NHS Workforce: Revised Offer to Unions

Victoria Atkins Excerpts

Tuesday 5th March 2024 Written Statements

[The Secretary of State for Health and Social Care (Victoria Atkins)]

After re-entering negotiations with the British Medical Association (BMA) and Hospital Consultants and Specialists Association (HCSA) committees last month, during which the consultants did not take up industrial action, I am pleased to inform the House that I have made a revised formal offer to both unions, which includes a package of reforms to be applied from 1 March 2024. Both unions will recommend this revised offer to their members.

If accepted by their members, this would end the prospect of damaging strike action, benefit patients and deliver for consultants by delivering much-needed reform.

All sides returned to the negotiating table in good faith and in recognition of the narrow margin by which the initial offer was rejected. I would like to thank the unions for their co-operation and willingness to come to a swift resolution.

This demonstrates that approaching negotiations constructively and with reasonable expectations can lead to a good outcome for patients, consultants and the taxpayer.

The principles and aims of the updated offer remain the same. The Government’s position is that the headline pay uplift for 2023-24 was settled through the pay review body process. This updated offer adds further clarity and specificity, as well as addressing concerns that consultants have raised. The Government’s position remained that the headline pay uplift for 2023-24 was settled through the pay review body process.

This is a reform offer. The core contract for consultants has not been updated for 20 years and this offer will deliver reform to reflect modern ways of working, such as enhanced shared parental leave, in line with other NHS staff. It invests in modernising the consultants’ pay structure—reducing the number of pay points and the time it takes to reach the top of the pay scale.

As we originally proposed, this would make it faster for consultants to progress and help mitigate the gender pay gap, which was expressly highlighted in the independent review into gender pay gaps in medicine in England. Under the revised offer, the Government have agreed to include an uplift for consultants with four to seven years of experience, in direct response to members’ concerns.

To enable these reforms, unions have agreed to end local clinical excellence awards going forward—an employer level bonus scheme that has been seen to contribute to pay inequalities.

The updated offer reaffirms our intention to introduce pay progression arrangements, which link pay progression and evidence of skills, competencies and experience, and further clarifies how this will work in practice.

In addition, the Government will enact changes to the operation of the Review Body on Doctors’ and Dentists’ Remuneration (DDRB) to address matters raised by the BMA and HCSA. This offer sets out the detail of work to improve the process for the appointment of members to the DDRB, and revises the panel’s terms of reference.

The Government have listened carefully to the concerns of consultants and their representatives, particularly around retention, motivation and morale. This revised offer has been carefully balanced to meet those concerns while also ensuring value for the taxpayer. This offer, should it be accepted, will improve the working lives of consultants while ending the prospect of damaging strike action, which has had a detrimental impact on patients and the NHS.

The BMA and HCSA will recommend this offer to their members in a vote in the coming weeks. No further industrial action will be called while this happens.

[HCWS311]

Martha's Rule

Victoria Atkins Excerpts

Wednesday 21st February 2024 Written Statements

[The Secretary of State for Health and Social Care (Victoria Atkins)]

I would like to update the House on the Government’s commitment to implement Martha’s rule in England. Today we are announcing plans to implement Martha’s rule in at least 100 acute or specialist NHS sites in England by March 2025. Martha’s rule is an initiative that gives patients and their families who are concerned about deterioration in their physiological condition the right to initiate a rapid review of their case 24 hours a day from someone outside of their immediate care team.

Calls for Martha’s rule came following the tragic death of 13-year-old Martha Mills, who, after being admitted to hospital following an accident, contracted sepsis and deteriorated quickly.

Sadly, the signs of sepsis were not acted upon by doctors quickly enough, despite Martha’s family raising concerns with clinicians. Coroners found that Martha would probably have survived if doctors had identified the warning signs and transferred her to intensive care earlier.

