Oral Answers to Questions

Tim Farron Excerpts

Tuesday 6th December 2022 Commons Chamber

[Helen Whately]

My hon. Friend makes an important point. I, too, have heard from family carers about the difficulties that they have faced in getting skilled professional help, which, in turn, gives them support and respite. At the moment, we provide £11 million annually for a workforce development fund, which social care employers can access to help to pay for staff training. Looking ahead, we are working on social care workforce reforms, of which training and skills will form a substantial part. I commit to looking into his suggestion that specialist training for MND care should be part of that.

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

In the lakes, we have a problem with social care: although the people working in the care industry are phenomenal, talented and dedicated, the average age of the population is 10 years above the national average, so the number of people who need to be cared for is greater and the size of the workforce is smaller. Undoubtedly, poor pay, poor conditions and a lack of career prospects are a major problem in recruiting and retaining the care staff that we need. We also have a special problem in our area because of the absence, or indeed, the evaporation, of the long-term private rented sector, which is where the carers normally would have lived. Will the Minister talk to her colleagues in the Department for Levelling Up, Housing and Communities to make sure that we have a comprehensive package for communities such as mine in Cumbria, so that we have well-paid carers and places in which they can afford to live?

[Helen Whately]

The hon. Member makes a really important point. I will say two things. In the short term, we are supporting social care with £500 million through the discharge fund this winter. That will go into increasing capacity in social care and addressing some workforce challenges in areas such as his. In the long term, we are introducing social care reforms, including in the workforce. One thing we need to look at is ensuring that housing is available for the social care workforce.

Accountability in the NHS

Tim Farron Excerpts

Wednesday 30th November 2022 Westminster Hall

[Sir Mike Penning (Hemel Hempstead) (Con)]

I beg to move,

That this House has considered accountability in the NHS.

It is a pleasure to serve under your chairmanship, Sir George. I called this debate on accountability in the NHS. As a nation, we love our NHS which does a fantastic job for us, day in, day out. However, like any human being or organisation, sometimes it makes mistakes. When the NHS makes mistakes, the process of trying to get an apology or a mistake rectified is invariably a bureaucratic nightmare.

I have a couple of examples I would like to raise. I have permission from one to use their name, but I probably will not do so, because I will yet again pass correspondence to the Minister. I appreciate that the Minister here, my hon. Friend the Member for Colchester (Will Quince), is not responsible in the Department for this subject. The relevant Minister, my hon. Friend the Member for Lewes (Maria Caulfield), is on the Floor of the House answering questions, and I thank this Minister for explaining why she is not here.

We in Parliament are here to speak up for those who sometimes cannot speak up for themselves. When something goes wrong, Sir George, you would think we could get answers for constituents and get matters rectified, but within the NHS there is a lack of ministerial accountability, which I will come to in a moment. The complaints procedure eventually ends up with the ombudsman, but it takes for ever. There is a feeling in my constituency that, when things go wrong, the longer the process can be delayed, the more people will just accept what has happened. In some cases, they will sadly not be around any more. For their families and loved ones, this short debate is very important.

Probably the most dramatic example for me, not of the physical effects of surgery but of the effect on someone’s life, concerns one of my constituents. The NHS decided in 1986 that he needed an operation on his nose, but the operation that took place was not the one that was supposed to. I will use the language: it was botched. It was probably not intentional; it was a mistake but, to this day, that has had detrimental effects on his quality of life.

My constituent tried to go through the process of getting it rectified. I have tried to find out what was going on. He has pushed from pillar to post by different trusts: University College London and West Hertfordshire. I have written to previous Ministers over the years, only to be told that Ministers do not interfere in individual cases. I accept that but, when we reach a situation where there is nowhere else to go, ministerial accountability is important.

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

I am grateful to the right hon. Gentleman, not least for the sensitivity of the issues he is raising. Ministers under Governments of all colours have sought to keep NHS operational matters at arm’s length. Does he agree that that reduces accountability and effectiveness? I am thinking more generally about the current huge backlog in cancer diagnosis and treatment. I do not see any direct and urgent Government intervention. Does the right hon. Gentleman think that is partly the result of the lack direct operational accountability for Ministers to the service?

[Sir Mike Penning]

I thank the hon. Member for his intervention. We have seen during covid that, actually, when things get really bad, Ministers can step in and Prime Ministers can step in, but when we talk about individual cases, they cannot.

In the case I am referring to, I ended up writing to the Minister, to be told to go to the ombudsman. I got fobbed off by the ombudsman, after we had been to the trust three or four times. I then wrote to the Minister again—this is over the course of years—to be told to take legal advice. This particular person has now been told, “Go back to your GP and get them to re-refer you if you’ve still got problems.” He has problems because they did not do the operation properly in the first place, and it has had a massive long-term effect on this gentleman’s quality of life.

