Health and Social Care

Steve Barclay Excerpts

Monday 5th September 2022 Ministerial Corrections

[Steve Barclay]

My right hon. Friend is right that there is a need for care and compassion, and she highlights an extremely important point. She will be aware that the sexual health review is currently being conducted. That will report later this year and will look into the issue that she raises.

[Official Report, 20 July 2022, Vol. 718, c. 981.]

Letter of correction from the Secretary of State for Health and Social Care, the right hon. Member for North East Cambridgeshire (Steve Barclay).

An error has been identified in my response to my right hon. Friend the Member for Basingstoke (Dame Maria Miller).

The correct response should have been:

[Steve Barclay]

My right hon. Friend is right that there is a need for care and compassion, and she highlights an extremely important point. She will be aware that the sexual and reproductive health action plan is currently being conducted. That will report later this year and will include ensuring women have equitable access to abortion within the current legal framework.

Work of the Department during the Summer Recess

Steve Barclay Excerpts

Monday 5th September 2022 Written Statements

[The Secretary of State for Health and Social Care (Steve Barclay)]

Over the summer recess, the Department of Health and Social Care has made significant progress in many areas, both to prepare the NHS and social care systems for the winter and to lay the foundations for further improvements in the coming years.

In respect of preparations for winter, the Department has worked closely with NHS England and other Departments across Government to:

Widen and launch the covid autumn booster programme, including through the first approval worldwide of two “bivalent” vaccines, which protect against both the original and omicron strains of covid-19;

Increase capacity in primary care, including through additional roles in primary care;

Put in place plans to boost the NHS’s capacity by the equivalent of 7,000 beds, including through the use of innovative “virtual” beds;

Increase the numbers of call handlers in both the 999 and 111 services respectively, with a target of having 2,500 call handlers in 999 and 4,800 call handlers in 111 by the end of December; and

Agree a new ambulance auxiliary contract with St John Ambulance, providing at least 5,000 hours of extra support each month.

The Department, the NHS and local authorities also continue to work together to address ambulance handover delays and delayed discharges, including by identifying the actions for which NHS leaders are responsible, and those for which social care leaders are responsible, thus supporting accountability.

Over the summer recess, we have also been focusing on increasing the NHS and social care workforce, by drawing on both domestic and international sources, with the aim of increasing the capacity of the NHS and social care systems both in the short term and over time. Our international recruitment taskforce is developing plans for implementing a “support hub” to help care providers recruit from abroad, and the Department is laying regulations to help increase the capacity and capability of the professional regulators to test the standards of overseas recruits. We also launched a consultation on 28 August with the aim of extending “Retire and Return” NHS pension changes through to 31 March 2023, allowing retired and partially-retired NHS staff to continue to receive important pension changes if they re-enter the workforce. Further work is also under way, including the consideration of further options on the pensions of healthcare professionals.

The Department continues to work closely with NHS England to address the covid-19 waiting times backlog—104-week waits were virtually eliminated, in line with the elective recovery plan, and the NHS is making good progress to address 78-week waits by April 2023. In support of this:

A further 50 surgical hubs were given the go-ahead over the summer, in addition to the existing 91 surgical hubs;

A further seven community diagnostic centres were given the go-ahead. The programme has so far delivered an extra 1.7 million tests; and

Choice of provider at the point of GP referral will be available to all patients from April 2023 at the latest, supported by information to be made available to patients through the NHS app

A number of reforms looking to the long-term needs of the NHS and care system are also now under way:

Work led by Professor John Deanfield is considering how we better embrace home testing for a wider range of conditions through a modernised NHS health check;

The National Institute for Health and Care Excellence is expediting work to consider how to improve the uptake and adoption of well-evidenced MedTech; and

Standardised, modular hospital design—delivering scale and process efficiencies—will be adopted as the default for cohorts 3 and 4 of the new hospitals programme. Enabling works for the new hospitals at Whipps Cross, Kettering and Hillingdon have been unlocked, and the strategic outline case for Shrewsbury and Telford has been approved.

Good progress continues to be made on the development of framework 15 and the NHS workforce plan. The future needs of the NHS and social care systems are best met by a workforce which is trained flexibly, which is adaptable, which embeds new roles in clinical practice, and which allows all health and care professionals to practise at the top of their competence.

Taxpayers expect the Department and the NHS to continue to be effective stewards of public money. We have therefore imposed further controls on the use of consultancy, professional services and contingent labour, with the aim of generating at least £170 million of additional savings over this financial year, with further recurrent savings thereafter. We have also instituted new mechanisms to assist transparency: more than 50,000 people work in national and local NHS organisations which do not provide direct patient care; and to help those who work in the NHS and the wider public understand more about the value delivered, we are today publishing an organogram of the Department—to be made available on a searchable platform over the coming days—followed by searchable organograms for NHS England and the other national arm’s length bodies by the end of September. Integrated care boards are being asked to emulate this approach.

There has also been progress on a number of other very important issues including:

The publication of the women’s health strategy;

The launch of the Government’s dementia mission; and

Confirmation of interim payments to those who have been infected by contaminated blood and bereaved partners

In November 2021, the Government announced it would make £50 million funding available for research into motor neurone disease over five years. Following work over the summer with DHSC and the Department for Business, Energy and Industrial Strategy, through the National Institute for Health and Care Research and UK Research and Innovation, to support researchers to access funding in a streamline and co-ordinated way, we are pleased to confirm that this funding has now been ringfenced. DHSC and BEIS welcome the opportunity to support the motor neurone disease scientific community of researchers, as they come together through a network and link through a virtual institute.

The Department has taken these actions to help the NHS and social care systems be better prepared for the winter challenges ahead and beyond.

[HCWS291]

Urgent and Emergency Care

Steve Barclay Excerpts

Monday 5th September 2022 Commons Chamber

[The Secretary of State for Health and Social Care (Steve Barclay)]

With permission, Mr Deputy Speaker, I would like to make a statement on our support for urgent and emergency care. I know that this is an issue of great concern to right hon. and hon. Members, and I wanted to update the House at the earliest opportunity on the work that has been undertaken over the summer.

Bed occupancy rates have broadly remained at winter-type levels, with covid cases in July still high, with one in 25 testing positive—that compares with about one in 60 currently. This is without the decrease in occupancy that we would normally expect to see after winter ends, and ambulance waiting times have also continued to reflect the pressures of last winter, although I am pleased to see recent improvements. For example, the West Midlands service is meeting its category 2 time of less than 18 minutes.

I would like to update the House on the nationwide package of measures we are putting in place to improve the experience of patients and colleagues alike. First, we have boosted the resources available to those on the frontline. We have put in an extra £150 million of funding to help ambulance trusts deal with ambulance pressures this year. On top of that, we have agreed a £30 million contract with St John Ambulance so that it can provide surge capacity of at least 5,000 hours per month. We are also increasing the numbers of colleagues on the frontline. We have boosted the national 999 call handler numbers to nearly 2,300, which is about 350 more than we had in September last year, and we have plans to increase this number further to 2,500 by December, supported by a major national recruitment campaign. By the end of the year we will have also increased 111 call handler numbers to 4,800. As well as that, we have a plan to train and deploy even more paramedics, and Health Education England has been mandated to train 3,000 paramedic graduates nationally each year, which is double the number of graduates that were accepted in 2016.

Secondly, we are putting an intense focus on the issue of delayed discharge, which, as many Members know, is the cause of so many of the problems we see in urgent and emergency care—I think that is recognised across the House. This is where patients are medically fit to be discharged but remain in hospital, taking up beds that could otherwise be used for those being admitted. Delayed discharge means longer waits in accident and emergency, lengthier ambulance handover times and the risk of patients deteriorating if they remain in hospital beds too long—this is particularly the case for the frail and elderly. The most recent figures, from the end of July, show that the number of these patients is just over 13,000—these are similar numbers to those for the winter months. We have been working closely with trusts where delayed discharge rates are highest, putting in place intensive on-the-ground support.

More broadly, our national discharge taskforce is looking across the whole of health and social care to see where we can put in place best practice and improve patient flow through our hospitals. As part of that work, we have also selected discharge frontrunners, who will be tasked with testing radical solutions to improve hospital discharge. We are looking at which of these proposals we can roll out across the wider system and launch at speed. Of course, this is not just an issue for the NHS. We have an integrated system for health and care and must look at the system in the round, and at all the opportunities that can make a difference. For instance, patients can be delayed as they are waiting for social care to become available, and here too, we have taken additional steps over the summer. We have launched an international recruitment taskforce to boost the care workforce and address issues in capacity. On top of that, we will be focusing the better care fund, which allows integrated care boards and local authorities to pool budgets, to reduce delayed discharge. In addition, we are looking at how we can draw on the huge advances in technology that we have seen during the pandemic and unlock the value of the data that we hold in health and care, including through the federated data platform.

Finally, we know from experience that the winter will be a time of intense pressure for urgent and emergency care. The NHS has set out its plans to add the equivalent of 7,000 additional beds this winter, through a combination of extra physical beds and the virtual wards which played such an important role in our fight against covid-19. Another powerful weapon this winter will be our vaccination programmes. Last winter, we saw the impact that booster programmes can have on hospital admissions, if people come forward when they get the call. This year’s programme gives us another chance to protect the most vulnerable and reduce the demand on the NHS. Our autumn booster programmes for covid-19 and flu are now getting under way, and will be offered to a wider cohort of the population, including those over 50, with the first jabs going in arms this week as care home residents, staff and the housebound become the first to receive their covid-19 jabs.

Over the summer, we became the first country in the world to approve a dual-strain covid-19 vaccine that targets both the original strain of the virus and the omicron variant. This weekend, the MHRA approved another dual-strain vaccine, from Pfizer, and I am pleased to confirm that we will deploy it, along with the Moderna dual-strain vaccine, as part of our covid-19 vaccination programme in line with the advice of the independent experts at the JCVI. Whether it is for covid-19 or flu, I would urge anyone who is eligible to get protected as soon as they are invited by the NHS, not just to protect themselves and those around them, but to ease the pressure on the NHS this winter.

Today I have laid before the House a written ministerial statement on further work that we have been doing over the summer, and I want to draw the House’s attention to one particular feature in that statement which has garnered interest in the House in the past. In November 2021, the Government announced it would make £50 million of funding available for research into motor neurone disease over five years. Following work over the summer between my Department and the Department for Business, Energy and Industrial Strategy, through the National Institute for Health and Care Research and UK Research and Innovation, to support researchers to access funding in a streamlined and coordinated way, we are pleased to confirm that this funding has now been ring-fenced. The Departments welcome the opportunity to support the MND scientific community of researchers as they come together through a network and linked through a virtual institute.

I commend this statement to the House.

[Wes Streeting (Ilford North) (Lab)]

I thank the Secretary of State for advance sight of his statement, and wish him and the ministerial team well as the new Prime Minister appoints her first Government. I also welcome what he said towards the end of his statement about the importance of vaccination and funding for motor neurone disease.

Emergency care is in crisis. After 12 years of Conservative Governments, the NHS can no longer reach patients on time. The outgoing president of the Royal College of Emergency Medicine said earlier in the summer that ambulance delays had got so bad that the NHS was now “breaking its promise” to the public that life-saving emergency care will be there when they need it. Twenty-nine thousand patients waited more than 12 hours in A&E in June, more than ever before. Ten thousand urgent cases waited more than eight hours for an ambulance last month. It is estimated that the collapse of emergency care that we are now seeing could be costing 500 lives a week. If the statistics did not paint a stark enough picture, no one can ignore the case of 87-year-old David Wakeley, whose family had to build a shelter around him as he waited outside for an ambulance, with broken bones, for 15 hours. What a shameful indictment on 12 years of Conservative mismanagement of the NHS.

There have been recent reports that the NHS will tell patients to

“avoid A&E as the winter crisis bites early.”

That was in August. The simple fact is that we have gone from no crisis in the system in 2010, to annual winter crises, to the situation we have today where there is a crisis all year round—the worst crisis in the history of the NHS. There is no point in the Secretary of State blaming the pandemic or, indeed, the extreme heat we saw this summer, although they do not help. The reality is that, before the pandemic, the NHS had not hit the 18-minute response time target for emergency incidents since 2017. Will the Secretary of State, on behalf of the Government and his party, finally take some responsibility and admit what his colleague the Culture Secretary was honest enough to say, that the Conservatives left our health service “wanting and inadequate” when the pandemic hit?

The NHS needs Ministers to grip this crisis and work tirelessly to get patients the care they need, so where have the Government been all summer? It is almost as if, the moment the Conservative leadership candidates hit the road, the Cabinet turned on their “out of office” and hit the beach as the NHS slipped into the worst crisis in its history and the Government did diddly-squat on the cost of living crisis, which will also exacerbate people’s health problems.

I pay tribute to St John’s Ambulance for the vital work it does, and I am pleased it has now been formally commissioned to provide England’s ambulance auxiliary. Can the Secretary of State confirm that this capacity is being used by the system today? Perhaps he might have a word with his colleague the Secretary of State for Education, or his successor, about recruitment, because the shambles we saw on T-levels and the hand-wringing we saw from the exam boards is unacceptable and risks the pipeline of talent we need to staff the NHS.

Although extra capacity is important, let us be honest that it will not solve the ambulance crisis unless we tackle the delayed discharges that are causing logjams in hospitals. The Secretary of State talked about this, but let me be clear that one in seven hospital beds is occupied by someone who is medically fit to leave but cannot do so because there is no support available—some people are waiting up to nine months longer than needed. What is the answer to this staffing crisis? It has not been to pay care workers a decent wage so that we stop losing them to the likes of Amazon, and it has not been to provide a great career so that people in our country enter this important profession. The answer has been to pull the “immigration lever,” to quote the Government, and to recruit people from overseas on lower pay. How fitting that this Prime Minister’s Government ends with yet another broken promise. One year after promising to fix social care by hiking taxes on working people, where is the plan to tackle the work- force crisis without resorting to immigration every time?

Finally, the Secretary of State barely mentioned the cost of living crisis. The Under-Secretary of State for Health and Social Care, the hon. Member for Erewash (Maggie Throup), has said the Government are worried that if people cannot afford to heat their home, more will lose their life to flu. Has the Secretary of State made an estimate of the number of people who could fall ill as a result of soaring energy bills? As this is rightly a concern, may I point out that there is a plan right in front of him to freeze energy bills, fully costed and ready to go, paid for by a windfall tax on the oil and gas companies? When will the Government stop dithering, delaying and talking to themselves and start acting for the country? Rising energy prices will also push care providers to breaking point, with some facing closure as they are unable to absorb increases of 500% or more. What plans does he have to prevent care home residents from being booted out this winter and to prevent care home doors from closing?

The reality is that this Government are now out of time. A new Prime Minister will be appointed tomorrow who has suggested charging patients to see a doctor. I did not think anything could be worse than fining people for missing appointments, but our new Prime Minister has somehow managed it. Public satisfaction with NHS services is at its lowest recorded level, and patients are struggling to access the care they need. Under Labour, patients could call 999 knowing that an ambulance would come when they needed it, but the longer we give the Conservatives in power, the longer patients will wait.

[Steve Barclay]

Let me start with the areas where the hon. Gentleman and I agree. The David Wakeley case was shocking, and we accept that there have been severe pressures, particularly linked to certain trusts; just 10% of trusts account for 45% of ambulance handover delays. His second charge was about what the Government have been doing on this over the summer. We have had a 100-day sprint with NHS colleagues, a taskforce has been set up and I have met those troubled trusts, particularly Cornwall, to look at how we better support them.

Some of the factors affecting ambulance delays are within the trusts’ control. Those include understanding why delayed discharge is much lower at the weekend, and things that they can do within the emergency department. However, as the hon. Gentleman recognised, some factors are beyond the trusts’ control, whether that is variance in performance on conveyancing by ambulance trusts, differences in hear and treat or see and treat, or the challenges in social care. We recognise that, as I said in my opening remarks, the heatwave and a covid infection rate of one in 25, compared with one in 60 now, created significant pressure on the ambulance system.

In addition to the taskforce, we have enacted a whole range of other measures. NHS England has tasked the system with putting in place an additional 7,000-bed capacity for the winter. We have been expanding emergency department capacity. One thing we funded in spending review 2020, when I was in the Treasury, was additional funding for trusts where there are emergency department constraints.

The hon. Gentleman did not mention mental health, but I know he takes an interest in it, so he will be pleased to know that over the summer we have particularly targeted action that can be taken in emergency departments and across the hospital estate in support of mental health, led by Claire Murdoch in NHS England. We have increased staffing by 16% and there is an extra £2.3 billion going into mental health next year compared with 2016. There is additional funding and workforce, because we recognise the pressures.

There is also bespoke action with NHS colleagues. Sometimes, relatively low numbers of patients—for example, patients needing palliative care, patients with dementia and patients with Parkinson’s—are particularly challenging in terms of delayed discharge, and their discharge may be delayed for an extended period of time. Although the quantum of patients may be modest, that leads to delay.

The hon. Gentleman recognised other things we have been doing over the summer, such as the St John Ambulance contract that has been put in place to help with auxiliary ambulances, the work on international recruitment—I do not accept that people are being paid less; that is bringing people in to work in important roles in our care sector—and the consultation on retire and return.

Finally, the hon. Gentleman mentioned the cost of living. He will know that the new Prime Minister has made it clear that she will have further things to say on that over the next week, and I know there will be ample opportunity to debate that further in the House.

[Mr Robin Walker (Worcester) (Con)]

My right hon. Friend knows that Worcestershire is at the sharp end of ambulance pressures; I understand that Worcestershire Acute Hospitals NHS trust is one of six trusts that he has met in recent days to discuss those pressures. Can he assure me that he will do everything he can to reduce delayed discharge and address capacity at our A&E, so that I no longer have to witness situations such as the one I saw earlier this summer, with more than 10 ambulances waiting at the door of the emergency department?

[Steve Barclay]

I know my hon. Friend is a strong champion for this issue; when I was Chief Secretary to the Treasury, I remember him lobbying me about how a bridge from one bit of the hospital estate to another could provide additional capacity to meet the pressures his trust has faced. That is partly why we have been working intensively with the trusts that have the most severe cases of ambulance delays, looking through the work of the taskforce at best practice and what works best in those settings, and ensuring that the trust chief execs have the right level of support. It is important to recognise that the problem does not always manifest where it is caused. Quite often, challenges on the social care side, or further upstream in the conveyancing rate, put pressure on an emergency department and on the trust.

[Mr Toby Perkins (Chesterfield) (Lab)]

The Secretary of State is absolutely right about the abject failure in care that his Government have overseen over the past 12 years, but his statement did not refer so much to the pressures in A&E. It seems entirely wrong to me that if someone walks into an A&E department they are its responsibility, but if they turn up in an ambulance they are expected to sit in it for hours on end until the A&E is willing to take responsibility. Will the Secretary of State say more about dealing with the issue so that A&E departments realise that however someone arrives—whether they walk through the door or arrive in an ambulance—they should be the responsibility of the A&E, and the ambulance should be out fetching other people in the area?