I would like to pay tribute to Martha’s parents, Merope and Paul, who have worked tirelessly to raise awareness of what happened to Martha and to highlight the critical role that families play in recognising the signs of deterioration in their loved ones.

In September, the then Secretary of State for Health and Social Care, my right hon. Friend the Member for North East Cambridgeshire (Steve Barclay), asked the Patient Safety Commissioner, Dr Henrietta Hughes, to rapidly lead work on how Martha’s rule could be implemented in England. I am grateful to Dr Hughes for her extensive engagement with system leaders and stakeholders, and for her recommendations on what Martha’s rule should look like.

While some NHS trusts already offer rapid review processes similar to Martha’s rule—called Call 4 Concern—others do not have an equivalent mechanism in place. In recognition of these variations in readiness, we are initiating a phased approach to implementing Martha’s rule.

The first phase will see Martha’s rule rolled out to at least 100 acute or specialist provider sites in England in 2024-25, supported by up to £10 million. NHS England will lead the process of identifying which acute provider sites will participate in this first phase and supporting the development of their local processes. Alongside this, drawing from the local learning from new and existing schemes, NHS England will develop proposals for national roll-out in the next spending review period.

This approach will enable significant progress to deliver Martha’s rule next year and to evaluate the additional resources needed for national roll-out.

I also look forward to working with the Patient Safety Commissioner, whom I have asked to chair a stakeholder oversight group jointly with NHS England and the DHSC. This group will build on the extensive engagement that has taken place over the last year, and will bring together patients, clinicians and external experts to provide ongoing advice to NHS England on the delivery of Martha’s rule.

[HCWS273]

NHS Dentistry: Recovery and Reform

Victoria Atkins Excerpts

Wednesday 7th February 2024 Commons Chamber

[The Secretary of State for Health and Social Care (Victoria Atkins)]

With your permission, Mr Speaker, I would like to make a statement on our plan to recover and reform NHS dentistry. First, though, on behalf of the entire House and my Department, I send our very best wishes to His Majesty the King. His decision to share his diagnosis will be welcomed by anyone whose life has been touched by cancer, and I know that we are all very much looking forward to seeing him make a speedy recovery and resume his public duties.

Thanks to a once-in-a-generation pandemic, 7 million patients across England did not come forward for appointments with NHS dentists between 2020 and 2022. Since then, we have taken decisive action to recover services: we have made reforms to the dental contract, so that practices are paid more fairly for caring for NHS patients with more complex needs; and we have made sure that dentists update the NHS website regularly so that the public know that they are taking on new patients. That has delivered results, with more than 1 million more people seeing an NHS dentist last year than in the year before. However, we know that too many, particularly those living in rural or coastal communities, are still struggling to find appointments. This recovery plan will put that right by making NHS dental care faster, simpler, and fairer for patients and staff. It is built on three key pillars, which I will address in turn.

First, we will help anyone who needs to see an NHS dentist to do so, wherever they live and whatever their background. To do this, we must incentivise dentists across the country to care for more NHS patients. That is why I am delighted to tell the House that for the coming year, we are offering dentists two new payments on top of their usual payments for care—£15 for every check-up they perform on NHS patients who have not been seen over the past two years, and £50 for every new NHS patient they treat who has not been seen over the same period—because we know that patients who do not have a relationship with a dentist find it harder to get care. That is not a long-term ambition: our new patient premium will be available from next month.

We are also increasing the minimum payment that dentists receive for delivering NHS treatments, which will support practices with the lowest unit of dental activity rates to provide more NHS care. However, we know that in many of our rural, remote and isolated communities, dentists themselves are in short supply. That is why starting this year, up to 240 dentists will receive golden hello payments worth up to £20,000 when they commit themselves to working in one of those areas for at least three years. These dentists will give patients the care they need faster, make dental provision fairer and tackle health inequalities.

