, Moderna will, at its own cost, establish a UK based manufacturing facility and global research and development (R&D) centre, as well as commit substantial investment into UK-based R&D activities over the 10-year period, bringing the UK a step closer to becoming the leading global hub for life sciences. The manufacturing facility will be capable of supplying up to 100 million doses of respiratory vaccine per year in normal circumstances, increasing to up to 250 million doses in the event of a health emergency. The UK will have priority access to these vaccines where they are demonstrated to be safe, effective, and authorised by the MHRA. These include both Moderna’s proven and highly effective covid-19 vaccine and others in its pipeline, including against flu and RSV, providing health resilience.
Moderna has demonstrated expertise in mRNA development which has the potential to be a transformative breakthrough technology in several disease areas, including cancer, respiratory illnesses and heart disease. Also, mRNA vaccines have the potential to treat multiple pathogens in a single shot and be delivered in rapid timeframes.
The new Innovation and Technology Research Centre will look to unlock this potential by developing revolutionary treatments in the UK, which will benefit NHS patients and people worldwide. This will include running a significant number of clinical trials in the UK. Moderna has also pledged to fund grants for UK universities, including PhD places, research programmes and wider vaccine ecosystem engagement. The industry-leading, future-proof design of the plant will permit the addition of capability to manufacture a wide range of medicines and will be a massive boost to the UK’s R&D capability, as well as creating more than 150 highly skilled jobs.
The partnership, secured by the Vaccine Taskforce, will be taken forward by the Covid Vaccines Unit in the UKHSA. This will see the UKHSA working with Moderna to ensure early vaccine development, supporting the G7 mission to get from variant to vaccine in 100 days. Construction is expected to commence in early 2023, with the first mRNA vaccine expected to be produced in the UK in 2025.
[HCWS484]
NHS Workforce
Steve Barclay Excerpts(2 years ago)
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The Secretary of State for Health and Social Care (Steve Barclay)
The hon. Member for Ilford North (Wes Streeting) said that Labour has a plan. Let us look at that plan. More than a fifth of the entire population of Wales are waiting for planned care, and 60,000 people in Wales are waiting for more than two years. So we can see exactly what Labour’s plan in government delivers. He asked us to remember when Labour was last in power, and we still do. We remember the letter that said there was no money left. [Interruption.] He has just had plenty of time in which to discuss these matters. I did not feel the need to hector him, because I thought his points had so many flaws that it was important for the House to be able to hear them. He obviously feels that he did not make his case effectively, and would like to have another go. Does he want to have another go?
Steve Barclay
He does not want to intervene, so let me deal first with what he left out. His speech, like his motion, ignored a number of salient points. He did not mention, for example, the autumn statement, which one would have thought was fairly significant, providing an extra £6.6 billion for the NHS over the next two years. The NHS Confederation, no less, has described the day of that settlement as a “positive day for the NHS”, and the chief executive of NHS England has said that it should provide “sufficient” funding to fulfil the NHS’s key priorities.
The hon. Gentleman chose not to mention that significant funding. He also—much to the surprise of the House, perhaps—chose not to mention the uplift for social care that was announced in the autumn statement. Opposition Members often call for more funding, so I would have thought that they would be keen to hear about the extra £6.6 billion of additional funding for the NHS, about the biggest funding increase for social care provided by any Government in history, and about the £8 billion that we have committed to elective care. That, bizarrely, was also missing from his speech. He talked about the backlogs—those in England, that is; the backlogs in Wales are much greater—but he did not talk about that £8 billion for elective care, which will fund the building of diagnostic centres and surgical hubs in the constituencies of many Opposition Members.
Steve Barclay
I do not know whether there is a community diagnostic centre for a surgical hub in the hon. Lady’s constituency, but perhaps she will share with the House what extra investment is being made there.
Debbie Abrahams
As someone who worked in the NHS during the last period of Labour government, I was proud of being able to ensure that my constituents would have an appointment with a GP within 24 hours. I was proud of the fact that someone who needed elective care would receive it within 18 weeks. I was proud of the fact that the treatment of someone diagnosed with cancer would start within 60 days. That is not what is happening on the Secretary of State’s watch. Can he tell me why my constituency has fewer GPs than it had in 2015, along with an increase in demand? How is this delivering the quality care that I know we had on my watch and that of the last Labour Government?
Steve Barclay
We are investing in more doctors. We have 2,300 more doctors—a 3% increase. We also have 3% more nurses than we had last year. In fact, under the former Prime Minister, my right hon. Friend the Member for Maidenhead (Mrs May), there was the biggest ever increase in medical undergraduate places—a 25% increase—along with the opening of five new medical schools. Of course, the training takes about seven years, so that is still in progress. As was pointed out during Health questions this morning, we are dealing with the consequences of the pandemic, which is why we are investing in more checks, scans and other procedures, and there will be an extra 9 million of those by March 2025.
Emma Hardy
The right hon. Gentleman might recall that, when he was previously Health Secretary before his short break, I raised concerns around the criteria to reside and the number of people remaining in Hull Royal Infirmary who were unable to move into adult social care. At the moment, we have 30% vacancies in adult social care. The problem is that, although the money is promised, it is not delivered. That is partly because of the chaos that we have seen in the Government. He must acknowledge that, although this money was promised, it was not delivered and that we have 30% vacancies in adult social care across Hull and East Riding. Those vacancies always increase before Christmas because retail makes an attractive offer to those same workers. The money has not been delivered in time, and those 30% vacancies are only going to increase. With the greatest respect to the Secretary of State, there is little point in making promises if they are not quickly delivered in time to make a difference.
Steve Barclay
The hon. Lady mentioned the summer, and I think she knows that I visited the Jean Bishop integrated care centre and looked at the great innovations and brilliant work that her constituents, among others, are doing there. I looked at how it is bringing social care and the NHS together through an integrated model and how there has been new investment, supported by the amazing fundraising within the local community and by NHS funding. It would be great to get a bit of balance about the amazing feedback I heard from both staff and patients at the Jean Bishop integrated care centre who are working innovatively. I hope the hon. Lady would agree that the innovation of a centre such as the Jean Bishop is what we need to see in more places across the NHS. To her wider point, there are challenges in social care; she raises a fair point. That is why, despite the many competing pressures that the Chancellor faces, he has allocated £500 million for this year. It is also why he then committed the £2.8 billion for next year and the £4.7 billion for the year after—the biggest ever increase in that funding. But it is not simply about the funding increase; it is also about using new models such as that integrated care model to deliver far better care.
Dr Luke Evans
Is that not precisely the point? The NHS will gobble up the money, so it is about how we use the system. The integrated care systems and integrated care boards—established through the White Paper that the NHS asked for—are doing exactly that. They are trying to join up primary care, secondary care, social care, preventive health, county councils and borough councils all in one place to make a better stand on how we can produce healthcare that is better for our constituents and better for the taxpayer. Will my right hon. Friend make sure that, when he goes to the integrated care board chairs, he gives them the chance to solve the problems and unleashes the power to do exactly that, because they know best?