That is not the only case. I have been here for nearly 18 years, and I worked for a Member of Parliament for many years before that. In every constituency, this sort of case is brought before the MP. I have another example. Last summer, in the middle of heatwave in July, when the temperatures were unbelievably high, a very vulnerable young lady was brought in for a scan at my local hospital. She is the most vulnerable young lady. Her mother cares for her 24/7. She has carers in. She is a wheelchair user or bed-bound. She was left on a trolley in the heat for five hours when her ambulance did not arrive.

When I contacted the trust and said, “What happened there?” it blamed the ambulance trust. When I contacted the ambulance trust, it said, “No, it was cancelled by the trust—it was their fault.” I do not care whose fault it was. It was the NHS’s fault that this happened to a very vulnerable young lady. She had no drink and no food. She was very, very ill. The ambulance trust said that the return journey was cancelled because she was so poorly on the trolley—well, she was so poorly because she had been left there for five hours!

Trying to get to the bottom of what happens within the NHS when something goes wrong is so difficult. We have seen terrible situations in maternity services and in trusts around the country. These problems need to be addressed early on, instead of the drawbridge being brought up and people having to go through a massive complaints procedure where they have to complain three times before going to the ombudsman, and then the ombudsman will say it is out of time, and if they are not careful, they cannot go to court because that is out of time too. Is that the way we want our NHS to be seen by the public, who love the NHS?

The NHS sees the NHS as a single entity. As MPs—and I was a shadow Health Minister for four and a half years—we understand that it is not a single entity. It is a set of silos where everybody passes the buck back and forth. What we need is joined-up thinking. When Members like myself write to Ministers about these issues, the answer is not to say, “Nothing to do with me, guv” and pass it down the line to the ombudsman or a lawyer. That surely costs more money and does not put the NHS in a particularly good light with my constituents who have had their operations botched

NHS Staffing Levels

Tim Farron Excerpts

Tuesday 22nd November 2022 Westminster Hall

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

It is a pleasure to serve under your guidance again, Mr Hollobone. I am grateful to the hon. Member for Wirral West (Margaret Greenwood) for securing a really important debate.

I want to say a massive thank you to NHS and care staff. Undoubtedly, every year is a tough one for those working in this area, but the last few years have been incredibly demanding. The pandemic has taken its toll on people’s mental and physical health, and has led to real attrition within the various clinical and non-clinical services. It is worth bearing in mind how much worse it would have been had we not collectively taken the right decision to try to tackle the pandemic early on. Nevertheless, it has been incredibly hard.

I will focus on a few areas that are significant for NHS staffing, starting with dentistry. It is worth bearing in mind that we all pay our taxes, so 100% of my tax-paying constituents have paid for NHS dentistry, but only about a third of them are getting it, including roughly half of the children. At the moment—I have checked—there is not a single NHS dental place anywhere in the entire county of Cumbria, which is a disgrace. That could be solved in no small part if the Government were to address the issue of the treadmill of units of dental activity. If it were done differently, it would not necessarily cost the Government any more money to make sure that they do not push dentists into a position where they feel that they have no alternative professionally than to leave the NHS, that we bring back the people who have left, and that we value the ones we have working within it.

Secondly, I want to talk about GPs. The simple reality is that we have far fewer GPs entering the service than we need. Many rural communities in Britain, such as mine, have a smaller surgery population-wise because of the vast area that they cover. We are currently dealing with the potential closure of the Ambleside and Hawkshead medical practices—the Central Lakes Medical Group. It is out to tender at the moment, because the Government removed what was called the minimum practice income guarantee, a sum of money that made small rural surgeries financially sustainable. Their removal has led to three closures that I can think of in Cumbria—one in Eden and two in South Lakeland. A relatively small amount of money would keep those surgeries sustainable and make sure that we kept people working at them. Otherwise, we have NHS staff who are determined to work and serve those communities who simply find that they cannot.

Nothing is more important to solving the NHS staffing crisis than tackling care—we have talked about that a lot—and it is outrageous that the Government have chosen to kick dealing with that issue into the long grass for another two years. We have 32% bed-blocking in the hospitals of south Cumbria at the moment. The reason why is obvious: there are not enough care packages to help people when they leave hospital, because there are not enough carers. The impact on hospital capacity, on the capacity of A&E, on ambulances that take so much longer to drop off their patients and therefore take longer to respond to calls, and the lives put at risk, is blindingly obvious. For the Government to delay dealing with care, and to think it is delayable for two years is not a tough decision for them. It is a tough decision for the millions of people who will be affected and for the tens of thousands of people working in our care sector.