[Steve Barclay]

The hon. Member makes a very fair point. Within the question he raises is the unmet need where an ambulance does not reach a patient in the community, as opposed to the known risk once the patient is within the hospital trust’s purview. On capacity in A&E, as I touched on in my statement, we put in £450 million at the 2020 spending review to upgrade A&E facilities at 120 trusts.

With respect to the hon. Member’s specific point, he may be aware of the letter that the NHS medical director Professor Stephen Powis and the chief nurse Ruth May sent at the time of the heatwave about where risk sits within hospitals. The taskforce has been doing further work on pre-cohorting, post-cohorting and observation bays so that we can better free up that ambulance capacity and get it back on the road.

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

I very much welcome my right hon. Friend’s statement, particularly the focus on retention, training and recruitment. Earlier this year, I met people from the excellent Chertsey Make Ready Centre. They told me about the challenges that they face with staff wellbeing and staff retention, which are compounded by the horrendous abuse that they receive almost daily. Sadly, it is not limited to our paramedic workers: I met staff at the Crouch Oak practice in Addlestone in my constituency recently, and we spoke about some of the vile messages and threats that they have received. Will my right hon. Friend join me in thanking our health and care service workers for their fantastic work and in condemning the vile abuse that, sadly, some of them receive from a bunch of miscreants?

[Steve Barclay]

I am very happy to join my hon. Friend in thanking the staff for their work and in condemning the completely unacceptable violence, intimidation and abuse to which people are subjected. There should be zero tolerance of that from any hospital trust.

[Rushanara Ali (Bethnal Green and Bow) (Lab)]

We know that 117,000 people have died waiting for treatment on the NHS waiting list, and what we are hearing now is that 500 people a week are dying waiting for ambulances. Can the Secretary of State give us a date by which he can guarantee that people will not lose their lives waiting for an ambulance to come and get them and care for them?

[Steve Barclay]

What I can guarantee is that, through the taskforce, we are prioritising how we get ambulances back on the road and how we speed things up to reduce handover delays. We are looking in particular at the 10 trusts in which the issue is most acute, because there is an unmet need in the community if the ambulance is not there.

On the hon. Member’s point about the backlogs with electives, we announced over the summer, as part of the work that we have been doing, a whole series of surgical hubs and community diagnostic centres. We are working with the Getting It Right First Time team, under Professor Sir Tim Briggs, on different patient pathways. A whole range of work is being done to reduce waiting times, which is why we have already cleared the longest waits—the two-year waits—and are now turning to the 18-month waits.

[Tracey Crouch (Chatham and Aylesford) (Con)]

National headlines do not often reflect the hard work of those in our local hospitals. Although there will be—indeed, there have been—cases of unforgivable waits, will my right hon. Friend join me in thanking all the hard-working paramedics, first responders and emergency department teams who serve Medway, Maidstone and Tunbridge Wells hospitals, supporting my constituents in their time of need? Will he update the House on any conversations he may have had with the Department for Levelling Up, Housing and Communities about major planning applications that have progressed without the appropriate healthcare facilities being provided?

[Steve Barclay]

I am happy to join my hon. Friend in thanking the paramedics in Medway, in Maidstone and beyond for all their fantastic work, especially given the pressures the system has been under during the summer. As for levelling up, a number of Members have raised with me the need to ensure that developers are making a sufficient contribution as part of their housing plans, and I shall be happy to draw that to the attention of my colleagues in the Department for Levelling Up, Housing and Communities.

[Rachael Maskell (York Central) (Lab/Co-op)]

The Secretary of State is right to talk about the back door rather than focusing on the front door when it comes to the crisis in social care. About a quarter of the patients in our hospital in York are experiencing delayed discharges. However, if we do not pay care staff, we will never resolve the issue. What consideration has the Secretary of State given to putting those staff on a national pay scale, using “Agenda for Change” as a model?

[Steve Barclay]

This obviously involves debates with Treasury colleagues about pay—not just on the social care side, but in respect of the NHS and the interplay with pensions—but it is not just about that; it is also about ensuring that we have the right data, and through the integrated care systems we are acquiring much better data to improve our ability to join up what is being spent on delayed discharge within the NHS with what is being done in the social care setting. I am sure Members will agree that not only is it often very damaging for frail elderly patients to spend a long time in hospital, but hospital is usually the most expensive place in the system for them to be. It is not just a question of having more money, although that is often the default; it is a question of thinking about how to get flow into the system in a way that will deliver not only patient care, but a more efficient service.

[Dr Julian Lewis (New Forest East) (Con)]

On checking my website, I saw that it was in late 2005—not a period of Conservative government—that my right hon. Friend the Member for New Forest West (Sir Desmond Swayne), the then Liberal Democrat Member of Parliament for Romsey and I were complaining about the closure of in-patient beds in small community hospitals. Does the Secretary of State accept that there is a role for such beds in enabling appropriate discharge from the larger hospitals, thus dealing with one of the main causes of people being stuck in ambulances without being able to be given a bed?

[Steve Barclay]

That, I think, relates to the point that I just made about the need for flow in the system and an appropriate step-down capacity. Sometimes patients are not yet ready to be discharged to their homes, but some additional physio or other support may enable them then to go home, which is where they usually want to be. This is all part of taking a much more integrated approach, and part of that must be improving the quality of data in relation to the activity that takes place within community settings.

[Helen Hayes (Dulwich and West Norwood) (Lab)]

In July, the average wait time in London for an ambulance needed by someone describing the symptoms of a stroke was more than an hour—more than three times longer than the target time. Many of my constituents have told me that they are living with genuine anxiety and fear that if they or a loved one were stricken by illness or involved in a serious accident, the emergency help that they needed would not arrive in time. The Secretary of State has announced some measures today, but what my constituents want to know is when we can expect the time targets in London to be met once again, so that they can rest easy in the knowledge that if they need an ambulance, it will be there.

[Steve Barclay]

One of my reasons for going out with the London Ambulance Service—among others—over the summer was to answer the charge about what Ministers were doing, and to observe at first hand the challenges that the service had been facing. As the hon. Lady will know, performance has improved since the summer, but the service remains challenged. That is why we are considering a range of measures, such as boosting emergency departments, looking at pre and post-cohorting, looking at how we work with the taskforce, and looking at single points of access. One issue that paramedics emphasise to me is the need for, in particular, a better way for frail elderly patients to gain access to a single point for social care provision. We are working closely on that range of measures with colleagues in the London Ambulance Service.

[Martin Vickers (Cleethorpes) (Con)]

In recent weeks I have been supporting a constituent who has complained to the East Midlands Ambulance Service. The complaint centred on the fact that it took nine hours and 26 minutes following a 999 call for an ambulance to arrive at the home of my constituent’s mother. When she arrived at Scunthorpe Hospital, it took another two hours and seven minutes before she was handed over to the hospital staff. I find it particularly disturbing that the letter from the chairman of the East Midlands ambulance service, after explaining the procedure and protocol that was followed, says:

“I can confirm that the 999 call had been responded to appropriately.”

Needless to say, my constituent, who is a retired senior police officer and well aware of pressures on the emergency services, would not agree that it was dealt with appropriately. If I forward the details to my right hon. Friend the Minister, could he follow up with the East Midlands ambulance service and come back to me? Hopefully, that will mean the service provided to my constituents by the ambulance service can be improved.

[Steve Barclay]

I am very happy to ensure that that specific case, which is obviously concerning, is looked at. As my hon. Friend will know from my earlier remarks, we are boosting the number of 999 call handlers—those numbers are up and there are around 350 more call handlers than in September 2021—and we are also training more paramedics. Numbers are going up, but obviously demand has increased exponentially as well.

[Stephanie Peacock (Barnsley East) (Lab)]

A nurse in Barnsley East wrote to me about the incredibly traumatic death of her mother. When her mum suffered a brain haemorrhage, her dad called the emergency services twice. They told him to call back as they did not have an ambulance or a responder to help. An hour and 40 minutes later, the ambulance arrived but it was too late for her to receive any treatment, and she later passed away.

Sadly, this is not an isolated incident. Our emergency services are in crisis. They are understaffed and under-funded. What are the Government doing to prevent tragedies such as that from ever happening again?

[Steve Barclay]

We are putting in additional funding, whether that is the additional £1.5 billion put into GP capacity in 2020, the £450 million to upgrade A&E facilities across 120 trusts, the extra £150 million specifically put into the ambulance service, the £30 million put into the St John Ambulance contract over the summer, or the further £50 million that has gone into call handling to boost the 111 service. Significant additional funds are going in as part of the support for the significant pressure that we recognise there has been over the summer.

[Mr Philip Hollobone (Kettering) (Con)]

I thank my right hon. Friend the Health Secretary for visiting Kettering General Hospital in July and for his subsequent confirmation in August that the hospital has won £38 million, as a 10% down payment, to start the redevelopment of the hospital. During his visit, he visited the A&E department, which is one of the most overcrowded in the country, and saw the ambulances waiting outside. What is his assessment of the current state of play at Kettering General Hospital and its prospects for the future?

[Steve Barclay]

First I acknowledge on the record the campaigning that my hon. Friend and colleagues have done for a new hospital at Kettering. They particularly demonstrated the urgency of addressing issues with the energy plant, so I was pleased that we were able to get that enabling work done. All A&E facilities have been under pressure over the summer, which is why we have announced the additional funding. It is about boosting capacity in call centres, looking at how we address variation in performance among ambulance trusts, particularly on conveyancing, and looking at how we get more flow into hospitals. That is why, along with the hospital, I also visited a care home in my hon. Friend’s constituency, in order to look at how we better address the issue of delayed discharge.

[Sir Mark Hendrick (Preston) (Lab/Co-op)]

Can I bring to the Secretary of State’s attention the planned closure of the Preston ambulance station on Blackpool Road, Preston, and the closure in Broughton, just outside my constituency, which are to be replaced by an ambulance station 5 or 6 miles away on Sherdley Road in Lostock Hall? The decision was made by the North West Ambulance Service NHS Trust without consulting any staff or hospital heads, including the chief executive of the NHS Trust in central Lancashire, and without consulting trades unions and other stakeholders, including the councils. Will he look into this matter and see what has happened? It will add 26 minutes to a journey from the proposed site to the Royal Preston Hospital, which cannot be in the interest of any patient.

[Steve Barclay]

I am happy to draw that case to the attention of the relevant parties and ensure that the hon. Gentleman gets a written explanation.

[Anna Firth (Southend West) (Con)]

I think that the Secretary of State is aware of the acute problems at Southend University Hospital and of the fact that A&E capacity is the issue. We are waiting for capital funding that was promised years ago to be released. I know that Health Ministers have been working on this over the summer. There were 15 ambulances there yesterday. Our hard-working nurses and doctors would love news on that funding to be forthcoming.

[Steve Barclay]

As I said in my statement, additional funding has been put in to boost A&E capacity. There was some £450 million of funding in the spending review in 2020, which has been applied across 120 trusts. Of course, the ICSs will look at the commissioning priorities in particular areas, and the NHS England taskforce is looking at trusts where there is acute pressure.

[Helen Morgan (North Shropshire) (LD)]

I am concerned that people across England and Wales, including in Shropshire, have died as a result of the ambulance delays we have seen for a long period. I have raised the issue a number of times in this place. I welcome the improvement in the response times of the west midlands ambulance service, but I am worried that the regional data masks huge differences between rural areas such as Shropshire and densely populated urban areas. Will the Secretary of State consider the Ambulance Waiting Times (Local Reporting) Bill, which my hon. Friend the Member for St Albans (Daisy Cooper) tabled earlier this year, so that the disparity between urban and rural response times can be properly understood and tackled?

[Steve Barclay]

The hon. Lady makes an important point about variation not just between regions but within regions. As a rural Member of Parliament, I get the point that there is often significant variation within a region. That has been a key area of focus. The federated data platform, which is due to come on stream in April, will give her local ICS much better data on what is happening and on what community capacity there is. Over the summer, we have worked with ambulance trusts to look at operational performance data on a much more granular level. That is why I have flagged to the House the issue that a small number of trusts are driving a large proportion of the handover delays. That is exactly the sort of variation that we are looking at.

[Scott Benton (Blackpool South) (Con)]

My right hon. Friend will be aware of the £25 million Government investment in the new emergency village at Blackpool Victoria Hospital, with the new critical care unit opening only a few weeks ago. That will make a substantial difference by easing the pressures at the hospital, which are contributing to unacceptable ambulance waiting times. Will he join me in visiting the hospital to see the substantial difference it will make to my constituents?

[Steve Barclay]

As my hon. Friend knows, my parents live very near the hospital in question. I know he has been a huge champion of the additional funding. If the opportunity arises, I would be very happy to visit. I pay tribute to the work he has done to secure the additional facility, which will benefit his constituents and those across the Fylde coast.

[Emma Hardy (Kingston upon Hull West and Hessle) (Lab)]

In July, I met the Royal College of Emergency Medicine and the chief executive of Hull University Teaching Hospitals NHS Trust to discuss the ambulance delays and the delays at A&E. They both told me the same thing: the problem is actually with exit block. They cannot admit people if they cannot discharge people. I have been told by Hull Royal Infirmary that at points over the summer, more than 170 people were in the hospital who should not have been there because they were waiting for discharge packages. That works out at more than a fifth of hospital beds being taken up by people waiting for adult social care.

A number of months ago, I raised in this place a letter from the Conservative-led East Riding of Yorkshire Council, which said that it did not have the adult social care carers to meet the needs of the population. This situation will only get worse. The Secretary of State has said that he is looking at an international recruitment taskforce. I recommend a simpler solution: pay people more, and then we might get the workers we actually need to deliver adult social care. This is already a crisis and it will only get worse.

--- Later in debate ---

[Steve Barclay]

A good example from Hull, which I visited over the summer, shows that this is not simply about money, although that is obviously a relevant factor. The hon. Lady will be familiar with the Jean Bishop integrated care centre in Hull, where the social care staff say that no one has left the service because they really enjoy working in an integrated way. The patient feedback is also extremely strong. That shows the sort of innovation we should apply across the system. I hope the hon. Lady would welcome that innovation in Hull being applied more widely.

[Andy Carter (Warrington South) (Con)]

I know that the Secretary of State is aware of the pressures that Warrington Hospital has been under through the summer, particularly the wait times. I am grateful that he intervened and spoke to the chief executive about looking at some of the issues that it was facing. Having spent some time there and having talked to staff and the management, it is clear—I agree with him—that the real issue is delayed discharge. It appears that there is a 90-bed shortage in step-down care capacity in Warrington. Will he join me in urging Bridgewater Community Healthcare NHS Trust and Warrington Borough Council to make progress on increasing that capacity, so that we can try to address some of the issues in the emergency department?

[Steve Barclay]

My hon. Friend is absolutely right that a central role for the integrated care systems in future is to look at how they best use the better care fund, how we better integrate around step-down provision, and how we ensure that best practice is being followed through the delayed discharge, including regarding some of the additional pressures that Warrington faced specifically, as I know from when we spoke over the summer. He will also know that there had been additional funding for new capacity at Warrington, which strangely was not highlighted in the media coverage that I saw.

[Tahir Ali (Birmingham, Hall Green) (Lab)]

Two weeks ago, in the west midlands, it was being reported that some were waiting as long as 17 hours to receive service from an ambulance. It was also reported that at least 68 people have died since April while waiting for an ambulance, although that number was backdated to last August. It is now clear that our NHS is at breaking point due to a decade of Tory cuts; welcome to backlog Britain thanks to 12 years of Conservative Governments.

Trusts in the region report being poorly equipped for the burden of treating patients, with many reporting delays due to a shortage of beds. This crisis will only get worse in the coming months as we enter the cold period—a winter in the midst of one of the worst crises in living memory. What measures will the Secretary of State introduce immediately in response to the increased pressures that our NHS is facing, which are costing lives? Will he provide the extra measures that the NHS desperately needs to deal with this crisis—a crisis that was made by 12 years of Conservative Governments?

[Steve Barclay]

I fear that the question was written before the statement. In the course of the statement, we have covered the significant additional funding that is going in, whether that is in primary care with the £1.5 billion on GP capacity, the £450 million on A&E capacity, the £150 million on ambulances, the £50 million on 111 call-handling or the £30 million on St John auxiliary ambulance capacity—to name just a few areas.

As to the hon. Gentleman’s wider charge on Government funding for the NHS, I remind him that health funding is on track to be £4 in every £10 of day-to-day Government expenditure, which is a significant increase on 2010. We have also just been through a pandemic in which the fiscal response, as the former Chief Secretary to the Treasury, my right hon. Friend the Member for Chelsea and Fulham (Greg Hands) will know, was about £400 billion. Significant funding has gone in, and the statement today has shown that a number of factors, in particular the integration between social care and the NHS, are at the heart of solving the issue of delays on ambulance handovers.

[Debbie Abrahams (Oldham East and Saddleworth) (Lab)]

For the week ending 12 August, there were nearly 1,000 excess deaths. We know that that is just the tip of the iceberg and it is likely to get worse; that is about 10% more than the five-year rolling average. What are the Secretary of State’s estimates of how much worse it is going to get over the winter months, and what is he going to do about it?

[Steve Barclay]

I have set out a range of things that we are doing to tackle what we recognise are significant pressures facing the NHS, whether that is through the taskforce that we have set up, which is targeted on delayed discharge; the intensive work that has been undertaken with, in particular, the 10 trusts that account for 45% of ambulance delays; the improved capacity within our call handling; or looking at our data, as was raised earlier, on the variation in performance between ambulance trusts on areas such as conveyancing or within the integration between the NHS and social care. I pay tribute to the huge amount of work that is being done within the NHS and social care in recognising that there are significant challenges within the system, which is why so much work has gone into addressing that over the summer.

[Tony Lloyd (Rochdale) (Lab)]

The Secretary of State might recall that in his previous Health incarnation, he responded to a debate about the crisis in the ambulance service in my constituency. It is worse today—much worse. I take the point about delayed discharge, but, even so, is it not better to have people moving into a hospital setting, rather than people not being picked up by ambulances? That is where the real risk is. Will he also guarantee that I get an answer to my letter asking that Rochdale, which lost its A&E service some years back, gets it back? That would make a material difference.

[Steve Barclay]

On the hon. Gentleman’s second point, I will ensure that that particular letter to the Department is highlighted following this statement. On his first point, as I said in my statement, I agree that the greater risk is the unmet need if an ambulance does not arrive, rather than a patient who is in hospital. That is why Professor Stephen Powis and chief nurse Ruth May wrote to the system when there was pressure during the heatwave, flagging that as a specific issue. We have been working with trust leaders, including leading figures such as Anthony Marsh, on pre-cohorting and post-cohorting, capacity in emergency departments, and where risk sits in the system. I recognise the hon. Gentleman’s point.

[Lloyd Russell-Moyle (Brighton, Kemptown) (Lab/Co-op)]

This is about a lack of planning. I could say the same about the monkeypox response, because we still do not have the vaccines; they are now being watered down to half strength, because we have run out, they have not been delivered and we still have 100,000 to order. The ambulance situation is also about a lack of planning. My grandmother was admitted to the Royal Cornwall over the summer via A&E. The person before her waited 24 hours in an ambulance to be discharged. The person behind had been in a car crash, but the ambulance did not turn up for five hours and they had to make their own way to the hospital with a damaged lung. In Brighton, the Royal Sussex’s A&E has been given a very poor Care Quality Commission report. All of these cases are because of the lack of move on beds in social care. In Brighton, a senior care worker can receive less than £10 per hour to work. People get more working in shops on the high street. This needs to be addressed urgently. Is it not time for a national pay, and terms and conditions, for care workers? It would cost the Department nothing, but would stop the loss of many of our workforce.