Steve Barclay
My hon. Friend raises an extremely important point. It is not just about the significant funding increase that the Chancellor has allocated; it is also about how that funding is deployed, in particular through using population level data for the integrated care system to bring health and care together. One area that the hon. Member for Ilford North and I agree on is the impact of delayed discharges across health and our hospital trusts as a whole. We often see that manifested in ambulance handover times, which are so impacted by that.
On the investment that is going in, my hon. Friend the Member for Bosworth (Dr Evans) is right to say that it is also about how it is deployed. Again, missing from the Opposition motion was any reference to the commissioning of the former Labour Secretary of State, Patricia Hewitt, to look at how to take on board how that funding is spent in an integrated way. It would also be remiss of me not to draw the House’s attention to the £5.9 billion of capital funding that we are using to transform diagnostic services by making the most of new technologies and improving the equipment for our frontline staff, making it easier for them to deliver the patient outcomes that we need. That is investment, along with the investment in care, that this Government can be proud of.
In the motion, the shadow Secretary of State refers to a shortage of workforce, but he ignores the locum doctors and bank nurses that make up a significant proportion of the NHS workforce. He ignores the record numbers of doctors and nurses that we now have working in the NHS, with a 3% increase on last year in both doctors and nurses.
I am sure you will be surprised, Mr Deputy Speaker, given your background in Wales, to discover that we cannot see what the vacancy rate is in Wales because the Welsh Government stopped collecting workforce vacancy statistics in 2011. You would have thought that the motion would be an opportunity for the Opposition to encourage their Welsh colleagues, given the importance that they say applies to vacancy statistics. You would have thought they would be keen to see that information from across the Union of the United Kingdom. I thought that Labour was a party of the Union. Why would it not want to have that transparency across Wales on the vacancy figures? But the motion was silent on that point. Perhaps in closing, the relevant shadow Minister will make a commitment to encourage the Welsh Government to have that same level of transparency.
Dr Evans
The Secretary of State hits the nail on the head when it comes to comparing the different countries across the Union, because different countries choose to use different statistics on waiting times to manage their staffing. Does this not confirm the argument we should have a unified way of using those statistics across the four nations?
Steve Barclay
I very much agree. In fact, in the spirit of co-operation, I would be happy to write to Sir Ian Diamond at the Office for National Statistics to encourage that, if the Welsh Government were willing to make that commitment. I do not know whether the Opposition would be willing to sign up to encouraging the Welsh Government to have that level of transparency. They seem reticent about having that transparency.
Karin Smyth (Bristol South) (Lab)
Going beyond the party knockabout, I think that the issue of statistics across the Union is a really important one, and I have raised it in the House many times. Can the Secretary of State tell us what the vacancy rate is in North East Cambridgeshire?
Steve Barclay
Well, it depends on what we are talking about. Are we talking about doctors or nurses? Are we talking about locums? Are we talking about the churn within care? There is a range of factors. The reality is that we do not have a major hospital in North East Cambridgeshire. We are served by four different hospitals, at King’s Lynn, Peterborough, Hinchingbrooke and Addenbrooke’s. Someone particularly interested in data would need to look across those ranges.
Steve Barclay
Let me make some progress.
There is a fair list of omissions in the motion. It did not talk about how the Government are on track to deliver their manifesto commitment of 50,000 nurses by 2024, with nursing numbers over 32,000 greater than they were in September 2019, and the fact that there are over 9,300 more nurses and almost 4,000 more doctors than there were a year ago. There has also been a 47% increase in the number of consultants since 2010.
Wera Hobhouse (Bath) (LD)
The biggest problem for my constituents is access to GPs because there are not enough GPs in the system, so rather than talking about statistics, how can the Secretary of State make sure that my constituents can see a GP in time and not walk away in desperation because they cannot get an appointment?
Steve Barclay
I agree that it is not simply about statistics, but I think it is remiss not to point to the increase in doctor numbers, with 2,300 more in primary care—
Steve Barclay
Can I just answer the hon. Member for Bath (Wera Hobhouse)? I have taken a number of interventions. The hon. Lady is intervening on an intervention.
We must look at the increase in doctors in primary care of over 2,300, and we currently have over 9,000 GP trainees, but the hon. Member for Bath’s wider point is correct. It is not simply about the number of GPs; it is about ensuring that the wider primary care force operate at the top of their licence. It is also about access for patients, and avoiding the 8 am Monday crunch when lots of people make calls at the same time. That is why we are looking at the better use of telephony in the cloud and the latest that technology offers. It is also why we have the opportunity, through Pharmacy First, to make better use of what the pharmacists throughout our pharmacy network can do. It is about increasing the number of GPs, yes, but it is about the wider workforce, the use of technology and the use of different patient pathways, too.
Another omission from the motion is that there are around 90,000 more GP appointments every working day, excluding covid vaccinations, than there were last year. When I hear people say that they cannot see their GP, it is worth putting it in context—[Interruption.] The shadow Secretary of State is chuntering again. Does he want to have another go?
Wes Streeting
I am surprised and grateful that the Secretary of State has given way. His position seems to be, “You’ve never had it so good.” People cannot get an appointment to see their GP, they are waiting for ambulances and they cannot get into A&E and be seen within a reasonable period of time, but under this Government patients have apparently never had it so good.
Steve Barclay
As the hon. Gentleman knows, I have been at pains to point to the huge pressure the pandemic has generated, which he seems unwilling to accept.
In Wales, 60,000 people have been on a waiting list for more than two years, which is a huge example of what a Labour Government deliver in practice. Everyone recognises the huge demand for GP appointments, and there is no single solution, but GPs are seeing more people. Forty per cent. of appointments are booked for the same day, and almost 40% of patients have continuity of care.
Paul Bristow
Does my right hon. Friend agree that the £45.6 billion invested in health and social care is a phenomenal investment? The key to addressing the challenge is to make sure the money is spent wisely. If a Labour Government were in charge of making sure the money is spent wisely, with their record of wasting public money, it would be like putting Dracula in charge of the blood bank.
Steve Barclay
My hon. Friend raises an important point. The Government have increased the funding, which will be used in new, innovative ways to deal with the huge challenge we face as a consequence of the pandemic. That is why we have the elective recovery plan, on which we hit our first milestone over the summer in terms of two-year waits. We have rolled out 91 community diagnostic centres, which have delivered more than 2 million tests and scans.
The workforce is, of course, a vital component of this mission, which is why the ambulance workforce has increased by more than 40% since 2010, but we recognise there are significant pressures, particularly as a consequence of delayed discharges, which are having such an impact on the wards and in A&E. That reads across into the challenge of ambulance handover delays.
Margaret Greenwood (Wirral West) (Lab)
I have spoken to nurses who tell me that, when they get to the end of a shift, insufficient staff arrive for the night shift, so they have to hang on. They are working extra hours without being paid because of the shortage of staff. What would the Secretary of State say to them? They are in such a stressful situation. They want to ensure the safety of their patients, but they simply do not have sufficient colleagues to do so.