The lack of availability of affordable homes for care workers and NHS workers in communities like mine is also worth bearing in mind; that is a major reason why there are not enough staff working in health and social care. We now understand that the Government will kick the Levelling-up and Regeneration Bill into the grass on the other side of Christmas. That was an opportunity for the Government to decide that they would change the law to protect homes for local occupancy.

My final comment is on the cancer staffing situation. We currently have an outrageous situation where, in the south of Cumbria, 43% of people diagnosed with cancer are not getting their first treatment for two months, and 62% in north Cumbria are not getting their treatment for two months. That is an outrage. It is costing lives. Undoubtedly, staffing is a major part of that. I am chair of the all-party parliamentary group for radiotherapy, and we are to meet the Minister or his colleagues soon. Can I press him for a date?

In the meantime, I will share one important statistic with him. Radiotherapy UK surveyed 622 radiotherapy professionals—10% of the entire workforce nationwide—and 94% of them felt that the Government did not understand the impact of the current situation on their service; 72% felt that NHS senior managers did not either. As a consequence, we are losing people from the industry. We need a workforce plan specifically for cancer.

I hope the Minister will agree to meet with me and the APPG soon so that we can give him the all-party manifesto on radiotherapy, which will solve some of the problems and give those working in the NHS, particularly in cancer, some hope for the future.

Oral Answers to Questions

Tim Farron Excerpts

Tuesday 1st November 2022 Commons Chamber

[Steve Barclay]

First, I pay tribute to the work my right hon. Friend is doing to raise awareness of this issue. It is important that those patients who want access to face-to-face appointments are able to get them, and campaigns such as Movember are a great way of raising that awareness.

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

In Cumbria we have lost one in six of our GPs in the past six years, most recently at the Central Lakes medical practice in Ambleside and Hawkshead. Will the Secretary of State pay special attention to the letting of that new contract to ensure that there is a GP service running out of the surgeries in Ambleside and Hawkshead? Will he also give thought to the fact that the Government’s removal of the minimum practice income guarantee has cost many rural surgeries their ability to be sustainable, and consider bringing back a sustainable small surgeries fund so that small rural surgeries can stay open?

[Steve Barclay]

As a rural MP and having worked in Kendal earlier in my career, I know the geography to which the hon. Gentleman refers. That is why we are investing in more GP training, increasing the number from 2,671 in 2014 to 4,000, but it is also why we introduced the payment of £20,000, to encourage GPs into those areas that are hard to recruit in.

Rural Healthcare

Tim Farron Excerpts

Wednesday 12th October 2022 Westminster Hall

[Anne Marie Morris (Newton Abbot) (Con)]

I beg to move,

That this House has considered rural healthcare provision.

It is an absolute pleasure to serve under your chairmanship, Ms Elliott. I have already provided the Minister with a copy of the report by the all-party parliamentary group on rural health and care, which followed a three-year inquiry that we undertook with the National Centre for Rural Health and Care. It contains a lot of detail about the issues and suggested solutions. It looked far and wide across the world, not just across the United Kingdom, and I certainly hope that the Minister will give it more time than I suspect he already has in preparing for this debate.

The number of people living in rural settings is not small—9.7 million people live in rural England—and they have very different needs, so the current one-size-fits-all approach simply does not work. We have a different demographic. Generally, our constituents are older, they have complex comorbidities, they live in isolation, and many are in severe deprivation, but much of that is often hidden because the data collected is at such a high level that the issues are simply not identified. If levelling up, which is a commitment of the Government, is to mean anything, that has to change.

Covering everything in the report would take me more than the time available, so I will limit myself to the Government’s alphabet. Let me go through A, B, C and D. On ambulances—A—I absolutely applaud the Government’s position that the current situation is unacceptable and that we need shorter response times, particularly for category 1 and category 2 emergencies, but I am sure the Minister is well aware that the data shows that rural and coastal areas have some of the worst response times across the country, often because it is simply not possible to reach particular parts. In Devon, there are some areas where it really does not matter how many ambulances there are and how fast the roads might be—they are not—as there comes a point where it is not possible to get further.

We have not looked at a different approach. We have not looked at how we triage this differently so that we improve, rather than reduce, health outcomes. A one-size-fits-all approach means that those in rural areas are at much greater risk than those in urban areas. There is not a specialist centre of excellence for strokes that people can get to very quickly by being popped into an ambulance.