[Steve Barclay]

Far from there being a lack of planning, the very essence of integration between social care and the NHS through the ICSs is that we recognise the importance of both aspects working much more closely together. That is why we are bringing forward initiatives such as the federated data platform.

Monkeypox is outside the scope of today’s statement, but I know the issue is of particular interest to the hon. Gentleman. He will know that, fortunately, we have not yet had any fatal cases in the UK and the rate of infection has been falling. We purchased the maximum number of vaccines that we could; I wrote to the relevant charities with the details. Although smaller doses are being delivered compared with the initial 50,000, we still have doses in the system. We expect a further 20,000 very shortly and a further 80,000 later this month. We have procured doses, we are getting them out and it is fortuitous that cases are falling, but we are obviously keeping the situation under close watch.

[Justin Madders (Ellesmere Port and Neston) (Lab)]

This summer I have heard some horror stories from constituents with life-threatening conditions about the dangerous delays they have faced. When one constituent raised the issue with the NHS, she was told by the senior consultant at the A&E department that the NHS has collapsed. If senior frontline clinicians are saying that in the summer, God help us when we get to winter. I really fear where we are going to be, because there is no doubt that my constituent is very lucky to be alive. We have heard a lot of figures today about the number of excess deaths this year. Will the Secretary of State give us his estimate of the number of people who have died unnecessarily because they have been stuck in an ambulance waiting to get into A&E, or because an ambulance has not turned up at all?

[Steve Barclay]

Again, despite that colourful language, we have more doctors, more nurses and more paramedics. We are training more and meeting more demand, and significant additional funding has been applied to ambulance trusts, call handling and other parts of the system, including primary care. Part of reducing the demand on the ambulance system is related to GP capacity, which is why—to take that as an example—an additional £1.5 billion of funding has gone in.

[Jim Shannon (Strangford) (DUP)]

I thank the Secretary of State for his statement and for his clear financial commitment to trying to address the issue of ambulance response. I also congratulate the new leader of the Conservative party. In her statement at dinnertime, the right hon. Member for South West Norfolk (Elizabeth Truss) said that the NHS is one of her main priorities.

The Secretary of State will know that this week is Air Ambulance Week, which runs from 5 September to 11 September. Today, Air Ambulance Northern Ireland stated that it has had its busiest year ever, so will the Secretary of State allocate additional funds to the devolved Administrations, particularly in Northern Ireland, to help cope with the increasing use of air ambulances due to delayed response times and extortionate waiting lists?

[Steve Barclay]

I very much agree with the hon. Gentleman on the importance of the air ambulance. As a rural MP, I know full well the importance of the service it provides across the Cambridgeshire fens, and I know that it provides an essential service for his constituents. Again, if there are any specific issues, I am happy to ensure that the Department looks at them, but he is absolutely right to draw attention to the importance of the air ambulance within the wider response.

[Mr Deputy Speaker (Mr Nigel Evans)]

I thank the Secretary of State for his statement and for responding to 25 questions. We now move on to the final statement today, which is on energy prices.

Women’s Health Strategy for England

Steve Barclay Excerpts

Wednesday 20th July 2022 Commons Chamber

[The Secretary of State for Health and Social Care (Steve Barclay)]

With permission, Mr Speaker, I will make a statement on the women’s health strategy for England.

I know that many hon. and right hon. Members will agree that, for too long, women’s health has been hampered by fragmented services and women being ignored when they raise concerns about their pain. On too many occasions, we have heard of failures in patient safety because women who raised concerns were not heard, as with the Ockenden review into the tragic failings in maternity care and the independent inquiry into the convicted surgeon Ian Paterson. I also remember the outstanding work of my constituent Kath Sansom and her Sling the Mesh campaign where, once again, the response was too slow when women raised issues with their care.

We are embarking on an important mission to improve how the health and care system listens to women’s voices and to boost health outcomes for women and girls, from adolescence all the way through to later life. This is not only important for women and girls; it is important for everyone. This work is already well under way.

Last month we announced the appointment of Professor Dame Lesley Regan, one of the country’s foremost experts in women’s health, as the first ever women’s health ambassador for England. On top of this, we are investing an extra £127 million in the NHS maternity workforce and neonatal care over the next year, and we are creating a network of family hubs in local authorities in England.

Today we are announcing the next step. We are publishing the first ever women’s health strategy for England, which sets out a wide range of commitments to improve the health of women and girls everywhere. I take this opportunity to pay tribute to the almost 100,000 women who took the time to share their stories with us, as painful as it may have been. Your voices have been heard and were vital in shaping this strategy.

I will now set out the key components of the strategy. First, we are putting in place a range of measures to ensure that women are better listened to in the NHS. Indeed, 84% of respondents to our call for evidence recounted instances where they were not listened to by healthcare professionals. We need to do more to tackle the disappointment and disillusionment that many women feel. We are working with NHS England to embed shared decision making where patients are given greater involvement in decisions relating to their care, including when it comes to women’s health.

Secondly, we want to see better access to services for all women and girls. Women and girls have told us that the fragmented commissioning and delivery of health services can impact their ability to access them. That means they have to make multiple appointments to get the care they need, adding to the NHS backlog. There are better ways to deliver women’s health through centres of excellence in the form of women’s health hubs, designed specifically to holistically assess women’s health issues and where specialist practitioners can be more attuned to concerns being raised. We are encouraging the expansion of those hubs, and indeed I visited Homerton University Hospital this morning to see the benefits these local one-stop clinics bring, enabling women to have all their health needs met in one place.

Thirdly, it is essential that we address the lack of research into women’s health conditions and improve the representation of women’s data in all types of research. Currently, not enough is known about conditions that only affect women, as well as about how conditions that affect both men and women impact them in different ways. The strategy sets out how we will tackle the women’s health data gap to make sure that health data is broken down by sex by default.

Fourthly, we will provide better information and education on issues relating to women’s health. Our call for evidence showed that fewer than one in 10 respondents feels they have enough information about conditions in areas such as the menopause and that many people wanted trusted and accessible information about women’s health. The NHS website is currently a trusted source of health information for many people, and we will transform the women’s health content to improve its existing pages and add new pages on conditions that are not currently there. But we know that the NHS will not be everyone’s first port of call for health information, so we will expand our partnerships, such as the one between YouTube and NHS Digital, who are working together to make sure that credible, clinically safe information appears prominently for UK audiences. It is also important that medical professionals have the best possible understanding of women’s health, and I am pleased that the General Medical Council will be introducing specific assessments on women’s health for medical students, including on the menopause and on gynaecology.

Fifthly, our strategy sets out how we will support women at work. In the call for evidence, only one in three respondents felt comfortable talking about health issues with their workplace, and we also know that one in four women has considered leaving their job as a result of the menopause. So we will be focusing our health and wellbeing fund over the next three years on projects to support women’s wellbeing in the workplace, and we will be encouraging businesses across the country to take up best practice such as the menopause workforce pledge, which was recently signed by the NHS and the civil service.

Sixthly, we will place an intense focus on the disparities in women’s health. We know that although women in the UK on average live longer than men, they spend a significantly greater proportion of their lives in ill health and disability than men. Even among women there are marked disparities and our strategy shows our plans to give targeted support to the groups who face barriers accessing the care they need, for example, disabled women and women experiencing homelessness. It also shows how we are putting an extra £10 million of funding towards 25 new mobile breast screening units that will target areas and communities with the greatest challenges on uptake and coverage.

Finally, as well as these cross-cutting priorities, the responses to our call for evidence also highlighted a number of specific areas where targeted action is needed. Those include fertility care, where we will be removing barriers that restrict access that are not health-based but based, for example, on whether someone has had a child from a previous relationship, and making access to fertility services much more transparent. Another of our priority areas is improving care for women and their partners who experience the tragedy of pregnancy loss. At the moment, although parents whose babies are stillborn must legally register the stillbirth, if a pregnancy ends before 24 weeks’ gestation there is no formal process for parents to legally register their baby, which I know can be distressing for many bereaved parents. So we will be accepting the interim update of the independent pregnancy loss review and introducing a voluntary scheme to allow parents who have experienced a loss before 24 weeks of pregnancy to record and receive a certificate to provide recognition of their tragic loss.

This is a significant programme of work but we cannot achieve the scale of change we need through central Government alone. We must work across all areas of health and care. We will need the NHS and local authority commissioners to expand the use of women’s health hubs; the medical schools, regulators and Royal Colleges to help us improve education and training for healthcare professionals; the National Institute for Health and Care Research to help make breakthroughs that will drive our future work; and many others to play their part. I would like to finish by thanking everyone involved in the development of this important strategy, including the Minister of State, Department for Health and Social Care, my hon. Friend the Member for Lewes (Maria Caulfield), who is on the Front Bench with me today, for the determination she has shown in taking this strategy forward. I would also like to pay tribute to my predecessors, my right hon. Friends the Members for West Suffolk (Matt Hancock) and for Bromsgrove (Sajid Javid), the latter of whom is in his place, for their commitment to this important issue, even during the pressures of the pandemic. This is a landmark strategy, which lays the foundations for change and helps us to tackle the injustices that have persisted for too long. I commend this statement to the House.

--- Later in debate ---

[Madam Deputy Speaker (Dame Eleanor Laing)]

I call Sajid Javid.

[Steve Barclay]

rose—

[Madam Deputy Speaker]

Oh, I beg your pardon! It is probably a good idea if I allow the Secretary of State to answer the shadow Secretary of State. I am too many steps ahead.

[Steve Barclay]

I do not want those on the Opposition Front Bench thinking that their points have not been addressed.

I think there is much common ground on both sides of the House on the importance of this strategy and the need for a culture and system change in the NHS to address many of the concerns raised in past debates in the House on issues such as mesh, Paterson and Ockenden. I also think there are a lot of areas where colleagues on both sides of the House will work together to encourage commissioners in our constituencies to reshape services in a way that better reflects the needs set out in this strategy.

The hon. Member for Ilford North (Wes Streeting) is right to highlight the fact that many respondents felt they had not been heard in the past. That is why we have taken the first step of appointing a women’s health ambassador—Professor Dame Lesley Regan, who is an extremely respected figure in women’s health—to better champion women. It is also why I signalled in my statement the importance of data and of breaking it down by sex by default to better target our research on conditions that impact women differently from men or that affect only women and that are often not as well researched as they should be. Again, I think there is common ground on both sides of the House on the issue of research.

I agree with the hon. Gentleman about the need to improve training for existing clinicians as well as for those new to the profession. That is why I signalled in my statement our desire to work with the royal colleges and others to make sure that that continuing professional development is there.

The hon. Gentleman raised the issue of access to HRT. He will be aware that we have put prepayment certificates in place from April next year so that someone will pay only the equivalent of two prescription charges for their HRT supply. Officials in the Department have done considerable work on supply chain issues to tackle some of the difficulties that were there in the past.

On the hon. Gentleman’s point about how we address outcomes for patients, I saw a good illustration this morning at Homerton. Redesigning services avoids the need for invasive and more expensive theatre treatment, and the use of new equipment allows a better service to the patient. In the strategy, Professor Dame Lesley Regan makes the point that the irony is that we could deliver services that are far better for the patient but also cheaper for the taxpayer if we embraced a women’s hub model of the sort we see in Homerton. I very much look forward to taking the data we have forward in conversations with other commissioners around the country.

I am pleased that the hon. Gentleman recognised and welcomed the removal of barriers to IVF, as will Members on both sides of the House who have seen the challenges that that issue presents in constituency cases.

On speed of service, community diagnostic centres have an important role to play. The hon. Gentleman also raised the issue of ethnic minorities. We have put in place a maternity disparities taskforce, and ministerial colleagues have already met three times as part of that taskforce, so the characterisation that Ministers are not engaging on the issue is, I am afraid, wide of the mark.

The hon. Gentleman mentioned breast cancer. He will have noted from my statement that an additional £10 million has been targeted specifically at that issue, with a further 25 mobile units. Again, that is about addressing the disparity in women’s health data in different parts of the country.

Overall this is an important strategy. We have listened to the very large number of responses to the consultation, and that is reflected in the strategy. I think this is an area on which there is much common ground on both sides of the House.

[Madam Deputy Speaker (Dame Eleanor Laing)]

And now I call Sajid Javid.

[Sajid Javid (Bromsgrove) (Con)]

There was a time when I would follow right after the shadow Secretary of State, but not any more. However, I am very pleased to follow my right hon. Friend the Secretary of State, and I welcome him to his new role. He has the privilege of running a fantastic Department that is so important to the British people. He has excelled in every role he has held in Government so far, and I know he will do so again.

I strongly welcome the women’s health strategy—as we heard, it is the first published by any Government. I congratulate everyone involved, including all the officials and especially the excellent Minister of State, Department for Health and Social Care, my hon. Friend the Member for Lewes (Maria Caulfield), who is sitting on the Treasury Bench, and the previous Minister of State, my right hon. Friend the Member for Mid Bedfordshire (Ms Dorries).

Does the Secretary of State agree that, when it comes to women’s health, early diagnosis is essential? I absolutely welcome the commitment in the strategy on mandatory training in women’s health issues for new doctors, but will my right hon. Friend say a little more about what can be done on training for existing doctors and clinicians?

[Steve Barclay]

The work on this strategy was done before I arrived in the Department, so it was down to my right hon. Friend and to the Minister of State, my hon. Friend the Member for Lewes (Maria Caulfield). It is great to have this opportunity to pay tribute to my predecessor for all that he did to drive this agenda forward. He is absolutely right about the importance of training and early diagnosis. That is why addressing the issue of fragmented services is so important. As a respondent said, where women raise concerns, they often feel like a lone voice in the wind—that was a phrase in the strategy that really resonated with me. Having hubs, centres of excellence and the ability to look at that data and identify it early, alongside the other initiatives in which he played a major role as Secretary of State, such as the diagnostic hubs, are all a key part of the delivery of this strategy.

[Carolyn Harris (Swansea East) (Lab)]

I rise to speak specifically on the menopause services included in the strategy. As co-chair of the Government menopause taskforce, I broadly welcome the strategy but feel that it falls short in some places.

Although better menopause training for doctors of the future is essential, there is not much in the strategy now in terms of upskilling GPs or prescriber medics, such as pharmacists or women’s health nurses. With only 14% of women accessing hormone replacement therapy and menopause care, through medical lack of awareness in diagnosing and prescribing, training medical professionals of the future does nothing for women today.

With 50% of women not even discussing their symptoms, we need a public awareness campaign—outside the one being run by the media and by grassroots and celebrity activists—to ensure that all women get the memo, as it were. We need a commitment to a national formulary for HRT to end postcode lottery in quality, quantity and availability of body identical hormone replacement therapy—I emphasise body identical.

As for HRT costs, I am delighted that my private Member’s Bill that I negotiated with the Government last October now appears as part of the strategy, but I am bitterly disappointed that the timeframe for that once annual charge is delayed until April 2023— 18 months after it was promised—demonstrating to me a lack of urgency in dealing with women’s health issues that affect 51% of the population.

As we are talking about delays and women not being listened to, I am still waiting on responses to six letters to either this Secretary of State or to his predecessor dating back to 5 May asking to discuss all the issues that I have raised today. I would be grateful to have a meeting to discuss them further.

[Steve Barclay]

The hon. Lady says that she is not being listened to, but my understanding is that she is co-chair of the menopause taskforce, which has been set up to look at these issues. Indeed, she has also had meetings with officials on the subject of HRT. It is slightly remiss of her to suggest that she is not being listened to when Health Department officials are meeting with her and when we have a taskforce under way. There is much consensus around the points that she raises. She has highlighted, quite rightly, the importance of HRT, and we have acted on that. Part of the reason for the delay until April is that the IT systems need to be put in place. I well recall, when I was a Treasury Minister, being asked to move at pace in response to covid, because of the cash-flow pressures on businesses, and sometimes having the same colleagues complaining that forward controls and other issues had not been put in place. We need to put the right IT in place. We will do that for April, and the work is under way. The issues that she raises are being addressed, but in an effective way.

As I said to the shadow Secretary of State, we will work with the royal colleges to address the issue of training. It is a perfectly fair point, and I do not think there is disagreement in the House on that. On the wider issue of addressing disparities, that is exactly what the taskforce is about. That is why we have such a relentless focus on data, why we have a women’s health ambassador to give greater voice to these issues, and why we have brought forward specific measures, such as the family hubs and mobile breast screening units, to better address those disparities.

[Dame Maria Miller (Basingstoke) (Con)]

I welcome my right hon. Friend’s statement and its recognition of the need to have specific strategies to make sure that women have equal access to services. However, it is silent on the biggest healthcare injustice that women face in our country—that abortion is still treated under Victorian criminal law, with the most draconian laws in the world. Seventeen women in the past eight years have been subject to criminal investigation, including simply because they suffered the appalling issue of stillbirth. This strategy should stop that by expanding the Government’s own change in the law in Northern Ireland to ensure that abortion is an issue between women and their doctors, and that every woman is protected from criminal investigation at a time when what they need from us is care and compassion.

[Steve Barclay]

My right hon. Friend is right that there is a need for care and compassion, and she highlights an extremely important point. She will be aware that the sexual health review is currently being conducted. That will report later this year and will look into the issue that she raises.

[Stephanie Peacock (Barnsley East) (Lab)]

How will this strategy address the postcode lottery associated with gynaecological wait times?

[Steve Barclay]

Again, it is partly by having an ambassador that will be tasked with advocating in that space, by having the data to give visibility to that, and also by working in partnership with commissioning groups, with the NHS, and with the royal colleges on training, that much greater focus will be brought to these issues.

[Theresa Villiers (Chipping Barnet) (Con)]

I thank the Government for bringing forward this strategy. It really is astonishing that this is the first Government ever to have produced such a strategy. Will my right hon. Friend use this to drive forward improvements in care for endometriosis, including, in particular, updating the National Institute for Health and Care Excellence guidelines NG73 to make sure that people have earlier diagnoses and better access to pain relief for this debilitating condition, of which too many doctors do not have a high enough awareness?

[Steve Barclay]

That was one of the key issues that came out of the consultation responses. Indeed, in my conversation with Dr Watson at Homerton, we looked at different pathways for treatment that avoid the need for theatre. Key to that is some of the innovation on pain management that physicians are looking at, and how, through NICE, we socialise that innovation across the NHS.

[Chi Onwurah (Newcastle upon Tyne Central) (Lab)]

The north-east has some of the highest levels of health inequality in the country. North-east women spend more than a quarter of their lives in not good or poor health, which is almost 3 percentage points above the national average. Will the Secretary of State set out the steps that he plans to take to target those areas that already have high levels of inequality? Does he agree that, when he talks about research—I very much welcome the additional research—that should also target areas with high levels of existing inequality, which, unfortunately, is not the case at the moment?

[Steve Barclay]

We are already doing so on things such as the 75 family hubs that we have put in place. Again, a key part of this strategy is to then look at having women’s hubs, particularly in those areas where there is greatest disparity.