Steve Barclay
The hon. Lady raises a fair point. Nurses are under huge pressure, and I want to say how much we respect and value the work they do. The pandemic has placed huge strain on the NHS, which manifests in the pressures staff face. I am ready to speak further to trade unions about many of these issues and their impact on staff—there are sometimes concerns about safety and staffing levels—and about how we can have better investment in tech and the NHS estate.
I was up in Liverpool the week before last, and £800 million has gone into the Royal Liverpool Hospital. What a difference that is making to working conditions. We need to see more of that investment elsewhere. A range of things are contributing to the very real pressures staff face, which is why we have committed to investment in capital, both on the estate and in areas such as tech, which can make such a difference to working conditions.
Steve Barclay
The hon. Lady has had a go, so I will make some progress.
The hon. Member for Ilford North says that Labour would free up £3.2 billion by making changes in respect of non-doms—that was raised both at Question Time and in this debate. It will not surprise the House that the Opposition have now spent that money several times on their various pledges. His proposal ignores the fact that we need a tax system that is internationally competitive. His Majesty’s Revenue and Customs figures show that non-dom UK residents are liable to pay more than £6 billion in UK income tax, capital gains tax and national insurance contributions, so the proposal would leave us as a less attractive destination to people who, by their nature, are mobile and can go elsewhere. If they did, we would lose the tax they currently pay into the UK Exchequer.
The hon. Gentleman criticises the Government’s track record on medical training places, but it is worth reminding the House that it was this Government who, in 2018, funded a record 25% increase in medical school places and, in doing so, opened five new medical colleges. Of course, it will take time for that to bear fruit, and the first of those students will shortly enter the foundation programme training. This is an important investment for the long term, and it is why we now have a record number of medical students in training.
The motion covers nursing and midwifery placements. Here, too, we have seen progress, with more than 30,000 students accepting places on courses in England in the last year, a 28% increase compared with 2019. All eligible nursing and midwifery students will receive a non-repayable grant of at least £5,000 per academic year. NHS England has invested £127 million in the NHS maternity workforce and in improving neonatal care, on top of last year’s £95 million investment to fund 1,200 midwife posts and 100 consultant obstetrician posts.
As well as developing talent at home, we must also look to attract talent from abroad. In a motion focused on workforce, it is interesting that there seems to be no mention of recruiting from overseas. People hired from overseas make a fantastic contribution to our NHS, as I hope the House would agree. Unlike the Labour party, the Conservative party recognises the talent that international doctors, nurses and care workers offer, which is why we have been doing more international recruitment. It is interesting that the motion does not seem to welcome that fact, and does not seem keen on more international recruitment.
Wera Hobhouse
Yesterday I had a meeting with the Royal College of General Practitioners, which raised the issue of overseas talent wanting to work here and stay here. The Government and the visa system are making that very difficult. The Secretary of State might want to talk to the Royal College of General Practitioners about that point.
Steve Barclay
As part of making things easier, I set up a taskforce in the Department over the summer to look at how we can increase the numbers. We have increased the number of nurses recruited internationally, and care workers are on the shortage occupations list. If there are particular issues that the hon. Lady wishes to highlight, I would be happy to look at them with her, but we are keen to attract talent.
Wes Streeting
For clarity, is it the Secretary of State’s position that we are turning away thousands of talented people who want to study medicine and other health professional courses because we do not need them as we are recruiting from overseas?
Steve Barclay
No, of course not. The hon. Gentleman knows that is not the case. It is a bit like when he goes around the media to charge the Government with refusing to talk to the unions. Simply misrepresenting our position is not a fair reflection of Government policy.
The motion talks about workforce, and this Government have committed to increasing the number of international recruits in the NHS. The Leader of the Opposition seems to think we should not be encouraging that. That is the wider point to make. Of course, that sits alongside domestic recruitment, which is why, as I said a moment ago—again, the hon. Member for Ilford North has chosen to ignore this—we have had a 25% increase in medical undergraduate places, with five new medical colleges set up by the former Prime Minister, my right hon. Friend the Member for Maidenhead (Mrs May). That underscores this Government’s commitment to increasing the number of doctors in training.
Chris Stephens (Glasgow South West) (SNP)
The hon. Member for Bath (Wera Hobhouse) raised an important point about problems with the visa process, so will the Secretary of State outline what work he is doing with the Home Office to resolve some of these issues?
Steve Barclay
I discussed this issue with the Home Secretary this week: how we work together across Departments, not just on the visa system, but on other equities. For example, the amount of time spent by police on mental health is an issue of concern to not just the Home Office, but wider government. So there is scope across Departments to work more closely together and we are doing that, both on the issue of international recruitment, which is a key equity within the Department of Health and Social Care, and on mental health pressures on the police, which is an issue within the Home Office. That is how we are working more collaboratively across government, but we are clear that we are boosting the numbers in the short term while, in parallel, increasing the domestic supply of recruits, for example, with the boost in medical undergraduate places. We are also looking at what more we can do in areas such as apprenticeships: how we hire more nursing apprentices and boost supply through that as well.
Finally, the motion does not reflect the pay uplift that was awarded, where the Government accepted in full the recommendation of the independent NHS Pay Review Body. More than 1 million staff have seen an increase of at least £1,400 in their pay. Of course, that comes on top of the 3% rise last year, at a time when pay was frozen across the wider public sector.
Munira Wilson
One bit of feedback that my colleagues in outer London constituencies and I have had from health leaders in our area is that the high-cost area supplement, which is available for many inner-London boroughs but is not available for outer London boroughs, is causing huge problems with recruitment and retention. For example, somebody can earn £2,000 more for the same job in Wandsworth than they can in neighbouring Richmond or Merton. Health leaders are calling for a review of the high-cost area supplement, so is that something the Secretary of State is willing to look at?
Steve Barclay
The hon. Lady raises a fair point. That fund has been set up because there is an issue with how recruitment sometimes applies between different areas. We always face the challenge of where one draws that boundary, but I will of course look at specific data on any particular case she wants to raise. The fund is there more widely to recognise that often some areas—
Steve Barclay
I have said that I am going to give way to my hon. Friend the Member for Bosworth (Dr Evans), and then I am going to wrap up. As I was saying, sometimes there are areas where it is more difficult to recruit and we need to look at the data on that.
Dr Evans
When it comes to retention, pensions are a big issue, and the Opposition Front-Bench team have picked up on that. One recommendation from the Select Committee was to mandate for recycling to try to help with that. What other work is being done to try to ensure that senior colleagues with the most experience are incentivised to take on the extra lists and try to deal with the backlog, in all four corners of the country?
Steve Barclay
We are uniquely placed in having a Chancellor who has not only a deep understanding of health issues, but an understanding of recent Health and Social Care Committee reports. Obviously, that is an issue that we, with Treasury colleagues, will keep under review.
The motion ignores the vital work that the Government are doing to back health and care, the £6.6 billion of investment in our NHS that was announced in the autumn statement, and the social care investment of £2.8 billion and £4.7 billion next year. This Government are investing in our health and social care. We have always put the NHS workforce first and we always will.