Money is clearly an issue, but if we properly integrated our use of fire services, police, ambulances and first responders, we would get a better outcome. Let us triage the calls as they come in differently, and then let us use those individuals and organisations better. Currently, the barriers are different pay for different forces and the fact that those organisations—fire services, police and ambulances—have different lines of accountability to different Departments, which means that they do not work together.

We could find a much better and more efficient way of doing this. Fire services are vital, because they are often physically located in some of these very rural areas. There is not a lot of point trying to get an ambulance in every rural village; that would be completely inappropriate and unaffordable, and it would not work. Let us look at how we can deal with those blockages and do this differently.

B is for backlogs. The Government’s aim to reduce the backlogs is commendable, and the plan to get waits down to one year by 2025 is fabulous. However, those of us who have rural constituencies know that the resources right now are simply not available, and rural areas have a real challenge to recruit. They are seen as unattractive. Youngsters want to be near the nightlife and the fun when they are off duty. The idea of coming to a rural area is not attractive. That is well known to the Government, because there have been various planned pilots and initiatives to pay individuals more to attract them to rural areas. It simply does not work.

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

The hon. Lady is making an important point. When it comes to waiting times for cancer treatment, 41% of cancer patients in south Cumbria and 59% in north Cumbria are waiting more than two months to get their first treatment after diagnosis. We know that is certainly costing lives. Does she agree that tackling the cancer backlog has to be the absolute priority for this Government?

[Anne Marie Morris]

More than that, we need to look at the different pathways in rural communities for heart, cancer and stroke treatment. I agree with the hon. Gentleman, but there is a lot more than just cancer, and the rural pathway to care has to be reviewed to see what is realistic in a rural area.

All of this has been made worse by a funding formula that is not fit for purpose. Although there is provision to uplift for rurality, it is not enough and it has been done without any real understanding of some of the challenges.

--- Later in debate ---

[The Minister of State, Department of Health and Social Care (Will Quince)]

It is a pleasure to serve under your chairmanship, Ms Elliott. Before I start, let me pay tribute to the work of those in the NHS and social care services across England, who are delivering excellent care now and have done so throughout the pandemic. The country is rightly proud of each and every one of them.

I congratulate my hon. Friend the Member for Newton Abbot (Anne Marie Morris), who has been a champion not only for her constituency but, more widely, for the importance of improving health services in rural areas. I thank her for securing this important debate, and I pay tribute to her work and that of the APPG, whose report I read with interest.

Although my constituency of Colchester, a relatively new city, does not share the rural characteristics of Newton Abbot, I am committed to excellent healthcare outcomes for all people in rural and urban areas across our country. I probably cannot cover every single aspect of the report, or even all the issues raised by my hon. Friend today, but I will certainly try to cover as many of them as I possibly can. Of course, I am very happy to meet her and any other colleague who would like to meet. I am proud never to have turned down a meeting with a colleague, and that is a record I intend to keep.

We certainly recognise many of the challenges caused by rurality, including the distinct health and care needs of rural areas and the challenges of access, distance and ensuring a sufficient population to enable safe and sustainable services. I assure my hon. Friend that this Government will remain committed to improving health services in rural areas, as we are committed to doing across all of England.

[Tim Farron]

The Minister alludes to GP surgeries in rural areas, which the hon. Member for Newton Abbot (Anne Marie Morris) also mentioned. Generally speaking, they serve smaller numbers of people over much larger areas. They were supported in their sustainability by something called a minimum practice income guarantee. That disappeared a few years ago, leading to many closures. In Ambleside and Hawkshead in the Lake district in my constituency, some surgeries are facing potential closure because of the removal of that funding. Will the Minister consider introducing a specific rural surgeries subsidy fund to help ensure that surgeries in rural communities in Cumbria and elsewhere are sustainable?

[Will Quince]

I thank the hon. Member for his question. I am not going to make policy on the hoof, so I will not say yes now, but we are fast approaching the next GP contract, which will run from April 2024, so we have an opportunity to look at all these things in the round. I am passionate about securing access to GPs in rural and remote areas. Perhaps we can double-tag our meeting, make it twice as long and discuss that issue too. I will respond to some of the issues raised about GPs in a moment.

I reassure my hon. Friend the Member for Newton Abbot that we are in full agreement that the NHS needs to be flexible enough to respond to the particular needs of rural areas. That is vital, and that is why we passed the Health and Care Act 2022. The Act embeds the principle of joint working right at the heart of the system, promoting integration and allowing local areas the flexibility to design services that are right for them. Integrated care boards and integrated care partnerships give local areas forums through which to design innovative care models, bring together health and social care, and, importantly, prioritise resources to ensure that they best align with the needs of individual areas.