[Jackie Doyle-Price (Thurrock) (Con)]

I welcome my right hon. Friend to his place and the appointment of Dame Lesley Regan as the women’s health ambassador. I know them both to be very passionate and outcome-focused, and, between the two of them, I hope that we will make some headway. He rightly talks about how women do not feel listened to, and we know that women go for many years suffering from very common gynaecological conditions that do not get diagnosed. What role does he think that more public health education about healthy menstruation and what constitutes a healthy period can play to make sure that women are more empowered to look after themselves and get treatment earlier?

[Steve Barclay]

I thank my hon. Friend for her warm welcome. I agree with her about empowering patients, women in particular, with information. That is why part of the strategy is to focus on the information provided on the NHS website. There is also the need to work with trusted partners—to look at where people go for their health information, and how we can better empower them. For example, in the consultation, we heard of patients being told that heavy bleeding was normal—that it was something that they had to accept. Again, that was an issue highlighted by respondents in the call for evidence. It is about making sure people realise that, where there are issues, their voices are heard. That is at the heart of the strategy that we have set out.

[Hannah Bardell (Livingston) (SNP)]

I am delighted to see the UK Government follow in the footsteps of the Scottish Government with a women’s health plan. I am also pleased to see that they have taken on board the Stonewall campaign to bring the rest of the UK into line with Scotland on female same-sex couples’ access to in vitro fertilisation, because for far too long it has been a postcode lottery and lesbians have been discriminated against.

As co-chair, with the hon. Member for Kingston upon Hull West and Hessle (Emma Hardy), of the all-party parliamentary group on endometriosis, I am pleased to see the recommendations for more research and better care for those who suffer from that condition, but can we be certain that that will be backed up by proper support and funding? Women’s healthcare champions are fantastic, but they cannot replace proper funding and a proper strategy. I pay tribute to the work of Sir David Amess: I have no doubt that this strategy and the endometriosis aspects of it would not be there without the great work he did as chair of the all-party group.

[Steve Barclay]

I thank the hon. Lady in particular for that tribute to the work Sir David contributed to this, and agree with her on the issue of same-sex couples having access to IVF. She is right about better research and how we highlight that; that is a key part of the strategy. It is also interesting from the comments of the health ambassador that services can be reconfigured in a way that gives better outcomes for the patient without leading to higher cost. By having centres of excellence where the woman’s voice is heard, treatment comes more quickly and that delivers better patient outcomes.

[Alec Shelbrooke (Elmet and Rothwell) (Con)]

May I welcome my right hon. Friend to his place and say how good it is that he has had direct experience with Kath Sansom and the work of Sling the Mesh? I also pay tribute to the hon. Members for Livingston (Hannah Bardell) and for Kingston upon Hull West and Hessle (Emma Hardy); the three of us have worked closely cross-party to bring these issues to the Floor in Westminster Hall debates and in this Chamber, which I think has played a big part in today’s strategy. I thank them across the House for that work.

Within the strategy there is talk of centres of excellence and mesh centres, but those must be carefully monitored, because we are getting a lot of feedback now that mesh centres are perhaps not working in the way we think they are. That must be carefully monitored, and data collections may not be working in the way my right hon. Friend would hope, so that will be important.

I welcome the strategy on listening to women. Anecdotally, too often the words “sexist” and “misogynist” have been used about the NHS’s attitude to women, and we need to move to a stage where those words are no longer used and it is not saying, “Go and take some painkillers,” patting them on the head and saying, “It’s all very normal.”

On that final point, will my right hon. Friend talk to our right hon. Friend the Education Secretary about teaching in school about diseases such as endometriosis? If people do not know a disease exists, how can they know they have it? That is an important point. Overall, I welcome this strategy as a massive step forward, but we must all recognise that we cannot give up. There is much more to do to ensure that what is in the strategy actually works.

[Steve Barclay]

I am grateful to my right hon. Friend, who I know has campaigned for many years on this; mesh is a particular issue that he and I have spoken about in the past. On the quality of data I am very happy to work with him on any specific examples, and indeed with colleagues across the House, because I know there are others who have worked closely on the mesh campaign, to see how we get the right consistency and the right analysis of data, because that is a shared interest of all of us in the House today.

In terms of the Department for Education, I am very happy to take the matter forward with my right hon. Friend the Education Secretary to look at what schools can do to raise awareness. That ties in with the wider point about ensuring that patients have the right information and that, where issues and concerns arise, they are not fobbed off but taken seriously.

[Olivia Blake (Sheffield, Hallam) (Lab)]

There have certainly been times, including now, when it has been very difficult for me to talk about my experience of miscarriage—an experience that is shared by one in five women and that happens in one in four pregnancies.

Last year, I held a debate and got the Government to agree to support some of the measures in the review on miscarriage in The Lancet, named “Miscarriage Matters”. The Royal College of Obstetricians and Gynaecologists now supports abandoning the three miscarriage rule in favour of a stepped response and graded model of care.

However, I want to know whether the other things promised at the end of that debate are included in this strategy. The first was access for everyone to 24/7 care. The second was data and recording of miscarriage on medical records; when I was called for my flu jab and asked why I had been called, the nurse said, “Because you’re pregnant,” then looked down and said, “Oh, well, you’re not, are you?” The third was stopping the need for unnecessary miscarriages by making the care better; we can prevent miscarriage in some cases even when it is beginning, and stop people having multiple miscarriages and having to live with this pain, increasing their risk of suicide.

We could do so much more. Miscarriages are taboo and too often they are put in the “too hard to deal with” box. A certificate would be lovely, yes, but that is not enough. We need adequate care that rapidly reduces the need for people to go through this trauma again and again.

--- Later in debate ---

[Steve Barclay]

The heart of the whole House goes out to the hon. Lady, because the trauma of those experiences is so visible; I am hugely grateful for the powerful way she highlights them to the House. She will be aware that we have the pregnancy loss review reporting later this year, and we will be looking at the important issues she raises. I know she met recently with the Minister of State, my hon. Friend the Member for Lewes (Maria Caulfield), to discuss those and, as someone new to post, I will certainly look closely at the points she raises.

[Mrs Flick Drummond (Meon Valley) (Con)]

I pay tribute to the hon. Member for Sheffield, Hallam (Olivia Blake), because I know exactly what she is feeling. This is the place to make a difference, so I offer her every encouragement to keep going. This is an extremely good strategy and will make a difference to women. I thank the Secretary of State for recognising that domestic violence has a dramatic impact on women’s health, particularly for women who are reluctant or embarrassed to go to their GP. Can he ensure that there is more training in primary care settings to recognise and help those vulnerable women?

[Steve Barclay]

My hon. Friend is absolutely right about the importance of tackling domestic abuse. Indeed, last year the Government brought forward and the House passed the Domestic Abuse Act 2021 in recognition of that. There is an important read-across from issues of domestic abuse into the wider piece about data and how that in turn links into prosecutions, evidence gathering and empowering those who are victims with the support they need. It is an extremely important issue, and it is important that we take that legislation forward.

[Mohammad Yasin (Bedford) (Lab)]

We know that midwives and maternity services are struggling across the country. In my own constituency, we have seen Bedford hospital, despite its best efforts, struggling with midwife recruitment and retention. What steps are the Government actively taking as part of the women’s health strategy to ensure that maternity services are well staffed and resourced?

[Steve Barclay]

While this strategy sets out a number of future steps, there are also steps we have already taken, including on maternity services. The hon. Gentleman will be aware that we have announced an extra £127 million of support for the NHS maternity workforce and £95 million to recruit an additional 1,200 midwives and 100 consultant obstetricians. Steps have been taken, and more steps are set out in this strategy.

[Dame Caroline Dinenage (Gosport) (Con)]

As one of the former Health Ministers who carried the baton on this strategy for some time, I warmly welcome my right hon. Friend’s words and his commitment. It is so important—not least the commitment to addressing some of the fertility inequalities across the country. I met with his predecessor because my constituency is one of those most severely affected by that postcode inequity.

As my right hon. Friend says, there are some real health inequalities in the services provided—not just for women, but between women, particularly those women who are vulnerable and hardest to reach. It is not just about money, which is why I am pleased with his commitment to hubs, but about ensuring that integrated care systems have a focus on place and on the needs of local communities. I would love him to commit more to that.

Since 2015, there has reportedly been a 42% real-terms fall in contraception spending, so I would also like to have my right hon. Friend’s commitment that this document will align with the sexual and reproductive health action plan. That is important because for every £1 spent on those services, we save £9 on other public health spending.

[Steve Barclay]

I am grateful for the work that my hon. Friend did as a Health Minister in championing this agenda. She is right to highlight the difficulty, often, of accessing contraception, which is very much at the heart of the responses we had on the fragmented service that many women have experienced. She will be aware that a key part of our approach is the health and wellbeing funds and working with the voluntary and community sector on support in areas such as pregnancy loss.

A key part of this is the visibility of the women’s health strategy. Putting that to the fore in terms of a women’s health ambassador is, as she says, part of these conversations with the integrated care systems to ensure that this gets greater prioritisation within commissioning. A key part of securing that is having the data to demonstrate its importance and benefits.

[Munira Wilson (Twickenham) (LD)]

I, too, pay tribute to the hon. Member for Sheffield, Hallam (Olivia Blake) for her very powerful and moving personal testimony.

Last year, my constituent Nicola experienced her seventh miscarriage, which was her third in just 12 months. One in 100 women suffers recurrent miscarriage, often without known cause and without effective treatment, and a disproportionate number are black, Asian and other ethnic minority women.

I welcome the Secretary of State’s commitment to boost research in this area, but I am afraid that we have not heard any specifics on how much. Last year, the National Institute for Health and Care Research spent only 5% of its budget on reproductive health and childbirth, yet these issues affect some 17% of the population. Will he give an indication of how much more he is going to spend on research in this area?

[Steve Barclay]

Through highlighting the tragic case of Nicola, the hon. Lady demonstrates very effectively why research in this area is so important and the fact that it has been insufficient in the past. The amount of funding is, to a large extent, shaped by the research proposals that come forward. A key part of the strategy is the clear signal that we are sending to the research community that we are encouraging those willing to do research in the areas that have not been focused on in the past so that funding can be prioritised to them.

[Emma Hardy (Kingston upon Hull West and Hessle) (Lab)]

As joint chair of the all-party parliamentary group on endometriosis, with the hon. Member for Livingston (Hannah Bardell), and as joint chair of the APPG on surgical mesh, with the right hon. Member for Elmet and Rothwell (Alec Shelbrooke), I welcome this strategy, but I want to raise two issues that we would be really keen for the Secretary of State to look at.

First, we would like to see all the recommendations of the Cumberlege review implemented, including redress for the people impacted by vaginal mesh. Secondly, it was good to hear him talk about recognising how women’s health affects women in the workplace, but the charity Endometriosis UK is promoting making workplaces endometriosis-friendly by recognising that women who have endometriosis may have shorter periods of time off more regularly, which, in terms of HR policy, is frowned on and looked on badly, resulting in some women losing their jobs through no fault of their own.

[Steve Barclay]

I know from my own involvement in the mesh campaign just how central the hon. Lady’s role was in it, and I pay tribute the work that she has done on that and a number of other campaigns over recent years. In respect of mesh, she will be aware that an annual review is published. On the workplace issue, a key thing that comes out of the report is the significance of the time off work that many women are experiencing, with the difficulty, quite often, in having these conversations with employers. It is very welcome that the civil service has taken a lead, as has the NHS, in certain aspects of that, but there will clearly be more to do, and the point she raises will be part of that wider conversation.

[Dame Diana Johnson (Kingston upon Hull North) (Lab)]

I welcome the appointment of the women’s health ambassador, Dame Lesley Regan. It is an excellent appointment to that role.

The 2020 report on access to contraception by the all-party parliamentary group on sexual and reproductive health found that the current fragmented commissioning arrangements have a severe impact on women’s access to contraception due to a lack of joined-up services. With 45% of pregnancies in England being unplanned, what specific plans does the Secretary of State have to remove the barriers to co-commissioning of reproductive healthcare to require different parts of the system to work together to meet women’s healthcare needs?

[Steve Barclay]

I welcome the hon. Lady’s acknowledgement of the expertise that Professor Dame Lesley Regan brings as ambassador. I think she will be fantastic in that role. A key part of this strategy is addressing the fragmented health system and how that impacts on areas such as contraception. That is why we are having, for example, the women’s health hubs to provide a one-stop shop and centre of expertise so that we can better identify the services that people need.

[Rachel Hopkins (Luton South) (Lab)]

Black women are four times more likely to die during pregnancy and childbirth. What targeted preventive solutions will the maternity disparities taskforce apply to address this totally unacceptable position?

--- Later in debate ---

[Steve Barclay]

We are working through the taskforce’s recommendations and will publish our response shortly. Part of the reason the taskforce was set up is the disparity in data, which we clearly need to address.

[Ruth Cadbury (Brentford and Isleworth) (Lab)]

I really welcome this women’s strategy and hope that it will mean better care for women in relation to gynaecological and reproductive issues, breast cancer and so on, but it needs to go further. Too often, women experiencing severe levels of pain are sent away from their GP with painkillers and find out further down the line, sometimes too late, that they were actually experiencing a real health problem, whether lupus, cancer or one of any number of health conditions. This is backed up by a 2021 study that showed that men and women experiencing the same levels of pain are not treated equally by clinicians. Will the Secretary of State ensure that the focus on clinical training and retraining also addresses gender stereotyping in diagnosis and support?

[Steve Barclay]

Part of the reason this is a 10-year strategy is that we do need a change of culture as well as a change of systems, and that is what the strategy maps out. A key component of that is how we empower patients through areas such as the NHS website, working with trusted partners who provide health information. The hon. Lady is also right about training, not just for new entrants into the medical profession but for existing clinicians. We will be working with the royal colleges and others to drive that forward.

[Madam Deputy Speaker (Dame Eleanor Laing)]

And finally, Jim Shannon.

[Jim Shannon (Strangford) (DUP)]

Thank you, Madam Deputy Speaker. I have the strongest legs in the Chamber.

I very much welcome the Secretary of State’s announcement of additional moneys for women’s health training. He referred to one-stop clinics. I coincidentally spoke to a medical student who graduated in Cardiff today, who feels that more is needed for the specialty of women’s health, and specifically the menopause, which the hon. Member for Swansea East (Carolyn Harris) mentioned. What training will be extended to GPs, in the context of one-stop clinics, to ensure that each surgery has a trained GP available to advise and to help?

[Steve Barclay]

One of the key issues highlighted in the response to the call for evidence was how areas such as the menopause were being dealt with by the NHS. That is why we have a menopause taskforce looking at specific recommendations, one of which concerns the training of clinicians.

[Madam Deputy Speaker]

I thank the Secretary of State and everyone who took part in the statement.

Doctors’ and Dentists’ Remuneration

Steve Barclay Excerpts

Tuesday 19th July 2022 Written Statements

[The Secretary of State for Health and Social Care (Steve Barclay)]

The 50th report of the Review Body on Doctors’ and Dentists’ Remuneration (DDRB), the 35th report of the NHS Pay Review Body (NHSPRB) and the 44th report of the Senior Salaries Review Body (SSRB) are being published today. The reports will be presented to Parliament and published on gov.uk.

I am grateful to all the chairs and members of the review bodies for their reports, and I welcome their robust, independent recommendations and observations. I am accepting the pay bodies’ recommendations in full, recognising the vital contributions NHS workers make to our country.

This pay award comes on top of the 3% last year for staff under the remits of NHSPRB and DDRB, when pay uplifts were paused in the wider public sector. This year, most overall pay awards in the public sector are similar to those in the private sector. Survey data suggests median private sector pay settlement, which is the metric most comparable to these pay review body decisions, was 4% in the 3 months to May.

The NHSPRB has recommended a £1,400 consolidated uplift to the full-time equivalent salary for all Agenda for Change (AfC) staff. This will be enhanced for pay points at the top of band 6 and all pay points in band 7 so it is equal to a 4% uplift.

The DDRB has recommended a 4.5% increase to national salary pay scales, pay ranges or the pay elements of contracts for all groups included in their remit this year (consultants, speciality and associate specialist (SAS) doctors on the closed 2008 contracts, salaried general medical practitioners (GMPs) and general dental practitioners).

The SSRB has recommended a 3% increase for all very senior managers (VSMs) and executive senior managers (ESMs), with a further 0.5% to ameliorate the erosion of differentials and facilitate the introduction of the new VSM pay framework.

After careful consideration of the pay review body reports, we have decided to accept the pay review bodies’ recommendations in full. In doing so, we have committed to:

uplifting the full-time equivalent salaries of staff on Agenda for Change contracts—over 1 million NHS staff—by £1,400 on a consolidated basis, and enhanced for staff in bands 6 and 7, those with full-time equivalent basic pay up to £45,839, so it is equal to a 4% pay uplift. This means the lowest paid will receive a 9.3% increase compared to 2021-22;

uplifting the salaries of consultants (c.55,000 doctors) by 4.5% on a consolidated basis;

uplifting the minimum and maximum pay range for Salaried GMPs (c.15,000 doctors) by 4.5% on a consolidated basis;

uplifting the GMP trainers grant and GMP appraisers grant by 4.5%;

uplifting the pay element of the general dental practitioners contract (c.24,000 dentists) by 4.5% on a consolidated basis;

increasing the overall investment in the SAS workforce (c.12,000 doctors) on average, by 4.5%. The detailed arrangements for implementing this increase alongside the reformed 2021 SAS contract will be set out in due course; and

uplifting the salaries of all very senior managers and executive senior managers (c.2,500 staff) by 3% and providing NHS organisations with additional flexibility to provide a further 0.5% to ameliorate the erosion of differentials and facilitate the introduction of the new VSM pay framework. Further information will be shared with NHS employers in due course.

All pay awards will be backdated to 1 April 2022. This pay award is only applicable to NHS staff in England. The 2022-23 pay uplift for NHS staff directly employed by NHS providers will be funded by NHSE through system allocations.

The DDRB was not asked to make recommendations for staff groups in multi-year deals (contractor GMPs, doctors and dentists in training or SAS doctors on the 2021 contracts). However, we note the wider comments made by the DDRB regarding these groups.

This is an annual process and as is always the case, decisions are considered in light of the fiscal and economic context and ensuring awards recognise the value of NHS staff whilst delivering value for the taxpayer.

While it is right that we reward our hard-working NHS staff with a pay rise, this needs to be proportionate and balanced with the need to deliver NHS services and manage the country’s long term economic health and public sector finances, along with inflationary pressures. Sustained higher levels of inflation would have a worse impact on people’s real incomes in the long run, which is why we need proportionate and balanced pay increases recommended by the independent pay review bodies.

In written and oral evidence to the pay review bodies, the Government set out what was affordable within the NHS’s spending review settlement. The pay review bodies have recommended pay awards above this level. This Government are committed to living within its means and delivering value for the taxpayer, and therefore we are reprioritising within existing departmental funding whilst minimising the impact on frontline services.

The pay awards should be viewed in parallel with the £37 billion package of support the Government have provided for the cost of living, targeted to those most in need.