Oral Answers to Questions
Steve Barclay Excerpts(2 years ago)
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Allan Dorans (Ayr, Carrick and Cumnock) (SNP)
The Secretary of State for Health and Social Care (Steve Barclay)
We procured personal protective equipment at pace so that we could protect the frontline and save lives. In a highly distorted market, we worked around the clock to secure the life-saving PPE that we needed.
Allan Dorans
The Secretary of State will be aware of the high-profile reports in the media regarding Baroness Mone and her connection with PPE Medpro, contact with Government Ministers and the use of a VIP lane in relation to the procurement of PPE. Will he assure me—and more importantly the public—that a full and thorough investigation will take place into these matters and that, following that investigation, the report will be made public?
Steve Barclay
I can do much better than that. We have commissioned a full investigation and inquiry into the Government’s handling of covid and, as part of that, I am sure that the inquiry will look at PPE. But it is important to put it into context. We secured 23.2 billion items of PPE, which was a huge step, done at pace, to help protect our frontline.
Steve Barclay
Again, that ignores both the pressure of time at the start of the pandemic and the fact that there was international competition, with companies competing for scarce resources. It is also the case that although more than 19,000 companies were offering PPE, only 2,600 passed initial due diligence checks.
Andy Carter (Warrington South) (Con)
The Secretary of State for Health and Social Care (Steve Barclay)
In September 2022 there were nearly 2,300 more full-time equivalent doctors in general practice than there were at the same time in 2019, and more than 9,000 GP trainees.
Ruth Cadbury
A constituent of mine, a full-time GP in her 50s, told me that the pension rules mean she has to retire, work part-time or emigrate, which is hardly likely to help her patients to obtain appointments with her. Having hinted at a change in doctors’ pension rules last summer, the Government are only now announcing a consultation that will last until next spring, so there will be no change in these crazy rules until next summer at the earliest. Is this not too little, too late?
Steve Barclay
It is worth reminding the House that there are 3% more doctors this year than last year. As I have said, we have 2,300 more full-time GPs, and we are recruiting more. However, the hon. Lady is absolutely right about doctors’ pensions; that is a material issue, which is why we launched the consultation, and we are working with Treasury colleagues to address these concerns as quickly as possible.
Virginia Crosbie (Ynys Môn) (Con)
GP numbers are falling in Wales. Healthcare is devolved to the Welsh Labour Government, and although Ynys Môn is represented by five members of the Senedd in Cardiff, healthcare concerns constitute a staggering 25% of my postbag. Does the Secretary of State agree that families throughout Wales are not receiving the healthcare that they need and deserve from the Welsh Labour Government?
Steve Barclay
I do agree with my hon. Friend, and I think it would help the House to assess the performance of the Welsh Government if there were more transparency. For instance, the Opposition motion on today’s Order Paper refers to vacancies in England. I am sure it will surprise the House to learn that the Welsh Government stopped collecting statistics for workforce vacancies in 2011. I look forward to Opposition Members’ encouraging their Welsh colleagues to be more transparent.
Feryal Clark (Enfield North) (Lab)
Members on both sides of the House will have been shocked and appalled by the recent deaths of children from streptococcus A, and our thoughts are with all the families affected. Cases are on the rise, and as we head into winter it is vital for parents to be able to secure for their children the care that they so desperately need. The shortage of GPs means that too many are struggling to see a doctor, and now there are reports of shortages of antibiotics as well. What advice can the Secretary of State give parents whose children are exhibiting symptoms but who cannot obtain a GP appointment, and what assurances can he give on the supply and availability of antibiotics?
Steve Barclay
This is an important issue which I know is of concern to many families throughout the country, so I am pleased to be able to reassure the House about our response. While GPs are important in this regard, so are directors of public health, who are leading the response in respect of, for example, liaison with schools. We are seeing a peak in cases earlier than usual, which we believe is due to lower exposure during the pandemic, which in turn has led to lower immunity. There is no new strain, and that is one of the key points of reassurance, but the UK Health Security Agency has declared a national standard to improve the co-ordination of our response, including what is being done in schools.
Elliot Colburn (Carshalton and Wallington) (Con)
The Secretary of State for Health and Social Care (Steve Barclay)
As we heard earlier, the Government are committed to a programme to create 40 new hospitals by 2030. We have committed £3.7 billion—[Interruption.] The hon. Member for Ilford North (Wes Streeting) will get a go in a moment, and I look forward to hearing him welcome the increase in the Government’s capital spending, not just on our new hospitals programme but on, for instance, elective surgery. We are putting £5.6 billion into more surgical hubs and community diagnostic centres, and £1.7 billion has gone to more than 70 hospitals to enable them to deliver significant upgrades.
Elliot Colburn
Patients in Carshalton and Wallington will benefit massively from the building of a new hospital in Sutton and the improvement of St Helier Hospital under NHS plans approved by the Government. Will my right hon. Friend agree to meet me, and the NHS trusts? They are raring to go and to get spades in the ground next year.
Steve Barclay
I know they are raring to go because I personally have spoken to the chief exec about this scheme, but I can offer my hon. Friend something better: the Minister of State, Department of Health and Social Care, my hon. Friend the Member for Colchester (Will Quince), will personally be visiting shortly to discuss this further. But I also need to be transparent with the House: we are fundamentally changing how we are going to be building hospitals in the NHS estate—[Laughter.] I am not sure why something as important as new hospitals—learning from the Department for Education and the Ministry of Justice through a more standardised model that allows us to deliver more at a cheaper unit price and get them built quicker—is a source of mirth to Opposition Members. It is important that we standardise those designs, and that is what my colleague the Minister of State will be discussing with my hon. Friend.
Hilary Benn (Leeds Central) (Lab)
The new children’s hospital, the new adult building and the maternity centre at Leeds General Infirmary will bring much-needed new facilities to Leeds and the region, as well as wider economic benefits. It is unusual among the hospital building schemes. As the Secretary of State knows, the site is clear and the plans are ready, so may I urge him to give the go-ahead as soon as possible?
Steve Barclay
I visited that scheme over the summer. The right hon. Gentleman will know that the costs have inflated significantly since what was signed off by the Treasury in 2019. I think the point that has been missed by Opposition Members is that the way we deliver these schemes is to grip the cost better by using standardisation, and that is what I will be discussing with Leeds General. I agree with him that it is important that the scheme goes ahead, and we need to work together to make sure that it does so at a price that is affordable.
Scott Benton (Blackpool South) (Con)
The Secretary of State for Health and Social Care (Steve Barclay)
I had the question down as No.13, but given who is asking the question I can guess that it is related to the build of the King’s Lynn hospital.
I visited the site and looked at the scheme over the summer. I made it clear in a speech that I gave to NHS Providers that addressing the concerns of the RAAC—the rebar autoclaved aerated concrete——hospitals is my No. 1 priority. Obviously, I cannot comment on individual schemes while the process is ongoing, but I can assure my hon. Friend that we are working actively on it.