We are also enabling the NHS to establish place-based structures covering smaller areas than an integrated care system. That could match the local authority footprint, for example, or in some cases it could be even smaller—a sub-division based on local need. That is fully in line with the view expressed in the APPG report that the NHS should foster and empower local place-based flexibility. I think that is at the heart of the report.

As my hon. Friend knows, in establishing those models for the NHS to follow, we have set the framework but have left it to individual areas to tailor them to local needs. I think that is the right approach, because local areas know better than Ministers. We do not always hear Ministers say that, but I think local areas often know better than I do, sitting here in Whitehall, how best to organise themselves, and how to design and, importantly, deliver the best possible care for patients. While we in Westminster can support, guide, hold accountable and occasionally chest prod, it is right that we also protect local flexibility.

[Will Quince]

I have made a note of my hon. Friend’s question and I am going to come to it in a moment. The answer is no, but only because it is not my responsibility. It is the Minister of State, Department of Health and Social Care, my right hon. Friend the Member for Newark (Robert Jenrick), who has responsibility for hospital funding, and in the next seven minutes I intend to commit him to lots of meetings with every single Member present.

Let me turn briefly to the question of resources, about which I know a number of Members are concerned, and which has just been raised by my hon. Friend the Member for Isle of Wight (Bob Seely). It is vital that we allocate resources fairly, as my hon. Friend the Member for Newton Abbot mentioned. That is why NHS England asked the Advisory Committee on Resource Allocation to consider the issue and provide a formula for allocations to integrated care boards. That formula took into account various factors, including population, age and deprivation —but we changed it.

In 2019-20, we produced a new element of the formula, recognising the points that my hon. Friend the Member for Newton Abbot makes, to better reflect the needs of some rural, coastal and remote areas, which on average tend to have a much older population. With an older population very often comes complex health needs. NHS England is using that formula to make allocations accordingly, but we recognise that some systems are significantly above or below target, and NHS England has a programme in place to manage convergence over several years. We also recognise the important challenge in ensuring that rural areas have the workforce—another point rightly raised at length—to provide the integrated patient-centred services that we all want to see.

We know that doctors are more likely to stay in the places where they trained, as my hon. Friend said. That is why, as part of a 25% expansion of medical school places between 2018 and 2020, we opened five new medical schools in rural and coastal locations that historically have been hard to recruit in: Sunderland, Lancashire, Chelmsford, Lincoln and Canterbury. I am conscious that my hon. Friend would want far more; that is perhaps a conversation to have at a later date. We hope—in fact, we expect—that graduates from those schools will stay in the area and will have a far greater understanding of the lives, needs and challenges of the people they serve in the locality.

My hon. Friend mentioned ambulances. As part of our plan for patients, which we launched in July, there is an extra £150 million for 2022-23 to address issues relating to ambulances. I hear what she says about differential pay rates, particularly in rural areas, between different blue light services, and I will take that away. Ambulances fall under the remit of my right hon. Friend the Member for Newark, and I know that he would be delighted to meet my hon. Friend the Member for Newton Abbot to discuss that issue.

On backlogs, I completely understand the points that my hon. Friend makes about recruitment challenges. I will take away her point about incentives not working, and I will look at other measures to attract people to rural and coastal areas, because we know that is a particular challenge.

The hon. Member for Westmorland and Lonsdale (Tim Farron) raised cancer wait time variance. As the Minister with responsibility for cancer, that absolutely concerns me. We are opening new diagnostic centres, but we have to look at more.

[Tim Farron]

rose—

[Will Quince]

I am conscious of time, so I will have to come back to the hon. Gentleman. We are going to meet, and we can discuss that at length. I know it is a concern of his.

[Tim Farron]

This is about treatment, not diagnosis.

[Will Quince]

Yes—absolutely right.

My hon. Friend the Member for Truro and Falmouth (Cherilyn Mackrory) raised seasonal visitors. I know that is an issue across Cornwall and Devon, and I would be very happy to look at that. My hon. Friend the Member for Bosworth (Dr Evans) raised the issue of GPs, and extending training and career opportunities in rural areas. I totally agree, and we will soon have a date in the diary to meet and discuss that.

My hon. Friend the Member for Newton Abbot was right to raise community hospitals. Again, my right hon. Friend the Member for Newark will be delighted to meet to discuss that at great length, as he would be to discuss unavoidably small hospitals, which I know my hon. Friend the Member for Isle of Wight has raised with the Secretary of State.