Salaried general medical practitioners

For salaried GMPs the minimum and maximum pay range set out in the model terms and conditions will be uplifted. As independent contractors to the NHS, it is for GMP practices to determine uplifts in pay for their employees.

Clinical excellence awards and clinical impact awards

The Government have recently reformed the national awards in England, now named national clinical impact awards. The reforms aim to address issues with inequality previously raised by the DDRB.

Government acknowledges the DDRB’s comments on local clinical excellence awards and their reasons for not recommending an increase in their value this year.

[HCWS236]

Oral Answers to Questions

Steve Barclay Excerpts

Tuesday 19th July 2022 Commons Chamber

[Selaine Saxby (North Devon) (Con)]

13. What progress he has made on increasing the availability of NHS dentistry services.

[The Secretary of State for Health and Social Care (Steve Barclay)]

During the pandemic, we took unprecedented action to protect NHS dentistry capacity, providing over £1.7 billion of income protection. We also ensured that those who needed it most could access the available care by establishing 700 urgent care centres nationwide. NHS dentists are now returning to 100% of their contracted activity.

[Chris Loder]

I thank my right hon. Friend for his answer, but in West Dorset we are really struggling with dentist availability; at the moment there is no capacity for new patients, and the NHS appears to be incapable of solving the issue. Could my right hon. Friend tell me what he is doing to help restore dental services in West Dorset for those who need them?

[Steve Barclay]

My hon. Friend raises a very pertinent point. I recognise that there are significant challenges in NHS dentistry, including disparities across regions. Improving access for patients is a priority, and that is why just today the Government, together with NHS England, have announced a package of improvements to the NHS dental system, on which we have worked closely with the sector and the British Dental Association.

[Selaine Saxby]

Having seen the former Minister for dentistry on numerous occasions, we were assured of today’s announcement to tackle the appalling lack of dentists in dental deserts such as my North Devon constituency. Can my right hon. Friend explain how the measures in today’s written ministerial statement will rapidly deliver extra dental appointments?

[Steve Barclay]

I am grateful for my hon. Friend’s campaigning on this issue; it is something she has highlighted on a number of occasions. The sorts of areas where the measures announced today will help include the management of NHS dental contracts, increasing the use of the skills mix in the dental workforce, and rewarding complex treatment to better reflect the complexity of that work.

[Luke Pollard (Plymouth, Sutton and Devonport) (Lab/Co-op)]

There are 18,000 people on the NHS waiting list for dentistry in Plymouth; it is a real crisis. As a city, we have a cross-party plan for the new Cavell centre, a west end health hub as part of a health village in the city centre, with extra dental capacity with our brilliant dental school. However, we urgently need the Government to unlock the funding for it. Will the Secretary of State agree to meet a cross-party delegation from Plymouth to make the case for that, so that we can get on, get spades in the ground and get people’s teeth healed?

[Steve Barclay]

As part of the Government’s wider commitment to levelling up, we are very interesting in taking a place-based approach. Indeed, the essence of the integrated care boards is to help facilitate that. I am very happy to have discussions with colleagues across the House on how we best deliver that.

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

We all know that NHS dentistry was in crisis long before the pandemic. In my community, only a third of adults have seen an NHS dentist in the last two years, and fewer than half of children have seen a dentist in the last 12 months. It is obvious why: we have an ageing system—units of dental activity—based on a snapshot taken 15 years ago, which is completely unfit for purpose, as dentists and patients around the country are telling the Government. Will the Secretary of State listen to dentists and patients and reform the system urgently?

[Steve Barclay]

I hope the hon. Gentleman will look at today’s announcement, because it shows that the Department has listened. That is why, for example, it will facilitate better contract management, better reflect the floor price for units of dental activity and reward complex treatment, which was one of the key concerns. Equally, I hope that the hon. Gentleman recognises that this Government, through the £1.7 billion of income protection during the pandemic, have done much to facilitate dentistry’s ability to bounce back.

[Robbie Moore (Keighley) (Con)]

2. What steps his Department is taking to help the NHS achieve net zero.

--- Later in debate ---

[Rosie Cooper (West Lancashire) (Lab)]

4. What assessment he has made of the adequacy of the rate of reimbursement for mileage expenses for NHS community care staff.

[The Secretary of State for Health and Social Care (Steve Barclay)]

The reimbursement of travel costs for NHS staff is covered by the NHS terms and conditions, which are agreed jointly by employers and NHS trade unions. The terms and conditions set out the process for reviewing the rate, and that process includes reviewing fluctuations in fuel prices.

[Rosie Cooper]

Motorists across the country have seen the cost of fuel increase by as much as 60p per litre since this time last year. Fuel costs are penalising the many NHS staff who treat patients in the community for simply doing their job. The current reimbursement rate of 56p per mile drops to 20p after staff have travelled 3,500 miles, and that has not been adjusted since 2014. Does the Secretary of State agree that if the rate of reimbursement does not rise in line with prices at the pump, those staff can easily obtain jobs in the acute sector, where they will not face the extra fuel costs? Given that we want more people to be treated in the community, that would surely be a catastrophe both for staff and for patients at home.

[Steve Barclay]

This is an important issue, and it affects different parts of the workforce in different ways. The 56p is higher than the rate approved by Her Majesty’s Revenue and Customs, and, as the hon. Lady said, it drops to 20p after 3,500 miles have been travelled. Of course, the Government are taking other measures more widely in their fiscal response to the cost of living, such as cutting fuel duty, but there is a review mechanism in respect of the NHS specifically, which involves looking at these issues in the round.

[Dame Meg Hillier (Hackney South and Shoreditch) (Lab/Co-op)]

5. What steps he is taking to encourage covid-19 vaccine uptake in adults.

--- Later in debate ---

[The Secretary of State for Health and Social Care (Steve Barclay)]

We know that general practices are still under significant pressure and demand for their services is high. We are investing at least £1.5 billion to create an additional 50 million appointments a year by 2024, and of course not all appointments are, or should be, with GPs.

[Judith Cummins]

Last week, hospital clinicians raised with me their serious concerns that they are seeing incoming case notes of vulnerable and frail patients marked with

“telephone consultation during covid-19 pandemic”,

but those consultations were just in the last few weeks. This is clearly unacceptable and is leaving many of my constituents with the very real possibility of either a missed diagnosis or a misdiagnosis. What action is the Secretary of State taking to guarantee face-to-face appointments that are easily available for the elderly and vulnerable patients who need them?

[Steve Barclay]

The number of face-to-face appointments is increasing and in May 2022, excluding covid-19 vaccines, 64% of appointments were face-to-face, up from 55%. But the hon. Lady is right to say that patients should have the choice, and that is why the NHS access improvement programme has been supporting practices experiencing greater access challenges. Indeed, one of the first visits I did in my new role was to a GP practice to look at the practical measures it was putting in place to facilitate greater access for its patients.

[Kate Hollern]

The inverse training law is depriving communities in Blackburn of access to primary care. Blackburn already has one of the lowest ratios of GPs to patients in the country, and it struggles to attract and retain GPs. The Government have committed to provide 6,000 new GPs by 2024, but according to the British Medical Association there are actually 1,737 fewer GPs as of this month. What is the Secretary of State’s Department doing to level up primary care and deliver the incentives for GPs to train and practise in communities such as Blackburn?

[Steve Barclay]

I know this is an issue of concern that the hon. Lady wrote to my predecessor about, and indeed she raised its impact on her constituency in the House last month. There are specific programmes such as the targeted enhanced recruitment scheme that was launched in 2016, and the one-off financial incentives to attract GPs to the more deprived areas. We are also looking at how we can have the right skills mix to boost not just the number of GPs but wider access to appointments.

[Jo Churchill (Bury St Edmunds) (Con)]

I welcome my right hon. Friend to his place. I offer a solution. Will he commit himself to sorting out the transfer of electronic prescriptions between hospital consultants and GPs, which would stop people trying to get appointments for prescriptions written in hospital. That would simplify things enormously, and my GPs would really welcome it. We could also do rural dispensing doctors while we are at it.

[Steve Barclay]

I always welcome solutions from colleagues on both sides of the House. From memory, Tim Ferris, who leads on tech within the NHS, is looking at a tech solution—I think it is in beta testing, although I would have to check. Appointments made shortly after a person has been discharged from hospital are often quite complex cases and create additional pressure on GPs.

Another issue I am keen to explore is GP appointments that can be done through either better use of technology or the wider skills mix so that we can better focus GPs’ time on more complex cases where their expertise delivers the best patient outcomes.

[James Gray (North Wiltshire) (Con)]

A much-needed new medical centre at Calne in my constituency was approved by the NHS in 2021, but there have since been a number of blockages to do with covid and the contractors. Will the Secretary of State look into those problems to find out what the blockages are—I think they are largely bureaucratic—and clear them out of the way to give the people of Calne their much-needed new medical centre?

[Steve Barclay]

I am very happy to look into that specific issue, which I know my hon. Friend has raised with the Department. I am happy to have further conversations with him.

[Simon Lightwood (Wakefield) (Lab/Co-op)]

The GP survey out last week shows that the proportion of people reporting their overall GP experience as very poor or fairly poor doubled between 2021 and 2022. Instead of picking a fight or blaming someone else, will the Secretary of State tell us what he will do to ensure that people in places like Wakefield can see their GP when they need to?

[Steve Barclay]

Far from blaming anyone else—notwithstanding the fact I have been in post for less than two weeks—I have set out a range of things we need to do, because this is a shared challenge that affects all our constituents, and it is within the context of increased demand. The May figures show a significant increase in appointments—1.31 million appointments per working day this year compared with 1.24 million last year. There is increasing demand, and we need to harness GP time, the skills mix and better use of technology.

[Mr Robin Walker (Worcester) (Con)]

We need more GPs and junior doctors in Worcestershire, and there is strong support from our local GPs, our acute trust and neighbouring trusts for the Three Counties Medical School in Worcester. Will my right hon. Friend meet me to discuss the case for providing funded places as swiftly as possible?

[Steve Barclay]

My hon. Friend will be aware that, through this Government’s funding, we have opened five new medical schools and, from memory, 1,500 additional undergraduate places. That is thanks to the work of the former Secretary of State, my right hon. Friend the Member for South West Surrey (Jeremy Hunt), who championed this specific initiative to address workforce pressure.

More widely, I am always happy to meet my hon. Friend the Member for Worcester (Mr Walker) to discuss issues in Worcester.

[Kim Leadbeater (Batley and Spen) (Lab)]

Does the Secretary of State agree that one way we can take some of the pressure off overstretched GP services is to ensure that pharmacists can continue to play their vital role in looking after the health and wellbeing of patients? Pharmacies across the country are closing because of financial pressures, so will he urgently look into extra support for them to recruit and retain staff?

[Steve Barclay]

The hon. Lady raises a valid and important point about getting the right service to patients, which can often best be delivered by a pharmacist. That is why, as I signalled earlier, we need better use of tech to support patients in understanding where they can best access the advice they need.

[Kate Griffiths (Burton) (Con)]

Access to GPs is a huge problem across my constituency of Burton and Uttoxeter, as it is in other constituencies. A walk-in centre in Burton would significantly ease some of the load on our GPs and hospital services. Will my right hon. Friend meet me to discuss this possibility?

[Steve Barclay]

I have had quite a few meeting requests this morning, and I am always keen to meet colleagues. My hon. Friend will be well aware that part of the reason for having integrated care boards within the place-based approach is that commissioners can determine the best mix of services in the locality, including in Burton.

[Matt Western (Warwick and Leamington) (Lab)]

7. What recent estimate he has made of the average waiting time for emergency care.

--- Later in debate ---

[Ian Byrne (Liverpool, West Derby) (Lab)]

T1. If he will make a statement on his departmental responsibilities.

[The Secretary of State for Health and Social Care (Steve Barclay)]

I am honoured to have taken on the role of Secretary of State for Health and Social Care, and to have responsibility for incredibly important services that touch all our lives. I pay tribute to my predecessor, my right hon. Friend the Member for Bromsgrove (Sajid Javid), for everything he achieved in this role, and for the dedication he showed. I also welcome my new ministerial team.

Since my appointment, I have been relentlessly focused on the urgent pressures facing health and care, including this week’s extreme weather. Yesterday I updated the House on the strong support we are giving, including extra ambulance capacity and more call handlers, and we will stay vigilant so that we can make sure our health and care system is there for those who need it.

Today marks one year since we lifted covid restrictions. While the virus has not gone away, we are able to enjoy our freedoms, thanks to the incredible vaccine roll-out. I have accepted the Joint Committee on Vaccination and Immunisation’s advice for a covid and flu autumn and winter booster campaign, in which we will roll out that vaccine further.

[Ian Byrne]

I have been contacted by many constituents working in the NHS who are struggling to cope with financial pressures, exhaustion and stress. I recently spoke to a district nurse using our food pantry in West Derby, and it was a heartbreaking example of how the cost of living crisis is impacting people across our communities. That nurse was going to lose their home and was struggling to feed their children. How does the Secretary of State plan to address the dire situation that the very people he applauded as heroes during the pandemic now face? Maybe a start would be giving NHS workers an inflation-proof rise.

[Steve Barclay]

On NHS pay, I expect to announce a response to the integrated pay review bodies shortly. We are putting more funding into the NHS, as I signalled in my statement yesterday.

[Dr James Davies (Vale of Clwyd) (Con)]

T2. Making a diagnosis of dementia is important to allow appropriate treatment, support and time to plan for the future. Pre-pandemic, the diagnosis rate for dementia in England was meeting the two thirds target, but today it is 61.9%. In Wales, data capture and quality is poor, but the equivalent rate is thought to be just 50%. Will my right hon. Friend outline what steps he is taking to improve the situation?

[Steve Barclay]

My hon. Friend will be aware that the matter is devolved to the Welsh NHS, but I can say that in the last financial year, the Government allocated £70 million to NHS England to specifically address dementia waiting lists and increase the number of diagnoses. To further support recovery of the dementia diagnosis rate and access to post-diagnostic support, NHS England is funding two trusts in each region to pilot the diagnosing advanced dementia mandate tool, which will improve access to diagnosis.

[Mr Speaker]

I call shadow Secretary of State, Wes Streeting.

[Wes Streeting (Ilford North) (Lab)]

I welcome the Secretary of State to his first oral questions and, as this is likely to be his last oral questions, also wish him the best for the future. I associate myself with his remarks about his predecessor, who of course resigned from the Government on a point of principle as others chose to remain loyal; on that note, I also pay tribute to the former Minister, the hon. Member for Charnwood (Edward Argar), for the diligent approach he took to his work and the spirit in which he engaged with the Opposition. One of the contenders for the Conservative leadership says that public services are in a state of disrepair. Another describes the NHS backlog as frightening. A third called ambulance waiting times appalling, and of course the Secretary of State for Culture, Media and Sport said that the former Health Secretary’s preparation for a pandemic was “found wanting and inadequate”. They are right, aren’t they?

[Steve Barclay]

The Government are committed to putting increased funding into our NHS. I set out yesterday the position on the resource departmental expenditure limit. Just to remind the House of the capital departmental expenditure limit, capital investment in the spending review was £32.2 billion between this year and 2024-25. The Government are committed to putting record funding into our NHS. We are also committed to funding 40 new hospitals and have allocated £3.7 billion to that programme.

[Wes Streeting]

I cannot believe that the Government are still talking about 40 new hospitals with a straight face. Nobody believes that it is true. As for capital investment, we have the lowest in the OECD and we lag significantly behind.

We have the longest waiting lists in NHS history and record waits for ambulances. People are finding it impossible to book a GP appointment. There are 400,000 delayed discharges each month because the social care support is not there. The Government are finally acknowledging that covid is still a challenge, and that the hot weather is a challenge, but they do not want to talk about their record, which is, I am afraid, at the heart of the challenge. Does the Secretary of State really believe that it is reasonable to expect NHS employers to meet the pay rise for NHS staff from existing budgets?

[Steve Barclay]

We will respond shortly to the independent pay review body, which, as part of its recommendations, weighs up the pressures on the cost of living and the other factors within its remit. The Government are delivering more doctors, more nurses, more appointments and more treatments, investing in our estate and planning for the future. That includes investment in research and development, and in future technology through our life sciences. That not only delivered the vaccine that allowed us to lift the covid restrictions that the Opposition wanted to retain, but will unlock the technologies of the future.

[Mr Speaker]

I call the Chairman of the Health and Social Care Committee, Jeremy Hunt.

[Jeremy Hunt (South West Surrey) (Con)]

May I recommend some scintillating summer reading to the Secretary of State: the study of 4.5 million patients that showed that people who see the same GP over a long period are 30% less likely to go to hospital and 25% less likely to die? Will he, after reading that, consider changing the GP contract to get rid of the micromanagement, and replace it with what doctors and patients want, which is the ability to have a long-term relationship?

[Steve Barclay]

I think my right hon. Friend knows me well enough to know that I will have a close interest in reading anything over the summer that is data driven. He highlights an extremely important issue. Just yesterday, I met with Andrea and Simon Brady, whose daughter tragically died of cancer at the age of 27. One of the key concerns that they raised with me was the lack of consistency when it came to the GP that Jessica went to see, and the fact that she kept seeing different people, and there was not continuity of care. Specific cases that I am looking into speak to this issue, and I am happy to look at the data that my right hon. Friend can share.

[Janet Daby (Lewisham East) (Lab)]

T3. As the chair of the all-party parliamentary group on sickle cell and thalassaemia, I and the chief executive officer of the Sickle Cell Society were due to meet the Secretary of State’s predecessor to discuss the experiences of and health failings for people living with sickle cell and, indeed, sickle cell patients. Will the Secretary of State meet me—if he is still in post in September—or urge his predecessor to meet me and the CEO of the Sickle Cell Society?

[Steve Barclay]

I am not sure that I will urge my predecessor to do so, but if indeed there is a successor, I will be happy to share that with them. The hon. Lady raises an important point, and I am happy to look into it.

[Tracey Crouch (Chatham and Aylesford) (Con)]

We are becoming more aware of how poor lifestyles, including with respect to diet, physical activity and stress, can contribute to an increase in the risk of cancer. Research is also highlighting that exercise, particularly moderate-intensity aerobic training, reduces side effects from treatment, anxiety, depression and recurrence rates. With that in mind, will the Secretary of State ensure that alongside diagnostics and treatment, exercise forms a fundamental part of the forthcoming 10-year cancer strategy, not only for preventing cancer but for reducing its recurrence?

--- Later in debate ---

[Edward Argar (Charnwood) (Con)]

One of the great privileges of the three years that I spent at the Department of Health and Social Care was seeing at first hand the amazing work of our NHS workforce; I put on record once again my gratitude to them. Growing that workforce is vital to meeting the future health needs of our population, so will my right hon. Friend the Secretary of State, whom I welcome to his post, reconfirm the Government’s commitment to the target of 50,000 more nurses, and update the House on progress towards that target?

[Steve Barclay]

May I take the opportunity to thank my hon. Friend for his service as Minister of State? I think he was one of the longest-serving Ministers in that role; in fact, I think he took over from me, or shortly after me. He carried out the role with great distinction, as I am sure the whole House recognises.