James Wild
I warmly welcome the priority that my right hon. Friend has put on resolving the serious RAAC concrete issues at the Queen Elizabeth Hospital, but the decision on this was due in the spring. Christmas is coming and the only question that people in North West Norfolk have is, when will we get the present that everyone wants—a new hospital for the staff and patients?
Steve Barclay
I note the extensive support that my hon. Friend has among parliamentary colleagues, including my right hon. Friend the Member for South West Norfolk (Elizabeth Truss), who has recently added her support to the scheme. He will be aware that we allocated £20 million last year and £30 million this year to address some of the immediate issues, but we recognise that it is a priority and we are working on it.
Sir Greg Knight (East Yorkshire) (Con)
Helen Hayes (Dulwich and West Norwood) (Lab)
The Secretary of State for Health and Social Care (Steve Barclay)
We know that women can benefit from more personalised care, especially in pregnancy. The Tommy’s app is a new clinical decision tool for the NHS and for women, another example of how we are using artificial intelligence to improve our maternity system. That will help to end some of the variation in maternity care from hospital to hospital. I am pleased to tell hon. Members, particularly my hon. Friend the Member for Rutland and Melton (Alicia Kearns), who is a great champion of improved mental health, that today my Department, through our National Institute for Health and Care Research, has agreed to provide the funding needed for the next stage of the app’s development. I pay tribute to Sienna and all those other babies born stillborn to their parents and thank all those in this Chamber who have campaigned passionately on this important issue.
Helen Hayes
Another dental practice in my constituency recently handed back its NHS contract. When I contacted local NHS management about the impact of the closure, it stated that the area in question was adjudged to be well served for NHS dentistry practices because there are 11 practices within a half-mile radius. The experience of my constituents, now left searching for NHS dental services, is that none of those practices is accepting new NHS patients. What is the Secretary of State doing to ensure that assessments of the sufficiency of NHS dental services reflect the real situation on the ground, and when will we see a sustainable solution to the problems my constituents face?
Steve Barclay
The hon. Lady raises an important issue that is of concern across the House, as we have already seen in the exchanges the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Harborough (Neil O’Brien) answered. That in part was why, during the pandemic, we used £1.7 billion of funding to protect dentistry and why we got a commitment through the £3 billion a year funding of dentistry, but we are looking at how we localise that commissioning to get better value out of the contract, which was the point my hon. Friend raised.
Mary Robinson (Cheadle) (Con)
Wes Streeting (Ilford North) (Lab)
The chairman of the Conservative party claims that NHS strikes are exactly what Vladimir Putin wants, so why is not the Health Secretary negotiating to prevent them from going ahead?
Steve Barclay
I have seen the hon. Gentleman make that claim across the media a number of times. Just to reassure him, my door is open and I have been clear with the trade unions that I am available; I am available to them this afternoon or tomorrow. It is not I who set a precondition for those talks. When I met the trade unions, they raised a number of issues; not only pay, but safety of staff and other conditions, the estate, tech and so forth, and I am happy to engage with them on those points.
Wes Streeting
We get the warm words about wanting to negotiate, but a Government source briefed The Times last week that the Secretary of State’s plan is to wait for public sentiment to turn against striking nurses, saying:
“This is going to affect a lot of people…it could have a big impact on a lot of them and…in the end they will get fed up”.
He knows that this winter is going to be the most difficult that the NHS has ever faced, and he is using nurses as scapegoats to avoid the blame. That is the shameful truth, isn’t it?
Steve Barclay
First, it is a bit bizarre that, at departmental questions, the best the hon. Gentleman can manage is “a Government source”. Secondly, the revelation from that Government source is that this will affect “a lot of people”. I do not think that comes as any surprise. That is why we regret the action and are very open to having talks. The point is that he himself does not support the 19% pay demand of the trade unions. He stands here saying that we should be talking while he himself does not accept their proposal.
Bob Blackman (Harrow East) (Con)
Steven Bonnar (Coatbridge, Chryston and Bellshill) (SNP)
Intellectual property protections are an important way of protecting healthcare companies’ innovations, as we know. However, developments on intellectual property can also impact the rights of individuals, limiting access to affordable, life-saving and essential medical products. What recent representations has the Secretary of State made to colleagues in the Department for International Trade to seek assurances that nothing in the proposed free trade agreement with India will impact or jeopardise access to affordable medicines for NHS patients in Scotland?
Steve Barclay
I can reassure the hon. Gentleman on that. I would have thought that he would also welcome the commitment to a £15 billion to £20 billion increase in R&D investment, the championing of life sciences that the Minister for Health, my hon. Friend the Member for Colchester (Will Quince), has been leading on, and the opportunity we have to address greater variation within the NHS by bringing forward the innovations from our life industry and applying them much more quickly.
Alexander Stafford (Rother Valley) (Con)
Karl Turner (Kingston upon Hull East) (Lab)
Steve Barclay
The data is very clear; in fact, it is very stark on the extent to which the backlog is driven predominantly by the pandemic. That is why we have a programme, through the extra investment in the autumn statement: the £6.6 billion over the next two years going into the NHS, but also the £2.8 billion next year and £4.7 billion the year after into social care, and £8 billion in 2024. We recognise the size of those backlogs, so we can fund the surgical hubs and diagnostic centres.
Steve Barclay
I simply direct the hon. Member to the Barnett consequentials. As a former Chief Secretary who has had those discussions with the Welsh Finance Minister I know, and the hon. Lady should know, that Wales gets significantly more funding per head of population than England. I hope she welcomes the fact that, through the extra £6.6 billion in the autumn statement, the First Minister will have a significant uplift, and it is for him to decide how he wishes to spend that money.
Mr Gagan Mohindra (South West Hertfordshire) (Con)
I was recently contacted by Amanda in my beautiful constituency of South West Hertfordshire, whose 88-year-old mother had fallen in her flat and unfortunately broken her hip. After waiting for five hours and making two calls to 999, her mother was still lying on the floor. Once they arrived at A&E, Amanda and her mother waited several more hours before being seen. Can my right hon. Friend assure the House that he is doing everything possible to find a solution to this system-wide issue?
Steve Barclay
My hon. Friend raises an extremely important case. I am happy to meet him to discuss it further, because it is a concerning case and I am keen to engage with him on it.
Mary Kelly Foy (City of Durham) (Lab)
Steve Barclay
We are absolutely committed to addressing health inequalities. Rather than simply looking at 10 years’ time, we are looking at the immediate actions we can take, because what matters—[Interruption.] Those on the Opposition Front Bench chunter about White Papers, but what I am interested in is immediate delivery—what we can be doing now, rather than speculating about what is done in 10 years’ time.
Sajid Javid (Bromsgrove) (Con)
We are seeing a sad increase in suicide rates across the country. In 2012, the then Government published a 10-year cross-Government suicide prevention plan. Earlier this year, the Government under the leadership of my right hon. Friend the Member for Uxbridge and South Ruislip (Boris Johnson) committed to a new 10-year plan that would be published before the start of 2023. There is no sign of that cross-Government 10-year suicide prevention plan, but maybe I am wrong, and perhaps the Government are about to publish it, because I know that so much of the work has already been done. May I ask my right hon. Friend the Secretary of State to show that he takes suicide prevention seriously and publish this plan as soon as possible?