My hon. Friend the Member for Newton Abbot and others mentioned doctors. I entirely hear what she says about data. Data is important for choice, but I completely understand that in some rural, remote and coastal areas, there is no choice; there is just one GP, pharmacist and dentist, so we have to look at it differently. But data is important, because it allows the local integrated care board to identify where there are challenges and which practices are struggling. From November, for the first time, we will be publishing practice-level data on appointments and missed appointments. That is important because the patient deserves to see how their tax money is being spent. It also enables us to hold the integrated care board to account for how it is holding to account the practice and ensuring it modernises, is more efficient, and addresses the issues that its patients face. As part of our plan for patients, we are looking at that at great length.

Dentists are a real passion of mine. Dentistry is not looked at in the depth that it should be as part of wider NHS services. My hon. Friend rightly pointed out a number of reforms that were put in place in July. They are starting to take effect, and she will see more as they come to fruition. It is a top priority for me, and I am looking for areas for potential further reform. I encourage my hon. Friend to talk to her integrated care board about what more can be done on centres for dental development.

We absolutely recognise the importance of giving rural areas special consideration. They face a different range of challenges to the NHS in urban and suburban areas, and it is right that we give local systems the flexibility to respond to that. I hope I have reassured my hon. Friend and others that the current system does that. I am sure she will want to continue her work and the important work of the all-party parliamentary group. I certainly look forward to working with her.

Question put and agreed to.

Oral Answers to Questions

Tim Farron Excerpts

Tuesday 19th July 2022 Commons Chamber

[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.

Health and Care Bill

Tim Farron Excerpts

Consideration of Lords amendments
Wednesday 30th March 2022 Commons Chamber

[Edward Argar]

I may regret giving way to my right hon. Friend. I do not often say that, but perhaps I do now. I believe that this is about striking an appropriate balance in workforce planning and understanding supply and demand. I believe that the approach we have adopted as a Government, with the commission and the subsequent commission from the Secretary of State, is the right one. We are working closely with all NHS organisations from NHS England down, and I am sure that we will continue that collaborative work and that they will recognise the value being added by these commissions.

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

Will the Minister give way?

[Edward Argar]

I will make a little progress if I may, but if the hon. Gentleman can shoehorn his way in a little later, I will, assuming I am making good progress, try to find a way to come back to that point for him.

On Lords amendments 30 and 108, while we recognise the concerns of the other place, we think it is important to enable the Secretary of State to intervene in reconfigurations with greater flexibility where such an intervention is warranted. While the Secretary of State already has powers over reconfigurations, our proposals will allow them to better support effective change and respond in a more timely way to the views of the public, health oversight and scrutiny committees and, indeed, parliamentarians in this House. It will reduce wasted time and effort, and it will allow Ministers to become involved at the right stage, not simply at the end stage of the process. For that reason, we urge the House to reinstate clause 40 and schedule 6.

[Tim Farron]

rose—

[Edward Argar]

I think the hon. Gentleman is seeking to intervene. I find it difficult to say no to him, so I will give way.

[Tim Farron]

The Minister is a thoroughly good man, and I am very grateful. He will be aware of the National Audit Office’s projection that there are probably 100,000 undiagnosed cancer cases since the pandemic. Tragically, clinicians reckon that probably 20,000 of those people have already passed away. Will he agree and commit to a specific workforce strand when it comes to cancer? We desperately need cancer specialists, nurses, oncologists, radiotherapists and so on if we are going to be able to tackle this problem, but also make sure that we are not overburdened in the future, so that we can save lives?

[Edward Argar]

I am pleased I took the hon. Gentleman’s intervention on an issue that I know he has long taken an interest in. As well as the overall macro-trends of supply and demand, I expect the work being undertaken to look at the specialisms sitting beneath. He and I have discussed the significant increase in percentage terms in the number of radiographers, radiologists and others since 2010, but I acknowledge his underlying point that there is more to do if we are to achieve the ambitions set out in our consultation on the 10-year cancer plan and our broader ambitions for cancer care and treatment. We continue to look at that, and those specialisms will form a part of that work.

The hon. Member for Lewisham East raised a subject that I suspect will come up in contributions to the debate, including from my right hon. Friend the Member for South West Surrey (Jeremy Hunt). Regarding Lords amendment 48, we have heard the strength of feeling in the other place about the gravity of this issue, and I know that no one in this House would support the use of forced labour in creating NHS goods or their coming from areas where genocide may be taking place. We are fully committed to ensuring that that does not happen and we are now proposing further measures to tackle the use of forced labour, but we do not believe that this is the right legislative vehicle for introducing those changes, especially those made in the other place relating to genocide.