I am very happy to reconfirm our commitment. I think the number is at about a third of a million, and great progress is being made. That enlarged measure is down to my hon. Friend’s work as Minister of State.

[Kate Hollern (Blackburn) (Lab)]

T5. I wrote to the Secretary of State’s immediate predecessor on 16 May and followed that letter with one to the Prime Minister about the case of a young man in my constituency, Elliott Simpson. Sadly, I have not had a response. Elliott was misdiagnosed with a water wart in a telephone consultation with a GP. When Elliott finally got to see someone face to face, he had late-stage skin cancer. National Institute for Health and Care Excellence guidelines do not currently allow him to receive the necessary life-saving treatment. Will the Secretary of State meet me and Elliott’s family to discuss what can be done to get this young man the treatment that he desperately needs?

[Steve Barclay]

I am very sorry, as I am sure the whole House is, to hear of the circumstances that the hon. Lady sets out. I am happy to look at the case, as I said to her ahead of this sitting, when I discovered that she had written to my predecessor. As I also flagged earlier, the number of face-to-face appointments is increasing. Telephone consultations are not a new thing; they have been around for a long time and are an important part of the mix—indeed, some patients prefer the flexibility that they offer. But of course I am happy to meet the hon. Lady in due course.

[Greg Smith (Buckingham) (Con)]

Long Crendon Parish Council in my constituency has an exciting proposal for an innovative new health and wellbeing centre, including GP services. It has the land from planning gain, and it has an agreement to put Unity Health in as the GP partnership, but we are stretched for funds to build it. I am grateful to my hon. Friend the Member for Charnwood (Edward Argar) for his engagement over the past year. Will my right hon. Friend the Secretary of State meet me over the summer to discuss how we can move the project forward?

[Steve Barclay]

Again, as I am sure my hon. Friend will appreciate, these decisions should not be run from Whitehall and the centre. We should take a place-based approach, letting local decision-makers and commissioners make the decisions to shape the best services through their integrated care boards. My hon. Friend the Minister of State or I will engage with him to ensure that his representations are very much at the heart of any decisions that are taken.

[Rushanara Ali (Bethnal Green and Bow) (Lab)]

T6. An estimated 117,000 people are reported to have died while on NHS waiting lists. A record 6.6 million people are waiting on the NHS for treatment, and they are in pain and suffering and, in many cases, fearful for their lives. This is a direct consequence of more than a decade of mismanagement and incompetence. What will the new Health Secretary do to give the British people the guarantees that they need to make sure that more do not die while waiting for treatment on the NHS?

[Steve Barclay]

That is why we have launched a range of initiatives, such as surgery hubs and diagnostic centres, to address the very real backlog resulting from the pandemic. Indeed, the NHS has published its delivery plan for tackling the covid-19 backlog of elective care, and that is focused on four areas: increasing health service capacity, prioritising diagnosis and treatment, transforming the way that NHS provides elective care, and providing better information and support to patients.

[Dame Caroline Dinenage (Gosport) (Con)]

I welcome both the Secretary of State and the new Minister to their places and warn them that the one statistic that they will hear me say time and again is that cancer is the biggest cause of death of children under the age of 14. Both of their predecessors met my constituent Charlotte Fairall, who lost her daughter, Sophie, to a very aggressive form of rhabdomyosarcoma. Their story inspired the speech that the former Secretary of State, my right hon. Friend the Member for Bromsgrove (Sajid Javid), gave when he launched the 10-year cancer strategy. With that in mind, I would really appreciate it if the new Secretary of State restated his commitment to that strategy and to including a childhood cancer mission at its very heart.

[Steve Barclay]

The House recognises how my right hon. Friend has championed this issue over many years. There can be few more emotive issues than the one she draws to our attention. Of course, in keeping with my predecessors, I would be very happy to engage with her on this important issue.

[Ronnie Cowan (Inverclyde) (SNP)]

T7. [R] I refer hon. Members to my entry in the Register of Members’ Financial Interests. I am asking specifically about intractable epilepsy. Three NHS prescriptions have been written for the appropriate medicine, so we have proven that that can be done and that the medicine can be provided free on the NHS. When can families and friends, who scramble every month to raise thousands of pounds to pay for private prescriptions, reasonably expect to receive this medicine on the NHS?

--- Later in debate ---

[Beth Winter (Cynon Valley) (Lab)]

T8. Today, the Office for National Statistics reports that real pay is dropping at the fastest rate since records began in 2001. However, it is reported that the Government are going to punish our hard-working NHS staff even further by forcing through a real pay cut of between 5% and 6%. Will the Minister please dispel that by confirming that NHS staff will be awarded an inflation-proof pay rise?

[Steve Barclay]

The Government have committed to giving NHS workers a pay rise this year, on top of last year’s 3% rise when pay was frozen in the wider public sector. The independent pay review bodies base their recommendations on a number of factors, which include but are not limited to the cost of living and inflation, as well as the economic context and issues such as recruitment and retention. The Government are considering carefully the content of the pay review body’s report and will respond shortly.

[Alicia Kearns (Rutland and Melton) (Con)]

I want to raise the case of 10-year-old Lucas from my constituency, who has a rare form of cancer called DIPG—diffuse intrinsic pontine glioma. The only drug that would prolong his life has to come from Germany. The family have raised the funds to pay for the drug, but they are now being charged £530 per shipment in import duty. Will my right hon. Friend please help me to lobby the Treasury for an exemption, because it should not be making money off the back of this poor boy’s lasting difficulties?

[Steve Barclay]

As my hon. Friend recognises in her question, that is a decision for Her Majesty’s Treasury, but I am very happy to highlight with the Chancellor the case that she brings to the attention of the House.

[Christian Wakeford (Bury South) (Lab)]

T9. Many people in the Chamber will know of my passion for addressing alcohol harm and addiction. However, 2022 marks a decade since the last alcohol strategy was introduced, and a decade of Government inaction. With deaths reaching the highest level in 20 years and the number of those drinking at high risk rising steadily, what plans do Ministers have to introduce a new comprehensive alcohol strategy to reduce the number of lives lost to alcohol harm and save the vast cost that alcohol imposes on our society?

Ambulance Pressures

Steve Barclay Excerpts

Monday 18th July 2022 Commons Chamber

[The Secretary of State for Health and Social Care (Steve Barclay)]

Following the announcement by the Met Office on Friday of a red warning for extreme heat, I would like to update the House on the impact of extreme weather on health and care, the current covid infection situation and our plans for covid and flu vaccines this autumn.

This is the first time in its history that the Met Office has issued a red warning for extreme heat. The warning covers today and tomorrow. In addition, the UK Health Security Agency has issued its highest heat alert. Its level 4 alert, issued to health and care bodies, means that the heat poses a danger to all of us, not just high-risk groups. Although for many the risk from this heat can be mitigated by simple, common-sense steps, the extreme temperature poses a particular risk in respect of cardiovascular conditions, including heart attacks and strokes. Level 4 does not change the contingency plans in place across the health system, only their likelihood.

We have taken a number of steps in response. Cobra has convened several times, including over the weekend and earlier today, to co-ordinate every part of the Government’s response to this emergency, and I have held a series of meetings with the chief executives of ambulance trusts to discuss the specific measures that they are taking. Steps include increasing the numbers of call handlers; extra capacity for ambulances; and extra support for fleets, including the buddy system, so that calls can be diverted to another trust if there are delays in the area people are calling from. We have held numerous meetings with NHS leaders, including the chief executive of the NHS and her senior team, to continue to implement their long-standing heatwave plans. We had a further meeting again this morning. Meanwhile, ministerial colleagues have continued to liaise with our local resilience forums to co-ordinate across both health and social care.

Even before this heatwave, ambulance services in England have been under significant pressure from increased demand, just as they have across the United Kingdom. The additional pressure on our healthcare system from covid-19, especially on accident and emergency services, has increased the workload of ambulance trusts; increased the average length of hospital stays; and contributed to a record number of calls. Taken together, that has caused significant pressures, which are now being compounded by this extreme heat.

We are taking action in a range of areas. In May, NHS England published a tender for auxiliary ambulances to provide national surge capacity to support ambulance responses during the period of increased pressure. Alongside measures in ambulance trusts to assist with call handling and capacity, NHS hospital trusts are taking steps to address handover delays, in the interests of patient safety. On Friday, the NHS medical director, Steve Powis, and the chief nursing officer, Ruth May, wrote to the chief executives of NHS trusts, ambulance trusts and integrated care boards setting out some of the urgent interventions we need to make; most significantly the focus was on improved ambulance handovers and increased hospital bed capacity.

On ambulance handovers, we are asking health leaders to look again at the balance of risks across the system. We know that leaving vulnerable people in the community would have serious implications for patient safety. Equally, we know that keeping people in ambulances for too long carries other risks, especially from heat. NHS leaders are therefore asking hospital trusts to create additional space for new patients in their units. That may involve the creation of observation areas or exploring ways to add additional beds elsewhere in hospitals, including by adjusting staffing ratios where necessary, as we did during covid, and working to identify areas to mitigate additional workload, such as through greater support on wards with pharmacy and administration.

The NHS is executing its urgent and emergency care recovery 10-point action plan, which includes action across urgent, primary and community care to better manage emergency care demand and capacity. The NHS medical director and chief nursing officer both recognise that this will place an additional burden on some staff, so they are asking trusts to increase efforts on staff wellbeing and support. Alongside the measures being taken by the ambulance services and NHS trusts, the UK Health Security Agency is leading on public health comms to reduce the burden on NHS staff by making sure that we do not create unnecessary demand. We can do that by following the common-sense public health guidance and by looking out for others, in particular the elderly and the vulnerable.

With services under so much pressure, we must make sure that 999 calls are reserved for life-threatening emergencies. We must also consider what advice we can get through other services such as NHS 111, NHS online resources and local pharmacists. In addition to the immediate steps to mitigate the pressures on 999 calls, ambulance services and adult social care, we will keep building on our operational response, with particular attention to discharge and expanding on our pockets of best practice.

That is particularly pertinent, given the current levels of covid, which continue to rise. The latest data from the Office for National Statistics shows that the percentage of people testing positive for covid continued to increase across the UK. In England, an estimated one in 19 people tested positive in the week to 6 July, compared with an estimated one in 25 during the previous week, with more than 13,000 patients admitted to hospitals with covid-19.

Given those pressures and the expected pressures this autumn and winter from respiratory viruses, we are taking important steps to further align our offers on covid and flu. On Friday, I accepted the Joint Committee on Vaccination and Immunisation’s recommendations for a covid-19 autumn booster programme, focusing on vulnerable cohorts, including everyone aged over 50. At the same time, I took the decision that we should keep offering flu jabs to more cohorts than we did before the pandemic. Taken together, this will reduce the number of people getting seriously ill this autumn and winter, easing pressure on the NHS at a critical time. Vaccines have always been, and continue to be, one of the best protections we have, both for ourselves and for the NHS.

From this heatwave to the foreseeable pressures in autumn and winter, I will continue to work closely with colleagues across health and social care, as well as with Members across the House, to ensure that we can address the challenges ahead. I commend this statement to the House.

[Dr Rosena Allin-Khan (Tooting) (Lab)]

I thank the Secretary of State for advance sight of the statement and welcome him to his new role. It would have been helpful if, ahead of the current temperatures, he had responded to our urgent question last week, but I am glad that he is here now.

The Secretary of State claims that everything is in hand, but I know from my own experience and that of colleagues across the country that that is far from the truth. We have already seen ambulance wait times soar and pressure on staff spiral, all while the NHS struggles to find the essential staff needed to deliver patient care. I am sure that everyone across the House will agree that our frontline workers are truly amazing. But if nurses and doctors are so overworked and do not have the time and resources to take care of themselves in this heat, the care that they can give patients will be impacted. The Government must step up and show the urgency that this crisis demands.

The Secretary of State talks of creating additional space for new patients in hospitals. How will that happen—with what money, what resources and what staff? Will the Government try to call those new hospitals, too? Is not the reality that creating capacity elsewhere in hospital really means patients being left in corridors on trolleys or in car parks? Can he assure us today that that will not be the case?

Under the Conservatives, the NHS is simply struggling to cope. A record 6.6 million people are waiting for NHS treatment—and they are waiting longer than ever before, often in pain and discomfort. The people in our thoughts this afternoon are those waiting in queues outside hospitals in ambulances, with soaring temperatures and no air conditioning. If it were dogs or cattle, it would be against the law, but these are people in tropical heat unable to enter hospitals. People with conditions triggered by excessive heat are unable to get an ambulance, because ambulances are logjammed outside A&E. Will the Secretary of State apologise to them and their families?

This situation is impacting mental health, too. People attending A&E experiencing a mental health crisis cannot get a bed in a psychiatric hospital, so they wait in A&E, some of them for more than three days. Why? Because the Government have spent the past decade cutting a quarter of mental health beds.

I worked in A&E over this weekend and saw the amazing work being done by staff to prepare for the record heat. The heatwave and surge in covid cases are putting additional pressures on the NHS. I am glad that the Secretary of State recognised that in his statement. Without doubt, 12 years of Conservative mismanagement and underfunding have left our health service unable to cope, which not only has an impact on patients but hurts staff. Staff morale is at rock bottom. Is it any wonder that 5.7 million days were lost to mental ill health in the NHS last year?

Last week, the Minister of State claimed that the Government had procured a £30 million contract for an auxiliary ambulance service, but, moments later, it was revealed that it was yet to be awarded. Can the Health Secretary confirm whether the Minister of State has issued a correction yet?

On Wednesday, ambulance trusts were placed on their highest possible alert level. A national emergency was declared on Friday and, over the weekend, hospitals were scrambling to increase capacity. Why then has it taken until today for the Health Secretary to step up and show leadership? Can he tell us who he met over the weekend? I do not mean at Chequers; I mean from the NHS. Can he also tell us why the Prime Minister did not think it necessary to chair Cobra today? Just when we thought irony had reached a peak, the Prime Minister spent the weekend partying when he should have been dealing with a health emergency. Has the Secretary of State spoken to the Prime Minister today? The Health Secretary has been too slow. The Prime Minister has not even bothered to turn up and the Government have gone AWOL.

If the Government will not step up now, then Labour will. As temperatures reach a record high, all we are getting from the Government is more hot air. This is a crisis. The country has one message for Ministers: stop squabbling and plotting, do your jobs and get a grip.

[Steve Barclay]

Let me start with the area on which the hon. Lady was correct, which is that I recognise the increased pressure on ambulances and hospitals. That is why we put in place the long-established contingency plans. Since the heatwave in Paris in 2003, it is the case that each year in May, we put in place our heatwave plans. That is what has been activated. Those plans were refreshed as recently as two months ago and sit alongside the work that has been done on urgent and emergency care, including the 10-point action plan that was set out last September.

The hon. Lady is right: the House as a whole will recognise the significant pressure on the system, which is why we are taking the steps from our contingency plans. It is also why we have put in specific funding, such as: the additional £150 million of support targeted at the ambulance service; an additional £50 million for 111 calls to build capacity; and as she said, an additional £30 million for auxiliary ambulances, which is what the Minister of State, my hon. Friend the Member for Lewes (Maria Caulfield), was referring to in the House last week.

The Met Office and the UK Health Security Agency went to level 4 on Friday. As you will know, Madam Deputy Speaker, I updated the House on the first available sitting day after that. The irony will not be lost on the House that this issue is seen as so important that the shadow Secretary of State for Health and Social Care has failed to turn up to this statement in the middle of a heatwave. [Interruption.] Well, he is not here, which speaks for itself.

The hon. Lady also suggested that these challenges, which are being faced across Europe as a whole, were in some way due to the overall investment in the NHS. I remind the House that, to take the resource departmental expenditure limit alone, RDEL in 2010 was just under £99 billion and last year it was £150 billion. That is a good indication of the significant funding. We could also come on to capital investment, not least with the 40 hospitals programme, part of a £22 billion package to 2030, which underscores this Government’s commitment to investing in our NHS—an investment that, most recently, the Labour party voted against when we brought it to the House.

The hon. Lady asks about an apology for operational levels of performance. I do not know whether she is asking for that apology from the Welsh Government or just from the English Government. She may want to clarify that, given the performance of the Welsh ambulance service under the Welsh Government.

On the hon. Lady’s point about auxiliary, the Minister of State, Department for Health and Social Care, my hon. Friend the Member for Lewes, said in her statement that we had seen improvements in May. I referred to that as context, but on auxiliary in particular I can clarify for the House that a contract is being procured for auxiliary ambulance services and is expected to be concluded shortly.

Finally, the hon. Lady asked what meetings I have held over the less than two weeks that I have been in post. I am happy to share with the House that I have been on visits to four different hospitals, in Whipps Cross, Hillingdon, King’s Lynn and Bedford; I have been out on two different ambulance shifts, been to three different ambulance centres, been out to see GPs to look at boosting access to their services and been to look at life sciences. I have been engaging, and that sits alongside, for example, the meeting with chief execs of ambulance trusts on Saturday, Cobra on Saturday and other such meetings that I have had in the course of my duties.

Finally, the hon. Lady asked about the Prime Minister’s engagement. Just as the Chancellor of the Duchy of Lancaster set out that he was engaging with the Prime Minister in his role chairing Cobra as Minister for the Cabinet Office, I am happy to confirm to the House that I also engaged with the Prime Minister over the weekend, updating him on the health plans we have put in place. He has been closely engaged on the contingency we have put in place.

[Madam Deputy Speaker (Dame Rosie Winterton)]

I call the Chair of the Health and Social Care Committee, Jeremy Hunt.

--- Later in debate ---

[Steve Barclay]

I am grateful to my right hon. Friend for that warm welcome. I was Minister of State when he was Secretary of State, and hugely valued the expertise, diligence and insight that he brought in that role, which provide useful context as I take on my new duties. He is absolutely right; indeed, he will recall, in 2018, looking in detail at delayed discharge, and work on that key issue continues. For example, on 1 July the NHS launched a 100-day sprint looking at all the known interventions. One issue that he and I have discussed in the past is how to socialise best practice and industrialise innovation at scale, and we are looking specifically at that. There is also a call for expressions of interest in pioneer science to better use tech and innovation on delayed discharge, and of course there is £2.6 billion of investment in the better care fund to support that integration work through the integrated care boards.

[Mrs Paulette Hamilton (Birmingham, Erdington) (Lab)]

Although I welcome the additional resource in response to the heatwave, it is simply not enough. Does the Secretary of State agree that until the Government address the systematic problems in social care to ensure that it is properly funded and people can be discharged quickly into the community, and we no longer see the revolving door service that is proving so damaging in the sector, we will not truly be able to reduce the pressures on the ambulance service?

[Steve Barclay]

The hon. Lady brings great practical insight on these issues from her profession as a nurse. The point she raises, as did my right hon. Friend the Member for South West Surrey (Jeremy Hunt), is absolutely right—delayed discharge has long been a key issue. That is why we have made the tough decisions we have on national insurance and why we brought forward the changes on integrated care boards. It is an area of common ground across the House that we need to work better to address delayed discharge, which blocks the pipe and, in turn, delays ambulance handovers and causes problems at an earlier stage. It is a key issue. I have set out a number of practical measures that we are taking, and further work is ongoing.