Patricia Gibson (North Ayrshire and Arran) (SNP)
The chair of the Royal College of General Practitioners has expressed concerns about patients with chronic conditions such as asthma, diabetes and even serious mental health conditions refusing sick notes because they cannot afford time off work. What discussions has the Secretary of State had with Cabinet colleagues about the adequacy of statutory sick pay during this cost of living crisis?
Steve Barclay
I refer the hon. Lady to the autumn statement, in which my right hon. Friend the Chancellor set out a wide range of support packages to help with the cost of living across the United Kingdom, including the cost of energy. That is part of wider discussions that we have on a regular basis with the Treasury.
Dr Caroline Johnson (Sleaford and North Hykeham) (Con)
The pandemic has had a devastating effect on the number of people waiting for treatment. In 2019, there were 54 women waiting more than a year to see a gynaecologist. That number is now more than 40,000. What is my right hon. Friend doing to reduce this wait?
Steve Barclay
This is a good illustration of the challenge the country faces with backlogs that are very much driven by the pandemic. We are working with senior figures such as Jim Mackey and Professor Tim Briggs and the Getting It Right First Time programme to look at patient pathways, how we use our diagnostics and our surgical hubs and streamlining the way we get services to patients where backlogs have built up.
Gavin Robinson (Belfast East) (DUP)
This morning, we tragically learned that a five-year-old girl who was a P2 pupil at Black Mountain Primary School died yesterday in Belfast with strep A. I am grateful to the Minister for the answer she gave to the hon. Member for Eltham (Clive Efford) on strep A and her encouraging commitment that antibiotics including penicillin are available, but can she ensure that our public health agencies across this United Kingdom co-operate with one another and that if additional resource is required, it will be made available?
Mr Peter Bone (Wellingborough) (Con)
Can the Secretary of State give the House an undertaking that no NHS or social care facility will be decommissioned and used to house asylum seekers in Northamptonshire or the rest of the country?
Steve Barclay
I am not aware of any proposal on those lines. On my hon. Friend’s earlier point, as I said, I am happy to meet him to discuss the issue of step-down care and I am sure that there will be an opportunity to discuss any other concerns that he has at the same time.
Mrs Emma Lewell-Buck (South Shields) (Lab)
My constituent Margaret Cramman is a full-time carer for her daughter. Throughout the pandemic, she was denied respite care. Now the care setting insists on testing for visitors and mask wearing for staff, which causes distress to some of the young people being cared for, who rely on vital facial recognition. Nearly all the other covid guidance has been reviewed, but the guidance for respite care remains the same. Why are carers and those they care for always an afterthought for the Government?
Margaret Ferrier (Rutherglen and Hamilton West) (Ind)
What assessment has the Secretary of State made of geographic variation in access to innovative liver cancer treatments, such as selective internal radiation therapy?
Steve Barclay
It is a brilliant question on which to close, because one of the things that all hon. Members should be hugely interested in is how we are adopting innovation more quickly and industrialising that innovation across the NHS as a whole, as opposed to in silos. That is something that we are focused on in the Department and it is a key priority. I am happy to speak to the Scottish Government and others about how we can work together on that.
Oral Answers to Questions
Steve Barclay Excerpts(2 years, 1 month ago)
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Michael Fabricant (Lichfield) (Con)
The Secretary of State for Health and Social Care (Steve Barclay)
The recent Health and Social Care Committee report rightly highlights the importance of continuity of care, recognising that there is sometimes a trade-off between speed of access and continuity of care.
Michael Fabricant
I welcome my right hon. Friend back to the Front Bench in this position; it is great to see him there. Investigations in the United States and in Australia show that if there is a close relationship between a patient and one specific general practitioner, the outcomes are better in terms of both morbidity and visits to A&E. What can the Government do to encourage that practice, and what is the Government’s view of that practice?
Steve Barclay
My hon. Friend raises an important point. If one looks at the GP survey of patients, around two in five have a GP that they would like to have continuity of care with, and more than one third of those say that they see them a lot of the time or always. It is more pertinent with complex cases, where that continuity of care adds most value, as opposed to patients who want speed of access on an isolated incident.
Seema Malhotra (Feltham and Heston) (Lab/Co-op)
We have seen a cut of almost 5,000 GPs and the closure of hundreds of practices in the past 10 years. My constituents are having a terrible time trying to get GP appointments and, when they do, the lack of continuity of care is impacting the effectiveness of that care; it is a strain to tell the same story again and again, particularly for older people and those with complex conditions. Can the Secretary of State outline what he is actually going to do about it?
Steve Barclay
In fact, around 80,000 more GP appointments a day are happening, so significantly more demand is being met. The Government have invested an extra £1.5 billion to create an additional 50 million general practice appointments by 2024, increasing and diversifying the staff available for those patients seeking care.
Sir Mike Penning (Hemel Hempstead) (Con)
One way GPs can get better outcomes for their patients is to see them face to face if possible, particularly with prostate cancer in men. Men just do not present themselves to their GP as often as they should. Today is 1 November—Movember—so what is the Secretary of State going to do to promote men’s coming forward to see their GPs so that we can get this disease eradicated?
Steve Barclay
First, I pay tribute to the work my right hon. Friend is doing to raise awareness of this issue. It is important that those patients who want access to face-to-face appointments are able to get them, and campaigns such as Movember are a great way of raising that awareness.
Tim Farron (Westmorland and Lonsdale) (LD)
In Cumbria we have lost one in six of our GPs in the past six years, most recently at the Central Lakes medical practice in Ambleside and Hawkshead. Will the Secretary of State pay special attention to the letting of that new contract to ensure that there is a GP service running out of the surgeries in Ambleside and Hawkshead? Will he also give thought to the fact that the Government’s removal of the minimum practice income guarantee has cost many rural surgeries their ability to be sustainable, and consider bringing back a sustainable small surgeries fund so that small rural surgeries can stay open?
Steve Barclay
As a rural MP and having worked in Kendal earlier in my career, I know the geography to which the hon. Gentleman refers. That is why we are investing in more GP training, increasing the number from 2,671 in 2014 to 4,000, but it is also why we introduced the payment of £20,000, to encourage GPs into those areas that are hard to recruit in.
Steve Brine (Winchester) (Con)
The new Secretary of State—it is great to see him back—understands that there is a wealth of evidence that higher levels of continuity of care in general practice are good for patients and, indeed, for GPs themselves. I wonder if I could press him a little further. Is the new ministerial team open to limiting the list size of patients a GP has, as more GPs come online through the Government’s plans? Would he like to see personal lists reimplemented in the GP contract during his tenure?
Steve Barclay
Alongside the Government, no one wants to see better patient outcomes more than GPs themselves. By their training, they are evidence-led, so I look forward to discussing with the GP workforce how we can work together in a constructive spirit to deliver on whatever the evidence is showing. As I said, there is a body of evidence around continuity of care, but it is more weighted towards those with more complex needs, and not every patient prioritises that in terms of access to their GP.