The Government will bring forward new rules for transforming public procurement in the forthcoming procurement Bill, which will cover all Government procurement and further strengthen the ability of public sector bodies to exclude from bidding for contracts suppliers that have a history of misconduct, including forced labour. We believe that that is the right vehicle for such provisions. The review of the 2014 modern slavery strategy will be published in spring this year, and will provide an opportunity to build on the progress we have made and to adapt our approach to take account of the evolving nature of these terrible crimes. We know that the NHS is one of the biggest procurers in this country, and it is for that reason that we are introducing measures in this Bill to ensure that NHS procurement works for the good of all.

NHS England and NHS Improvement agreed a new slavery and human trafficking statement for 2022-23 on 24 March, with new modern slavery countermeasures in the NHS supplier road map, updates to the NHS standard contracts to strengthen our position on modern slavery, and the development of a new strategy to eradicate modern slavery across the NHS supply chain. We are going to go further than that, though. In amendment (a) in lieu of amendment 48, we propose to introduce a duty on the Secretary of State to carry out a review into the risk of slavery and human trafficking taking place in NHS supply chains, and to lay before Parliament a report on its outcomes. That review will focus on Supply Chain Coordination Ltd, which manages the sourcing, delivery and supply of healthcare products, service and food for NHS trusts and healthcare organisations across England. As well as supporting the NHS to identify and mitigate risk with a view to resolving issues, the review will send a signal to suppliers that the NHS will not tolerate human rights abuses in its supply chains and will create a significant incentive for suppliers to revise their practices. I will listen to my right hon. Friend the Member for South West Surrey when he makes his contribution and endeavour to respond when I wind up this debate. I know he has strong views on this subject, as do other hon. Members

Elective Treatment

Tim Farron Excerpts

Tuesday 8th February 2022 Commons Chamber

[Sajid Javid]

I agree with my hon. Friend about the importance of the workforce, but I am afraid I do not agree with his comments about the plans for mandatory vaccination. I will not go through the details again; I did make a statement to the House on that last week, and in fact it was supported by the vast majority of Members of this House. The short answer to his question is that it is all about patient safety. The Government and the NHS are always absolutely right to put patient safety first, and although the Government have now, in the light of omicron, rightly changed their plans, it is still the professional responsibility of everyone working in healthcare to get vaccinated.

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

I am grateful for what the Secretary of State said about diagnostic hubs. Will he investigate personally why the planned hub for Westmorland general hospital has been delayed until 2023? I am also grateful for what he said about cancer services more generally. He knows that there have been 60,000 missed cancer diagnoses over the last two years, and I am sure he knows that radiotherapy is a key factor in tackling the backlog. Is he aware that radiotherapy ought to be accessed by 53% of cancer patients in this country but is accessed by only 23%, and that, as a proportion of our cancer budget, funding for radiotherapy in this country is only a little more than half the average for similar developed countries? Will he therefore make it a priority to meet with the all-party parliamentary group for radiotherapy and look at our manifesto, so that we can work together to save tens of thousands of lives that would be needlessly lost otherwise?

[Sajid Javid]

The hon. Gentleman raises a series of very important points, especially in what he said about cancer and radiotherapy. I believe he already has a meeting in the diary with Health Ministers, and I will look out for the output of that meeting. I agree with what he said about radiotherapy and the importance of investment in that, and there is a lot more investment. I referred earlier to the £6 billion extra capital budget, and a large part of that will be used for new diagnostics. I hope he also agrees with me that, as well as radiotherapy, we need to invest in the very latest cutting-edge technology for cancer care, such as proton beam therapy, which I saw for myself last week in London.

Health Inequalities: Office for Health Improvement and Disparities

Tim Farron Excerpts

Wednesday 26th January 2022 Westminster Hall

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

It is an honour to serve under your chairmanship, Mr Twigg. I congratulate the hon. Member for Bootle (Peter Dowd) on securing the debate and making an excellent opening speech. I also endorse what has been said by hon. Members on all sides—predominantly those from urban areas, because poverty is a major driver of health inequalities and discrepancies. I hope that my colleagues will understand if I now focus on some rural discrepancies, which are also significant and in some ways overlap with those on which hon. Members have focused so far.

The first area I will look at is social care. Social care is, obviously a huge issue and under massive pressure everywhere in the United Kingdom. There is an extra problem in rural communities like Cumbria. In my constituency, the average house price is 11 times the average household income; there are twice as many second homes in my patch as there are council houses. At this moment, 150 people who should be in social care are stranded in hospital beds, and one of the reasons for that is that the Government underfund social care. Not a penny of the national insurance rise that is coming will go into the pockets of hard-working care workers, so it is hard to retain and recruit them from a relatively small working-age workforce.