[Tim Loughton (East Worthing and Shoreham) (Con)]

On Friday afternoon, I spent a shift with the A&E staff at the fantastic Worthing Hospital, which is clearly being impacted, in particular, by older people affected by the heat. The staff said to me—the Chairman of the Health Committee mentioned this—that more than 15% of the beds are being occupied by people medically fit to be discharged. They also said that a huge amount of their time is being taken up by people with mental health problems, including those being brought in by the police, most inappropriately. What more can be done to make sure that people with mental illness are being looked after away from A&E departments, as is far more appropriate, and to speed up the process of freeing up those beds?

[Steve Barclay]

My hon. Friend is absolutely right on mental health and where a patient is violent, as I saw for myself on my visit to Bedford, for example, that can be unsettling for A&E. I am happy to have further conversations with him on what measures can be taken. The fact is there is no single intervention in this space; it is a question of looking at the integrated approach. That is what the call for evidence is about. Also key is understanding the data and seeing where it can better target action on areas such as mental health that can have a disproportionate impact.

[Daisy Cooper (St Albans) (LD)]

It is absolutely right that we limit the amount of time that patients must spend in the back of ambulances, and I welcome that measure, but it is putting intolerable pressure on hospitals. This morning, health leaders told me that they simply do not have the space or the staff, and the one thing they need in the next few hours is more staff. Can the Secretary of State commit himself to ensure that in the next few hours there are no financial or other barriers to the NHS being able to access more NHS bank staff, paramedics and ambulance drivers from the fire service, and, if necessary, from the military?

[Steve Barclay]

The principle of subsidiarity is that, as part of the extreme heat plans, local trusts make decisions locally on targeting resource, whether that has an impact on outpatients or other services, to meet the increased pressure. The hon. Lady is absolutely right that there is significant increased pressure, as we see in the call volumes coming in to 999 and 111. Part of the contingency plans that are in place is to surge resource, but it is also partly about being clear where risk best sits. At the heart of the letter from NHS medical director Stephen Powis on Friday was the importance of not pushing risk out into the community where it is an unmet need, or into the ambulance, where it is best that patients are, but having that risk more on the ward, where a patient is known and can receive care. Local contingency plans are in place to allocate resource to meet that.

[Mims Davies (Mid Sussex) (Con)]

I pay tribute to all my Mid Sussex constituents on the frontline of all our emergency services in this extreme heat. They are absolutely continuing their heroic efforts, whether on the NHS backlog, managing discharges, as we have heard, or managing the impact of covid. Following recent media reports, will the Secretary of State note the constraints in certain ambulances, which my constituents have also raised, with cabs being too small and seatbelt use impacted for those over 6 feet tall? The impact of those new ambulances is on the agenda at a meeting for West Sussex MPs with SECAmb—South East Coast Ambulance Service NHS Trust—this Friday.

[Steve Barclay]

First, I am happy to join my hon. Friend in paying tribute to the work of the local staff in her ambulance trust. She raises an important point about the fleet, and I was very interested in this issue four years ago when I was ambulance trust Minister and discovered that there were, I think, 32 different types of ambulance. When I was out with crews over the past fortnight, one of the issues we discussed was the merits of tailgates so that people are not suffering work absence and musculoskeletal injuries because they are trying to push heavy loads on to an ambulance. I am interested in exploring with her and colleagues how we get the right standardisation and the right fleet in place. Indeed, we have been targeting additional money to support that work.

[Matt Western (Warwick and Leamington) (Lab)]

Since March, West Midlands ambulance service has been on the highest level of alert, and I understand that it was joined by the other ambulance services across England last week. In May, Mark Docherty, the director of nursing for West Midlands ambulance service, predicted that the service would collapse by 17 August—that is a month away from now—if hours lost by crews delayed outside hospitals kept increasing, which of course they have. Can the Secretary of State give some specific answer on what he is doing to address the issues in the west midlands, and also in our care homes, which are a root problem of trying to get people out of hospitals?

[Steve Barclay]

The hon. Gentleman is right that the west midlands in particular has been under significant pressure, and 111 ambulance service response times are significantly challenged, which is driven by wider system pressure and delayed handing over of patients. The measures taken through the national support that is going in include handover delay improvements, on which works is taking place across all integrated care boards. NHS England has allocated an additional £150 million to support the system, and an extra £20 million of capital is going into fleet. Given that I am new in post, I am happy to meet the hon. Gentleman to discuss any specific issues about the West Midlands ambulance service’s performance.

[Philip Dunne (Ludlow) (Con)]

May I congratulate my right hon. Friend on his new role and say how important, given this particular crisis, his previous experience as Minister of State for Health is? He took over that role from me, and he had ministerial responsibility for ambulances.

On Friday, I attended an ambulance summit with other Shropshire and Telford MPs, West Midlands ambulance service and NHS leaders in Shropshire, where we were told that one of the critical issues in ambulance response is the handover wait times at hospitals. Royal Shrewsbury Hospital was averaging two and a half hours for handover in the first two weeks of July, and the Princess Royal Hospital in Telford was at three hours.

The problem is not so much conveyance by ambulance because it is hard to reach patients, but ambulatory walk-ins at our hospitals increasing the volumes of patients being seen in A&E. The problem with that increase in patient volume is patient flow and discharge at the far end. May I suggest that the quick win would be to increase resources for social care, particularly for domiciliary care workers who at present, particularly in rural areas, have to pay for their own transport to get from one patient to another? If we could improve those conditions, it would boost the ability to discharge patients.

[Steve Barclay]

My right hon. Friend, partly through the direct experience he brings to these issues, highlights the integrated nature of the challenge we face and in particular the importance of getting the right domiciliary care and care home support in place. Part of that challenge in the coming weeks, ahead of any autumn and winter pressure, will be to understand what the capacity is and what the constraints on it are, so that through the integrated care boards we can better focus on unlocking that capacity to relieve the pressure on ambulance handovers, as he sets out.

[Rachael Maskell (York Central) (Lab/Co-op)]

Older and more vulnerable patients can become medically compromised very quickly in extreme heat. In Yorkshire, category 1 calls can be waiting for 9.5 minutes over the expected time, category 2 calls can be waiting for 18 minutes over, and those with other medical conditions can be waiting 2 hours 41 minutes over. People clearly need support and assessment far earlier. What is the Secretary of State doing to deploy first responders in such areas so that people can get a medical assessment and early intervention far quicker?

[Steve Barclay]

I broadly agree with the hon. Lady on providing targeted support, particularly to those in domiciliary care; we are working with those in primary care on that. In coming days, that will happen specifically through local resilience forums, but in the medium term it will be more through the integrated care boards. That is part of a wider package of support measures that need to be put in place. It will include working with primary care, looking at mental health support, and looking at what can be done to raise productivity through better use of innovation and technology. We will look at all the interventions available across the board to assist us in dealing with the pressures that she highlights.

[Andrew Percy (Brigg and Goole) (Con)]

I spent this weekend on duty, in my role with the Yorkshire ambulance service. I remind my right hon. Friend of the important work and extra resilience that community first responders will provide in the next few days, as they are stepped up and attend the most serious 999 calls. The reality is that even before this situation, when attending very serious cases, we were often waiting much longer than we did in the past for back-up from the crew. Will he look at a model that I have pushed before: the advanced paramedic model, which gives paramedics more clinical confidence to discharge patients to their home, and so reduces demand on hospitals?

[Steve Barclay]

I am happy to look at that, and I thank my hon. Friend for his service locally. I am keen to follow up on his point, because it is absolutely right. From the feedback from ambulance trusts so far, it seems that category 2 average response times were broadly stable at the weekend, but how we triage, how we categorise calls, and what additional support can be given by considering the skills mix are all factors in improving performance.

[Helen Morgan (North Shropshire) (LD)]

I also attended the meeting on Friday morning about Shropshire’s health crisis, and I echo the comments of the right hon. Member for Ludlow (Philip Dunne) on that. Quite apart from this week’s heatwave, there is increased demand on Shropshire’s ambulance service, and the local team are clearly working hard to find solutions, but I did not feel reassured that they had any quick fixes for this crisis. One of their big problems is with recruiting social care workers; the team say that they have never seen a market like it. What is the Secretary of State doing to address the critical workforce problem in social care, not only in rural areas but across the country?

[Steve Barclay]

Through initiatives such as the better care fund and the £2.6 billion of investment, we are looking at how to allocate funds in an integrated way. That requires better integration of data between the care sector and the NHS, and that is an area that I am keen to explore.

[Lee Anderson (Ashfield) (Con)]

I recently had the good fortune to spend a few hours with an ambulance driver from Ashfield who drives for the East Midlands ambulance service. He told me that he is so frustrated, because a lot of the time, the ambulance gets to the caller, and the person simply does not need an ambulance. He raised this with his bosses, but they are scared to admit that. Is it not about time that somebody from the Department of Health and Social Care had an honest conversation with the people who actually do the graft—the drivers and the ambulance staff?

[Steve Barclay]

I know from conversations in recent days that there has been significant work around dispatch, the assessment of calls and the role of clinicians, particularly in 111. There is further work with frequent callers. I went out with the London ambulance service, and one of our visits was to someone who had had 140 ambulances visit him over the past year and a half. There are initiatives, and work going on, on how we assess calls and get dispatch right, but I am very happy to take forward the comments that my hon. Friend makes.

[Chris Bryant (Rhondda) (Lab)]

I, too, congratulate the right hon. Gentleman on his new post.

The Chair of the Health and Social Care Committee raised the question of what happens when people are ready to go into the community, but there is nowhere there for them to go. There is an even worse example: people who have major brain injuries, for instance as a result of a road traffic accident. The ambulance staff will get them to the major trauma centre, which will save their life, but if they are to get back their life with any degree of independence, they need a prolonged period of neuro-rehabilitation. Some of that will happen in hospital, but across large swathes of the country, there is nothing—absolutely no provision—outside hospital. With any other condition, we would not expect treatment, once started, not to be finished. How can we make sure that neuro-rehabilitation services, which give people back their life, are available across the whole country, and that there is no postcode lottery?

[Steve Barclay]

I know the hon. Gentleman is co-chairing, with the Minister for Care and Mental Health, a strategy board looking at these issues, and I would be very keen to explore that with him in due course. There is an opportunity—not just from a health perspective, but from a levelling up perspective—to look at the pockets where there are gaps in the way he sets out, and to see how we can get better coverage geographically as well as address the very real health needs he identifies.

[Mark Pawsey (Rugby) (Con)]

My constituents attribute the deteriorating response times in Rugby to the decision of the West Midlands ambulance service to close our community ambulance station at the Hospital of St Cross—a decision taken without reference to doctors, councillors, residents or the local MP. Does the Secretary of State agree that decisions of that nature should be made only after consultation and with the support of local stakeholders?

[Steve Barclay]

I do not know the specific circumstances of the case my hon. Friend highlights, but in general good consultation and engagement with stakeholders will of course lead to better and more informed decision making. Where decisions have been taken and the outcomes proceed in a sub-optimal way, I know from my knowledge of my hon. Friend that he will make such a case in the strongest terms.

[Clive Efford (Eltham) (Lab)]

It is worth remembering that the 2010 to 2015 Conservative Government took £6 billion out of social care, so it is no wonder that we are facing a logjam. Since 2015, not once have the Government hit their four-hour target at A&E, and it is down to less than 72% on average right now. This logjam is created by the Conservative Government’s mismanagement of our national health service, so what is the Secretary of State going to do to get back to the four-hour target for A&E?

[Steve Barclay]

This Government are investing in our NHS. That is why the resource departmental expenditure limit, which in 2010 was £99 billion, went up last year to £150 billion. It is why we are investing more than £10 billion in capital this year alone. It is why the NHS will get an uplift of about £38 billion over the five years from 2019-20 to 2024-25, and it is why this Government have invested in our 40 hospitals programme as part of a £22 billion commitment.

[Jack Brereton (Stoke-on-Trent South) (Con)]

We have seen some serious issues with the West Midlands ambulance service and congestion at the Royal Stoke University Hospital, and it is only a few years ago that we saw people dying in the corridors at that hospital. Will my right hon. Friend look at what we can do to address these issues, and ensure that we do not just move people from queuing outside the hospital back on to high-risk corridors?

[Steve Barclay]

That specific point about where risk best sits within the system was addressed in the letter from the NHS medical director on Friday. Of course, the best way of addressing that risk is to address the issue of delayed discharge. We are getting people out of hospital through initiatives such as the better care fund, the £2.6 billion of investment and the use of integrated care boards. Their use will enable us to take a more integrated approach to unblocking those who are in hospital unnecessarily, which is not only very expensive but fundamentally bad for their care. It is important that we address delayed discharge as a key priority.

[Jim Shannon (Strangford) (DUP)]

I thank the Secretary of State very much for his responses to the questions that have been asked. To give an example that I hope will be helpful to him—this is a devolved matter—when one of my constituents fell and badly hurt her leg last week on rocks offshore, she was able to send a photograph of her injury, and as a result an ambulance was dispatched urgently and she was rescued. My concern is about those who are not high-tech enough to send photographs of injuries to prove that they are ambulance-worthy. Can I ask the Secretary of State how it would be possible to triage calls in a way that does not put pressure on people, but addresses the potential misuse of emergency ambulance requests?

[Steve Barclay]

I am happy to look at any specific issues that flow from the hon. Gentleman’s constituency case. The more we can use tech and innovation better to address those issues at pace, the more that will ultimately lead to better patient outcomes.

Public Health

Steve Barclay Excerpts

Tuesday 14th December 2021 Commons Chamber

[The Chancellor of the Duchy of Lancaster and Minister for the Cabinet Office (Steve Barclay)]

Throughout today’s debate, we have heard the sincere and heartfelt views of hon. and right hon. Members from across the House. I recognise the strength of feeling, and will turn to each of the statutory instruments for consideration before the House, but before I do, may I recognise the constructive approach taken by the Opposition Front Bench?

We are learning more about the omicron variant each day, but we already know that no variant of covid-19 has spread this quickly. It will become the dominant variant in London in the next 36 hours, and soon across the UK as a whole. It is right that we take a cautious approach to the arithmetic, alongside a strong communications campaign of the sort called for by my right hon. Friend the Member for South Northamptonshire (Dame Andrea Leadsom).

[Dawn Butler (Brent Central) (Lab)]

Will the Minister give way?

[Steve Barclay]

In a moment.

There is much that we still do not know about this virus, as there is a wide range of opinions on its severity. Hospitalisations and deaths always lag infections by about two to four weeks. We are not at the topping-out point in South Africa, so we do not know what the peak will be, but even a small percentage of widespread transmission will be significant—a point rightly made by the Opposition Front Bench, and the Secretary of State when he opened the debate. This is not, as some suggest, solely an issue for the NHS. Widespread infection and staff absences would have a wider economic impact on areas from our supply chains to our factories.

[Chris Bryant]

The Secretary of State said earlier that he might be able to provide the House with an update on the issue of whether people who have come back from South Africa and are stuck in quarantine have to fulfil their whole quarantine. I have constituents from the Rhondda—rugby players—who are still stuck. They had already done 10 days of quarantine in South Africa; surely they can be released tomorrow.

[Steve Barclay]

I will come to that matter directly—not just because they are rugby players, but because it is an extremely important issue.

[Chris Bryant]

They are Welsh rugby players.

[Steve Barclay]

Indeed.

[Dawn Butler]

The Minister is absolutely right that we have to do all that we can to stop the spread of the omicron variant. I am sure that, like me, he is encouraging people to take the vaccine and the boosters. Parliament is a really large venue; about 3,000 people work here. Will the Minister confirm that everybody on his side of the House has been doubly vaccinated, and that a covid pass situation will be relevant to MPs, who will be huddled together—hundreds of us—voting today? What protections will MPs have to ensure that we are safe?

[Steve Barclay]

I am not sure whether the hon. Member has been in the Chamber for the whole debate, but throughout the day there has been consensus across the House on the importance of being vaccinated and of boosters; that has been a point of agreement. Obviously, the management of the House is a matter for Mr Speaker, not for me. As my hon. Friend the Member for Bexhill and Battle (Huw Merriman) correctly highlighted, he and our constituents will continue to be able to access all facilities, as before. I point out to the hon. Member for Brent Central (Dawn Butler) that it is still possible to go to nightclubs, just as it is possible to vote, and these measures will not prevent that.

As well as omicron’s transmissibility, we are also beginning to learn more about the effectiveness of our vaccines against it. Boosters were important before omicron, but they are now critical and, as of this evening, we have delivered 24 million across the United Kingdom. Boosters are, without question, the single most effective thing we can do and plan B buys us more time to get more boosters into more arms. I pay tribute to my hon. Friend the Member for Bosworth (Dr Evans), who, as a GP himself, highlighted the importance of addressing the 15-minute wait period to increase the flow of boosters—a decision that the chief medical officers across the UK have supported. I also concur with my right hon. Friend the Member for North Somerset (Dr Fox), who rightly highlighted that the second dose is important alongside the booster.

The early evidence suggests that a booster dose is extremely effective; analysis by the UK Health Security Agency shows that a booster dose is 70% to 75% effective at preventing symptomatic infection. That is particularly important given the speed at which this infection is spreading, which means that the increase will be sharper, and its impact more concentrated, over a shorter period of time.

The hon. Member for Rhondda (Chris Bryant) raised an issue. The Health Secretary flagged up in opening the debate that he intended to remove all 11 remaining countries from England’s red list as of 4 am tomorrow. The Health Secretary has urgently considered the issue of releasing people from managed quarantine before they have completed the 10-day isolation—a point also raised by the right hon. Member for Exeter (Mr Bradshaw) and a number of Members from across the House. The Government’s decision is that we should permit early release of those who went into managed quarantine before the changes to the red list and require them to follow the relevant rules as if they had arrived from a non-red list country. Anyone who has tested positive will need to continue to stay in managed quarantine. That will require changes to regulations. We will look to implement that as quickly as possible and we will set out further specific guidance for affected individuals imminently.

I turn now to the statutory instruments before the House. The weight of scientific evidence shows that face coverings can make a difference, even if, as my right hon. Friend the Member for South West Wiltshire (Dr Murrison) said—he is a clinician himself—it is the least that we can do to wear these wretched things. Regulation 1400, which extends the use of face coverings, is a simple step to help slow the spread and I welcome the support of Members. Even those with concerns, such as my hon. Friend the Member for Winchester (Steve Brine), said that they would not oppose such a measure.

It is vital that we draw on our testing capacity to keep Britain moving. Regulation 1415 enables close contacts of confirmed or suspected covid cases who are fully vaccinated to take lateral flow tests every day for seven days. In response to my right hon. Friend the Member for Tunbridge Wells (Greg Clark), the lateral flow tests will be self-reported.

Regulation 1416 regarding entry to venues and events is one I know that hon. Members have given considerable attention. But this is very far from what has been described as a vaccine passport—a point that the Health Secretary made in opening the debate. This measure will mean that a negative lateral flow test is required to get into nightclubs and large events, with an exemption for the double vaccinated. Once all adults have had a reasonable chance to get their booster jab, we intend to change this exemption to require a booster.