Rachael Maskell (York Central) (Lab/Co-op)
The Health and Social Care Committee report showed that continuity of care was best for patient safety, which is so important, but in order to deliver that, there needs to be some headroom at practice level to bring about a reorientation of local services. How will the Secretary of State create that headroom, and will he adopt the report’s findings in full?
Steve Barclay
I know that the hon. Lady has a lot of expertise in this area, and she raises a valid and important point. That is why, through the GP contract framework for 2020-21, we announced a number of new national retention schemes and continued support for existing schemes to retain more GPs. It is also why, at the other end, we are boosting training numbers, to get more GPs into the pipeline.
Feryal Clark (Enfield North) (Lab)
The Secretary of State says they are investing in GPs, but this Conservative Government have cut 4,700 GPs in the last decade. Patients are finding it impossible to get a GP appointment in the manner in which they want one. Seeing the same doctor for each appointment means better care for patients, but under the Tories, that is becoming rarer and rarer, much like seeing the same Health Secretary at the Dispatch Box. Even his own Chancellor wishes he had done more on the issue of continuity of care, so why is this Secretary of State not matching Labour’s ambition to bring back the family doctor?
Steve Barclay
First, as I have touched on, the number of GPs in training is up. The number of GP appointments is significantly up, because there is more patient demand, so they are seeing more patients. There is often in this House a real focus on GP appointments, and that is important, but it is about the skills of the primary care workforce as a whole. If one looks, for example, at the women’s health strategy, women want to be able to go to specialist services, not always requiring the GP. It is about looking at the primary care workforce as a whole, alongside the appointment of GPs.
Clive Efford (Eltham) (Lab)
The Secretary of State for Health and Social Care (Steve Barclay)
We are making progress on increasing numbers. The number of doctors in general practice has increased over the past three years, from 34,729 in September 2019 to more than 37,000 in September this year.
Clive Efford
I am grateful for that answer. I recently met representatives of the local GP network in my constituency who described to me their difficulties in employing GPs. What can the Secretary of State do to ensure that people choose to go into general practice and to make the job much more attractive, so that he hits his target of recruiting 6,000 more GPs, which he is woefully way off doing?
Steve Barclay
I touched on that exact point in an earlier answer. There are parts of the country where it is more difficult to recruit GPs; that is why we have a targeted fund to attract people into those areas, with grants of up to £20,000. Alongside the appointment of GPs, we are also looking at using the wider primary care skills workforce, so that people can get to the appointment that they need.
Priti Patel (Witham) (Con)
Will my right hon. Friend tell me how patients in the Witham constituency will benefit from the really important investment in more GPs and more GP training? And if he cannot tell me today, will he write to me about the progress being made on the Witham health hub, through which more health workers and GPs need to come together to serve the local community?
Steve Barclay
I am grateful for that question. The plan for patients, which was set out by my predecessor, my right hon. Friend the Member for Suffolk Coastal (Dr Coffey), addressed the issue that my right hon. Friend the Member for Witham (Priti Patel) raises on behalf of her constituents. That includes how people make an informed choice about which practice is best for them, how we make it easier for them to book an appointment and how we harness technology better—in particular, the very significant number of patients, including in Witham, who will have downloaded the NHS app and will be able to access services through it from this month.
Harriett Baldwin (West Worcestershire) (Con)
The Secretary of State for Health and Social Care (Steve Barclay)
It is an honour to return to the Department of Health and Social Care to continue its important work, especially ahead of the challenges this winter. I pay tribute to my predecessor, my right hon. Friend the Member for Suffolk Coastal (Dr Coffey), for everything that she has done to get the system ready for the challenges ahead. I welcome my experienced ministerial team to their posts and thank Ministers from the summer. I am also looking forward to robust, I am sure, but—based on our previous experience—very constructive engagement with Opposition Front Benchers.
I am pleased that all GP practices will soon be able to automatically provide patients aged 16 and over with access to the latest information and their health records through the NHS app. We are switching on that ability from today in a process that we expect to be completed by the end of the month. That is an important milestone for patient empowerment and is part of a process that sees patients play an even more active role in managing their health and care. I hope that Members across the House will welcome that on behalf of patients.
Harriett Baldwin
I congratulate the Secretary of State on his reappointment. Will he reiterate the importance of getting ambulance waiting times down? Would he endorse the use of minor injuries units in community hospitals, such as those in Malvern and Tenbury, as a very effective way to open up access through other routes for our constituents?
Steve Barclay
My hon. Friend raises an important point, particularly for category 3 and 4 ambulance journeys. As she highlights, there are numerous aspects to the challenge of ambulance delays: the blockage in the flow from social care and delayed discharge, which we have debated many times in the House; issues in accident and emergency with pre-cohorting, post-cohorting and triaging nurses; conveyance rates, which often vary significantly between ambulance trusts; call handling, which we have put additional money into; and the work of the auxiliary service. My hon. Friend is quite right that within the portfolio of options, minor injuries units are an area that can help to relieve pressure on busy A&Es.
Wes Streeting (Ilford North) (Lab)
I welcome the Secretary of State back and welcome his team, but I have had boxes of cereal with a longer shelf-life than Conservative Secretaries of State. As a consequence of the turnover and chaos, the truth is that the NHS is not prepared for this winter—it cannot even get allocated funds out of the door.
Let us turn to the future. Over the summer, the Prime Minister promised to establish a “vaccines-style taskforce” to tackle the Conservatives’ NHS backlog on “day one” and to have overall waiting list numbers falling by next year. May I ask the Secretary of State who is on that taskforce, how many times it has met and what its programme of work is?
Steve Barclay
I am grateful that the hon. Gentleman raises the issue of vaccines; in fact, I raised it in Cabinet today. The UK is the first country in the world to have introduced bivalent vaccines targeted both at omicron and at the original strain of covid-19. We have now made the covid vaccine and the flu vaccine available to all over-50s; I hope that Members across the House will promote that. I think the UK can be very proud of its work to roll out vaccines against both covid and flu, which are a key part of preventing some of the pressure on our A&Es.
Wes Streeting
I can forgive the Secretary of State for mishearing the question, but what I find unbelievable is that it seems as if this is the first time he has heard about the Prime Minister’s own proposed taskforce to deal with the Conservatives’ NHS backlog. That is what the Prime Minister promised, and that is what I asked the Secretary of State about. This is obviously another case of the Conservatives over-promising and under-delivering.
If the Secretary of State cannot stand by the Prime Minister’s pledges, what about the views of the man next door? When we announced our policy to train a new generation of doctors and nurses, paid for by abolishing non-doms, it was welcomed by the Chancellor as—and I quote—“something I very much hope the government also adopts on the basis that smart governments always nick the best ideas of their opponents.” In the spirit of constructive opposition that the Secretary of State asks for, Labour has a plan to tackle the staffing crisis. The Conservatives do not. It is fully costed and paid for, so will he nick it?