That has led to a number of issues. Just the other day, I was speaking to a person who needs a rota of six carers in order to function, but that person has not been able to find more than three for the last six to nine months. That is caused by a number of things, including silly visa rules, which the Government need to look at again, and the massive discrepancy between house prices and income—the availability of anywhere affordable to live for folks in the area.

Secondly, there is the issue of mental health—particularly young people’s mental health. Similar issues are present there when it comes to recruiting and retaining staff. There are wonderful staff—too few of them. When I did a survey of families in my constituency last year, we discovered that more than 50% of young people who presented with mental health conditions that needed attention waited more than three months, and 28% waited more than six months. Some 52% said their experience of that care was poor as a consequence.

If a 15-year-old broke their leg on a football field on a Sunday afternoon, they would be seen immediately, but if something invisible breaks within one of our young people, they wait six months or more. That is intolerable anywhere, but it is fuelled by the fact that we are in a rural area that is underfunded for mental health provision.

When it comes to GPs, a few years ago the Government got rid of the minimum practice income guarantee, which subsidised small surgeries. Small surgeries in rural areas are not small because they are bad, but because they cover the size of a small country but a relatively small population. Coniston, which mourns its doctor, Dr Simon Fisher, who sadly passed away just a few weeks ago, has a roll of just 900 patients, not because its practice is poor quality but because it covers a vast area. The Government took away that money.

The sticking-plaster money, called atypical practice funding, that went to some surgeries just to keep them going will fold when the clinical commissioning groups go and the new integrated care boards come in, in just a few months’ time. I ask the Minister to look carefully at that, as otherwise we may lose dozens, if not hundreds, of rural GP surgeries around the country.

On cancer provision, the National Radiotherapy Advisory Group states that it is bad practice for any patient needing radiotherapy to have to travel for more than 45 minutes for treatment. I can tell the Minister that not a single person in my constituency lives within 45 minutes of radiotherapy, and many of them must make four-hour round trips, day after day, in order to get treatment at an excellent but distant centre in Preston. If the Minister is committed to tackling discrepancies, she will finally do what Government after Government, including the one of which I was part, have failed to do—deliver the satellite radiotherapy unit at Kendal that we have long been campaigning for. That will shorten those journeys and save lives.

My final point is about accident and emergency. The nearest accident and emergency centre to most of my constituency is at Lancaster. There is a lot wrong with the hospital at Lancaster. It is an old site, at the wrong end of the one-way system, and could do with renewing. Talk of hospital improvement money going into it is welcome, but what is not welcome is the Minister’s Government’s continued insistence on looking at the option to close the Royal Lancaster Infirmary, merge it with the hospital at Preston and have a new hospital somewhere in the middle. If the answer is to make A&E for south Cumbria another 10 or 15 miles further away, that is the wrong answer. I ask the Minister to talk to the Secretary of State for Health and Social Care and others to take that option off the table, so that people from my communities do not have to travel dangerous distances to get the treatment they deserve.

I endorse what my colleagues from more urban areas said earlier in the debate, but I want the Minister to focus on the fact that many people in rural communities think they are overlooked by this Government, that their votes are taken for granted, and that as a result we get the situation that I have just outlined.

Oral Answers to Questions

Tim Farron Excerpts

Tuesday 18th January 2022 Commons Chamber

[Maggie Throup]

There are now six vaccination sites in the Bolsover district. A regular pop-up clinic was also set up in Shirebrook to address and identify the shortfall in uptake, but that has been phased out as new community pharmacy and primary care network clinics came on board to support the local vaccination programme and increase the number of Bolsover sites at the end of 2021. I am sure that my hon. Friend will be delighted to hear that a new roving vaccination van is being deployed across Derbyshire. It will visit Bolsover and surrounding villages to provide extra capacity and ensure that everyone has another way to get their booster jab. It will also allow those not yet vaccinated to come forward for this life-saving protection.

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

Undoubtedly, additional vaccine sites in rural communities will increase vaccine uptake, which is vital. However, does the Minister agree that, for NHS staff, counselling and one-to-one conversations are right and far more effective than the Government’s current plan potentially to sack the 5% of hospital staff in the Morecambe Bay region and indeed across the country who have not been vaccinated? That would cause a serious capacity problem in the NHS.

[Maggie Throup]

I reassure the hon. Gentleman that we are talking about patient safety. He is quite right that it is important to have that dialogue, and I know that colleagues across the board in the NHS are having that. It is interesting to note that more than 94% of NHS staff have already had their vaccine, and I commend them for that. As the chief medical officer Chris Whitty rightly said, those looking after other people who are very vulnerable have a “professional responsibility” to get vaccinated.