Vaccination has been and remains our best line of defence. We have heard many contributions from across the House on making vaccination a condition of deployment for staff in health and wider social care settings. I recognise how emotive this issue is. Whether it is our care homes, our hospitals or other health settings, everyone working in health and social care is there to avoid preventable harm to the people for whom they care. As the chief medical officer has rightly said, people who are looking after other people who are vulnerable have a professional responsibility to get vaccinated, which was a point that another clinician—my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter)—made.

In closing, I am grateful for all the contributions today. The measures before us will help us to buy time and deliver boosters, which will provide the best protection against this variant. Vaccination, which was already so important before omicron, is now doubly important, especially in those settings with some of our most vulnerable people. I commend the regulations to the House.

[Madam Deputy Speaker (Dame Rosie Winterton)]

Order. To address the point raised by the hon. Member for Brent Central (Dawn Butler), in the event of Divisions, it is likely that there could be a large number of Members voting in one Lobby this evening, so Mr Speaker has agreed that 12 minutes should be allowed before I call for the doors to be locked. Members should accordingly be aware that they do not need to crowd into the Lobby at the beginning of the vote, as there will be more time to vote than usual.

6.30 pm

The Deputy Speaker put the Question (Order, this day).

Healthcare (International Arrangements) Bill

Steve Barclay Excerpts

Wednesday 14th November 2018 Commons Chamber

[The Minister for Health (Stephen Barclay)]

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

This is a short Bill, with six clauses, to enable continuity of healthcare for British nationals and EU citizens after Britain leaves the European Union. It is clearly in the interests of the British public to ensure reciprocal healthcare arrangements continue when we leave the EU, whether that happens through an agreement with the EU itself or through individual agreements with EU member states. By enabling us to implement those arrangements, the Bill will help us to help nearly 200,000 British pensioners living in EU countries to continue to access the medical treatment that they need, and it will mean that the hundreds of thousands of British citizens who require medical treatment each year during holidays in Europe can still be covered for medical assistance when they need it.

The Bill will help to ensure that UK nationals who live and work in EU countries can continue to access healthcare on the same basis as local people. It will mean that EU citizens can be covered for reciprocal healthcare here, so that the UK continues to be a place tourists want to visit and vital workers, such as our NHS workforce, want to live in. The Bill will also mean that we can continue to recover healthcare costs from Europe as we do now.

[Henry Smith (Crawley) (Con)]

A few years ago, I presented a private Member’s Bill on the recovery of costs under the European health insurance card scheme. More than half of NHS trusts did not record the treating of foreign nationals at all so that they could claim back on those reciprocal arrangements. Can I get an assurance that, under the new arrangements, the NHS will be properly refunded for the care it provides to those from other countries?

[Stephen Barclay]

My hon. Friend makes an important point. Perhaps I should declare that, when I was a Back Bencher, I tabled a number of parliamentary questions on that very issue, relating to my hospitals and to claiming. We pay out around tenfold what we recover. I will come on to that point, but part of the Bill relates to the NHS’s increased focus on the issue, which he is correct to raise.

Reciprocal healthcare agreements benefit people in all regions and nations of the United Kingdom. The Department of Health and Social Care currently funds and arranges EU reciprocal healthcare for people from England, Scotland, Wales and Northern Ireland. The Bill will allow us to continue doing that, if agreed with the EU. We have been working for some time now with the devolved Administrations and will of course continue to do so to ensure that we legislate for reciprocal healthcare in a way that fully respects the devolution settlements.

We can all agree that access to healthcare is essential both for British nationals living in European countries and for EU citizens living in the UK. The Bill will also allow us to strengthen existing reciprocal healthcare agreements with non-EU countries and explore new arrangements. As the Prime Minister said last night, the negotiations for our departure are now in the endgame and we are working to reach an agreement. As Members would expect, we are continuing to make the necessary preparations for all scenarios. It is in everyone’s interests to secure a good deal, but it is the job of a responsible Government to prepare for all scenarios, including in the event that we reach March 2019 without agreeing a deal.

In the event of no deal, the powers in the Bill will help to implement deals with EU countries that will seek to provide continuity of care for UK nationals and avoid a cliff edge. The powers will enable the UK to act swiftly to protect existing healthcare cover for British nationals in the EU, the European economic area and Switzerland, whether deals are made with the EU or individual member states. That is in the interests of everyone and, most importantly, will benefit millions of UK nationals who live, study, work or travel in mainland Europe.

British people who have paid their taxes in the UK their whole working lives and have retired to Spain, France or other EU countries should not have to worry about healthcare and how much it is going to cost them. Similarly, the millions of British people who travel to mainland Europe each year should be able to do so with the peace of mind that the European health insurance card scheme brings. These schemes are popular across the UK. There are currently 27 million EHIC cards in circulation in the UK, with 5 million issued each year. Reciprocal healthcare arrangements enable UK nationals to access healthcare whether they live in, work in or visit EU countries.

The current arrangements involve EU member states reimbursing one another for healthcare costs. We support UK nationals in the EU by spending approximately £630 million a year on healthcare for British expats and tourists. At present, we recover £66 million each year from EU member states under the same rules, but that amount is increasing as the NHS gets better at identifying EU visitors and ensuring that the UK is reimbursed for care provided, which speaks to the point that my hon. Friend raised. It is a net spend because many more British pensioners and tourists go to Europe than the other way around.

It is clearly in the interests of the British public to ensure that reciprocal healthcare arrangements similar to those currently in place continue when we leave the EU. The Bill does not affect the UK’s ability to negotiate or enter into international agreements, and the details of any new reciprocal healthcare arrangements will remain subject to negotiation and parliamentary scrutiny.

Until now, the majority of UK-EU reciprocal healthcare has been enabled by EU regulations. Once we leave the European Union, the EU reciprocal healthcare arrangements will no longer apply in the UK in their current form and we will need new legislation to provide for future arrangements. With a deal, the withdrawal agreement will enable the continuation of existing reciprocal healthcare rules during the implementation period, and afterwards for people covered by that withdrawal agreement, but it is not a long-term arrangement for the British public as a whole, does not provide for the event of the withdrawal agreement not being concluded and does not cover healthcare arrangements with countries worldwide.

The UK already has important agreements in place with Australia, New Zealand and many of our Crown dependencies and overseas territories and the Bill will help us to strengthen those, should we wish to, or seek new arrangements with other countries. The Bill underscores the Government’s commitment to reaching a robust reciprocal healthcare agreement with the EU.

This is important and necessary legislation, introduced so that the British public can look to the future with confidence that they will get the healthcare they need, when they need it. I commend the Bill to the House.

--- Later in debate ---

[The Minister for Health (Stephen Barclay)]

With the leave of the House, I thank everyone who has spoken in the debate. This is a short and sensible Bill, which will ensure that the Government have the appropriate legal framework to give effect to a deal in relation to reciprocal healthcare arrangements, which so many of us, both here and abroad, enjoy. I am grateful for the support in principle for the Bill from both sides of the House, including from the Opposition Benches.

The level of interest in and the contributions to the debate demonstrate that it is clearly in the interests of the British public to ensure that reciprocal healthcare arrangements similar to those currently in place continue when we leave the EU. A number of questions have been raised in the debate, which I will endeavour to answer in my closing remarks. However, as my opposite number, the hon. Member for Ellesmere Port and Neston (Justin Madders), pointed out, we will have an opportunity in Committee to scrutinise those questions in more detail. He raised a number of very pertinent points, which I will be keen to explore with him.

I would like to reiterate the offer I made in a recent letter to all Members of the House to have meetings with me and the team of officials working on the Bill if they want to explore the Bill in more detail. I recognise—this point was picked up by my hon. Friend the Member for North Thanet (Sir Roger Gale)—that this issue genuinely concerns constituents of Members on both sides of the House. I am keen to engage with Opposition Members, the Chair of the Health Committee and other colleagues on the detailed issues they may wish to raise on behalf of constituents.

[Mr Philip Dunne (Ludlow) (Con)]

I am grateful to my hon. Friend, and I would like to take advantage of his offer, but I would also like to highlight another issue. I do not wish to extend the competence of the Bill unduly, but it is an opportunity for us to look at the reciprocal health agreements we have with the overseas territories, as mentioned by my hon. Friend the Member for Chichester (Gillian Keegan), and particularly with United Kingdom dependent territories—I am thinking here of the Channel Islands. Under the previous Labour Government, the reciprocal health agreement with Jersey was ripped up and terminated in 2009. Under the coalition agreement in 2011, it was reinstated. However, at present, there is no reciprocal health agreement with Guernsey, which is also responsible for Alderney and Sark. I ask the Minister to consider that during the passage of the Bill.

[Stephen Barclay]

I am grateful to my hon. Friend for raising that. Understandably, much of the debate today has focused on the EU element of the Bill, but he is quite right to recognise that the reciprocal element extends beyond the EU and particularly to Crown dependencies, overseas territories and countries such as Australia, New Zealand and elsewhere. I am very happy to have those discussions with him.

My opposite number, the hon. Member for Ellesmere Port and Neston, raised a number of points, one of which was the impact on people with long-term conditions. I agree that, without reciprocal healthcare, people with long-term conditions, including those who need dialysis, may find it harder to travel, which is the very essence of why the Bill is necessary, so that we can implement a reciprocal arrangement with the EU or, failing that, with individual member states to support the travel arrangements of those with long-term conditions.

The hon. Gentleman also questioned the £66 million figure that I referenced in my speech, and I am happy to point out that that was in relation to the 2016-17 value of claims made by the UK to EU member states. He also asked about cost recovery more generally and, since 2015, we have increased identified income for the NHS under reciprocal arrangements by 40%, and directly charged income has increased by 86% over the same period. I mentioned the increased focus on that to my hon. Friend the Member for Crawley (Henry Smith), which I hope gives a signal of intent as to the direction of travel on cost recovery.

The hon. Member for Ellesmere Port and Neston also mentioned the role of NHS Improvement, and I am happy to clarify that it is now working with more than 50 NHS trusts to improve their practices further, with a bespoke improvement team in place to provide on-the-ground support and challenge in identifying and sharing best practice.

The hon. Gentleman also mentioned an important point, and one that we will probably go into in more detail in Committee, on data. Again, the policy intent is continuity, rather than a change in our approach to data. Clause 4 expressly contains a safeguard for personal data, which can be processed only where necessary for limited purposes or funding arrangements. That covers, for example, where someone is injured while abroad, where personal data of a medical nature often needs to be shared to allow treatment to take place. At the same time, there are safeguards in the Bill, which I am sure we will explore.

My hon. Friend the Member for North Thanet expressed concern about cherry-picking, and I recognise his point. That is why we are looking for the reciprocal arrangements to continue, although even in the event of no deal and no bilateral deal, local arrangements often apply for healthcare, such as on the basis of long-term residency or previous employment. Those would be local factors, but obviously the policy intent is to have an arrangement with countries across the EU.

The hon. Member for Linlithgow and East Falkirk (Martyn Day) and my hon. Friend the Member for East Renfrewshire (Paul Masterton) spoke about the work of the devolved Assemblies and how we liaise with them. Indeed, I spoke with my Welsh counterpart just yesterday. In the other place, the Parliamentary Under-Secretary of State for Health has been working closely with the devolved Assemblies, as have colleagues and officials in our Department. How we work with the devolved Assemblies is a pertinent point, and we are keen to continue that active dialogue.

My hon. Friend the Member for Poole (Sir Robert Syms) correctly identified the importance of the EHIC card and of inward tourism to the UK. The point about continuity was reinforced by my hon. Friends the Members for Chichester (Gillian Keegan) and for Chelmsford (Vicky Ford) in their thoughtful contributions. It was also echoed by my hon. Friend the Member for Walsall North (Eddie Hughes) when he highlighted the importance of taking a practical approach to how these arrangements apply.

My hon. Friend the Member for Totnes (Dr Wollaston) raised a number of detailed points, and I am happy to have continued dialogue with her on them, although I hope she will draw some comfort from recent quotes and legislative developments in a number of EU27 states. For example, the French Minister for European Affairs said, “France will do as much for British citizens in France as the British authorities do for our citizens.” France has legislation under way. The Spanish Prime Minister said, “I appreciate, and thank very much, Prime Minister May’s commitment to safeguarding those rights. We will do the same with the 300,000 Britons who are in Spain.”

Again, I hope the fact that we actually pay out more to the EU than we currently receive, and the fact that both nations benefit from a reciprocal arrangement, gives an idea of the starting point of the discussions. Like my hon. Friend, I would welcome it if that were done across the EU27 as a whole.

My hon. Friend also raised the issue of dispute resolution, and the current arrangements between the UK and other member states require states to resolve differences, in the first instance, between themselves. That is the existing position that applies, but clearly it would be a matter for negotiation as to how a future UK-EU agreement might be governed. That is a cross-cutting issue; it is not one pertaining solely to this Bill.

It is clearly in the interests of the British public to ensure reciprocal healthcare, arrangements, similar to those currently in place, continue when we leave the EU, whether that happens through an agreement with the EU itself, as we very much want, or through individual arrangements with EU member states.

[Mike Amesbury (Weaver Vale) (Lab)]

Just for clarification, is the jurisdiction of the European Court of Justice still a red line in the sand?

[Stephen Barclay]

The issue in terms of the ECJ will be dealt with in other areas of the withdrawal agreement discussions. In the event of a deal, and in the event of no deal, it will be governed by the bilateral arrangements.

I commend this Second Reading to the House, and I look forward to working with colleagues on both sides of the House in Committee.

Question put and agreed to.

Bill accordingly read a Second time.

Healthcare in Essex

Steve Barclay Excerpts

Monday 5th November 2018 Commons Chamber

[The Minister for Health (Stephen Barclay)]

I congratulate my right hon. Friend the Member for Harlow (Robert Halfon) on securing the debate and on securing an early visit from the Secretary of State. As the whole House knows, he is passionate about the future of the Princess Alexandra Hospital in Harlow and he has raised this issue assiduously in a number of debates and interventions in the House. As he referred to, we had a very productive meeting with the hospital chief executive in June, when we discussed a range of issues, including the workforce and services offered at the hospital. That is in addition to an earlier Adjournment debate, as well as an Adjournment debate with my predecessor a year ago and exchanges at Health questions. On behalf of his constituents, he has brought these issues to the attention of the House extremely effectively.

I also place on record that I very much recognise that these issues are extremely important to Epping Forest as well, Madam Deputy Speaker. I know how assiduously you have campaigned on behalf of your constituents. Indeed, this is an issue that Members across Essex and Hertfordshire have spoken up on. That was reflected in previous debates and was reflected in the contribution from my hon. Friend the Member for Chelmsford (Vicky Ford). As we all recall, she was instrumental, as were other Essex MPs, including my right hon. Friend, in securing the new medical school, which, as she said, will help us to deliver the extra doctors to go with the buildings and capital spend, which we are discussing today.

As my right hon. Friend is aware, but for the benefit of the House, we have the sustainability and transformation fund as part of the Government’s commitment to upgrading the NHS estate. This investment will modernise and transform the NHS’s buildings and services, with the money going towards a range of programmes. This is part of the Government’s commitment to spending £3.9 billion on capital investment in buildings and facilities by 2022-23 and alongside the £20.5 billion a year extra that my right hon. Friend referred to. This investment—the biggest ever in the NHS—reflects the fact that the NHS is the public’s No. 1 priority, as indeed it is the Government’s No. 1 priority, and is an indication of the Prime Minister’s personal commitment to funding the NHS and ensuring it is fit for the future.

My right hon. Friend will be aware that the application window has now closed. I know that considerable work was done following the earlier application when a bid of between £500 million and £600 million was submitted. I am sure he will recognise that this was a significant sum but that the further work has brought it closer to the £330 million, and officials in NHS England and NHS Improvement are working closely with the Department to evaluate that bid alongside the other bids. As I mentioned in the previous debate, all bids will be assessed against standard criteria, including their value for money and contribution to transforming services and managing demand sustainably, as well as demonstrating their fit within a wider STP level estate strategy.

My right hon. Friend asked about timescales. The timescales are as previously referred to, with the commitment to decisions being made in the autumn. That position has not changed.

It is worth remembering that STP funding is only one element of support available to trusts. In 2017-18, the trust was successful in securing £2 million of emergency department capital funding to support the redesign of the emergency department. This funding was targeted to improve facilities and support improvements, including investment in paediatrics and the emergency department. In this financial year, capital funding to support winter pressures is also available to the trust, and this funding is part of the £145 million given to 80 NHS trusts across the country ahead of winter to improve emergency care. I understand that this money is earmarked for increasing bed capacity.

As we discussed in the summer, the trust recently exited special measures, with two thirds of services moving to a good or outstanding rating. This is a big achievement, and I know that the focus for 2018-19 is to achieve a good rating from the Care Quality Commission. My right hon. Friend has spoken about this in previous debates, and I join him once again in paying tribute to the staff who worked so hard to take the trust out of special measures.

It is clear that the hospital is a vital element of the local economy. I know that the Princess Alexandra Hospital NHS Trust has been working hard to improve recruitment and retention, and I am pleased that this is still a focus for it. The hospital is one of Health Education England’s nursing associate pilot sites through its lead partner, Hertfordshire Partnership University NHS Foundation Trust, and I am aware of plans for a huge expansion in the numbers of nursing associates through the apprentice route, which will positively impact on the work of the trust.

As I am sure the House is well aware, my right hon. Friend, like me, is a keen supporter of apprenticeships. I know that the hospital has taken on apprentices in the last year but that the number of apprentices is well below the target. It should be noted that any nursing associates in training as part of the scheme I just mentioned will not be included in the apprentice figures. As of April 2018, we know of 18 apprentices starting at the hospital, against a target of 76. I am keen to work with my right hon. Friend to continue the work that he has done in the House to ensure that the hospital meets that apprenticeship target. Both he and I are strongly committed to bringing more apprentices into the workforce.

My right hon. Friend referred to the Harlow science hub campus programme. Partly as a result of his campaigning, there will be a new public health campus in Harlow, at a cost of about £400 million. Not only are the Government making a significant contribution to the NHS, but the fact that the project is still on schedule—and by 2024, following a phased opening from 2021, approximately 2,700 staff will be based there—is a significant tribute to the work that my right hon. Friend has done, along with others, in securing a much-sought-after commitment to Harlow. I know that Public Health England and the Princess Alexandra Hospital have been discussing the opportunities that will arise as a result of the move to Harlow, and I hope to hear more about that soon.

I commend the work that my right hon. Friend is doing to raise support for the STP bid by the Princess Alexandra Hospital Trust. He has raised the estate issues faced by the trust on more than one occasion in the House, and in meetings with the Secretary of State and me, and I know that he raised them with my predecessor as well. We recognise that the hospital estate is in poor condition, which is why I am pleased that the trust has submitted the revised STP bid. I am also pleased that money was made available last year, and will be made available again this year, to make improvements to the hospital in the interim.

I look forward to continuing to work on this issue with my right hon. Friend, and to working on the future of the NHS in Harlow as well as the surrounding region. As has been made clear again this evening, Madam Deputy Speaker—alongside your own work—the patients and staff of the hospital can be confident that they could have no better champion than my right hon. Friend, who has campaigned to secure this much-needed investment.

[Madam Deputy Speaker (Dame Eleanor Laing)]

What an excellent, meaningful, well-targeted debate.

Question put and agreed to.