Steve Barclay
The hon. Gentleman skirts over the fact that it is this Government who have opened five new medical schools, who have significantly boosted medical undergraduate training, who are investing more in our NHS as per the long-term plan, who have invested a further £36 billion as part of our covid response, and who are investing in technology and the skills of the workforce as a whole. We are boosting the number of medical trainees and—I touched on this question earlier—we are also boosting the number of doctors in training to be GPs.
Sir Edward Leigh (Gainsborough) (Con)
Steve Barclay
My right hon. Friend raises an important point about face-to-face care, which matters to many constituents, but I gently remind him that in the Lincolnshire integrated care system, 71.9% of appointments were face to face in September 2022. It is not the case that every patient wants a face-to-face appointment; there can be instances in which an online service is better. For patients facing domestic violence, for example, it can often provide a much more convenient service.
Mr Speaker
Order. I know we are bedding back in, but Front Benchers have to think about Back Benchers. These are their questions as well, so please let us make sure that I can call as many of them as possible.
Martyn Day (Linlithgow and East Falkirk) (SNP)
The Scottish Government introduced new national guidelines to make it easier for retiring NHS staff to return to support the NHS, while drawing their pensions. However, there is a substantive issue of pension tax rules pushing senior clinicians to reduce their commitments or retire early. As we know, pension taxation is a wholly reserved matter, so will the Minister address this issue with Cabinet colleagues in order to find a permanent solution that will allow us to help the NHS retain senior staff?
Steve Barclay
Pensions are an important issue, and I shall be meeting the Chancellor later today.
Damian Green (Ashford) (Con)
Steve Barclay
Very much so. The hon. Member for Ilford North (Wes Streeting) asked about a taskforce. With our colleagues in NHS England, we launched a “delayed discharge” taskforce with a “100-day challenge” over the summer; we have also set up an international recruitment taskforce within the Department to prioritise the establishment of a “clearing house for care”. I will not add further to my answer, other than to say that this is a key area of focus.
Wera Hobhouse (Bath) (LD)
Steve Barclay
The wellbeing of staff—especially in the NHS, and especially after the pressure of the pandemic—is a crucial issue, and one on which I have focused in particular since returning to the Department. I look forward to having discussions about it with the hon. Lady.
David Johnston (Wantage) (Con)
Deidre Brock (Edinburgh North and Leith) (SNP)
Steve Barclay
Across the clinical workforce—whether we are talking about dentistry, nursing, social care or doctors—we are seeking to boost recruitment, including international recruitment, and to remove red tape. Within the GP population, however, we are looking at retention, recruitment and boosting the number of trainees.
Elliot Colburn (Carshalton and Wallington) (Con)
Gordon Henderson (Sittingbourne and Sheppey) (Con)
Members of the Kent and Medway integrated care board are doing their best to recruit more GPs, but they are finding it difficult to attract them to our area. One reason is their close proximity to London, where newly qualified GPs can earn thousands of pounds more than they can if they practise in Kent. Will my right hon. Friend consider extending the NHS London weighting allowance to Kent and Medway?
Steve Barclay
Part of the reason for having the targeted funding is so that ICSs can look at those areas under particular pressure for recruitment and do that on a place-based basis. It would be interesting to look at the evidence, but I know that the fund has been used by my hon. Friend’s local ICS.
Nadia Whittome (Nottingham East) (Lab)
Dan Jarvis (Barnsley Central) (Lab)
Tens of thousands of NHS workers are entirely dependent on the use of their car to do their vital job, but while petrol prices have rocketed, NHS mileage rates have remained frozen since 2011. Will the Secretary of State look at what can be done to increase NHS mileage rates?
Steve Barclay
That fits within the wider issue of how we work with and support our NHS workforce and what packages we can look at in discussion with Treasury colleagues. Of course, the approach to the NHS is also in line with other Government Departments, but the hon. Gentleman raises an important point and it is obviously one that Ministers discuss.
Maggie Throup (Erewash) (Con)
With flu cases on the rise, what action is my right hon. Friend taking to ensure that all parents are aware that they can access the free nasal vaccine at their GP surgery for all pre-school children?
Karin Smyth (Bristol South) (Lab)
This month a care provider in my constituency is closing, citing the workforce crisis. I have listened carefully to the Ministers’ answers, and the current Chancellor spent the last year telling us about the critical need for a workforce strategy. The door is open. Has the Secretary of State had a conversation with the new Chancellor to ask for a workforce plan on which we can all rely?
Jonathan Gullis (Stoke-on-Trent North) (Con)
Forty per cent. of GP appointments are now related to mental health. That is why James Starkie and I launched the cross-party “No Time to Wait” campaign, which had the support of the Prime Minister when he was Chancellor. We have a fully costed plan with the Royal College of Nursing to pilot such a scheme. Is the Secretary of State willing to meet James and me?
Dr Rupa Huq (Ealing Central and Acton) (Ind)
A respected woman pharmacist in my constituency, with a lifetime of NHS experience, went solo with her own practice in the hope and expectation of an NHS licence, which she has been denied. Will the Secretary of State look into the opaque decision-making process? Our increasing population otherwise means increasing demand, and my constituent cannot survive on private alone.
Tracey Crouch (Chatham and Aylesford) (Con)
Suicide is the biggest killer of under-35s in the UK, with more than 200 school-aged children taking their own life every year, including two, very sadly, in my constituency in recent months. We have heard about the pressures on mental health services, so will the Secretary of State look at alternative ways of supporting mental health by meeting the 3 Dads team and his counterpart in the Department for Education to discuss how we can embed age-appropriate suicide awareness and prevention in schools?
Steve Barclay
Part of the reason why we are putting an extra £2.3 billion into mental health is to recognise the sensitivity and the importance of this issue. I am very happy to look at all practical suggestions. The tragedy for constituents is something that unites the House. In particular, I will look at what technology can do to support people.
Kate Green (Stretford and Urmston) (Lab)
The New Statesman has reported that the spend on Healthy Start has fallen by two thirds in the last decade, and this afternoon I will be presenting a Bill that would help to increase take-up. Will the Secretary of State or one of his team meet me to discuss the details of what campaigners and I are proposing so that we can make this helpful benefit reach more of the families it is intended to benefit?
Steve Barclay
I am very happy to ensure that the ministerial team engages with the hon. Lady. I take this opportunity to commend my right hon. Friend the Member for South Northamptonshire (Dame Andrea Leadsom), who has done a huge amount of work on early years, which dovetails with this important issue.
David Linden (Glasgow East) (SNP)
Children who are born premature or sick are often discharged from neonatal care with energy-intensive equipment, such as oxygen machines, which has an impact in terms of the cost of living crisis. Is the Secretary of State willing to meet Bliss and myself to look at the costs faced by families who come out of neonatal care and how we can support them better?
Steve Barclay
The Bliss charity is recognised across the House for the extremely important work it does, and I know that the ministerial team will be happy to engage with the hon. Gentleman on how we can work on the matter he raises.