We are also delivering dentistry to our most remote regions without delay. This year, we will deploy dental vans to more isolated, rural and coastal areas. Staffed by NHS dentists, they will offer check-ups and simple treatments such as fillings. This model has been a tried and tested success across many regions. For example, last year in Cornwall, a mobile van visited five harbours, treating more than 100 fishermen and their families. We will be rolling out up to 15 vans across Devon, Gloucestershire, Somerset, Norfolk, Suffolk, Lincolnshire, Cambridgeshire, Dorset, Cornwall, North Yorkshire and Northamptonshire. This move has been welcomed by Healthwatch, the Nuffield Trust and the College of General Dentistry. We will let patients know when vans will be in their area, so they can get the care they need faster.

These reforms will empower NHS dentists to treat more than 1 million people and deliver 2.5 million more appointments. As the chief executive of National Voices, a group of major health and care charities, said:

“This extra money…should help thousands of people who have been unable to see a dentist in the last two years to get the care they need.”

These reforms are just the beginning. This recovery plan will also drive forward reforms to make NHS dentistry sustainable for our children and our grandchildren.

That brings me to the second pillar: growing and upskilling our workforce for the long term. Our long-term workforce plan, the first in NHS history, gives us strong foundations on which to build. By 2031, training places for dentists will increase by 40%—forty per cent—and places for dental hygienists and therapists, who can perform simple tasks such as fillings, will also rise by 40%. More dentists and more dental therapists will mean more care for NHS patients.

I am delighted to tell the House today that we are going further in three key ways. First, we will consult on a tie-in to NHS work for dentistry graduates, because right now too many are choosing to deliver private work over valuable NHS care. More than 35,000 dentists in England are registered with the General Dental Council, but last year almost a third worked exclusively in the private sector. Training these dentists is a significant investment for taxpayers, and they rightly expect it to result in the strongest possible NHS care. That is why, this spring, we will launch a consultation on a tie-in for graduate dentists and how this could deliver more NHS care and better value for taxpayers.

Secondly, we will take full advantage of our dental professionals’ skills. Today, even though they have the right training, without written direction from a dentist dental therapists cannot do things such as administer antibiotics. This year, we will change this, making life simpler for dentists and making care faster for patients. As the president of the College of General Dentistry has said, the

“use of the full range of skills of all team members will enable the delivery of more care and make NHS dentistry more attractive to dental professionals.”

Thirdly, we will recruit more international dentists to the NHS. We have a plan to do this by working with the General Dental Council to get more international dentists taking exams and to get them on to the register sooner, and to explore the creation of a new provisional registration status so that, under the supervision of a dentist who is already on the register, highly skilled international dentists can start treating patients sooner, rather than working as hygienists while they are waiting to join the register.

I turn now to our plan’s third pillar, which is prioritising prevention and giving children a healthy smile for life. This begins by supporting parents to give their children the best possible start. That is why family hubs up and down the country will offer parents-to-be expert advice on looking after their baby’s teeth and gums. As those babies grow up, we will support parents and nurseries in making sure that before every child starts primary school, brushing their teeth is part of their routine.

The evidence is clear: the earlier good habits are built, the longer they will last. Seeing a dentist regularly is vital for children’s health, but since the pandemic, too many have been unable to do that. That is why this year we are taking care directly to children. We will deploy mobile dental teams to schools in areas with a shortage of NHS dentists. They will apply a preventive fluoride varnish to more than 165,000 reception-age children’s teeth, strengthening them early and preventing decay. Our Smile for Life programme has already been endorsed by the College of General Dentistry.

Six million people in England already benefit from water fluoridation. In order to go further in protecting children’s teeth, we will consult on strengthening more of our country’s water with fluoride. Again, the evidence is clear: in some of the most deprived parts of England, enhancing fluoride levels could reduce by up to 56% the number of teeth that are extracted because of decay. That is why, through the Health and Care Act 2022, we have made it simpler to add fluoride to more of our water supply. As a first step, this year we will launch a consultation on expanding water fluoridation across the north-east—an expansion that would give 1.6 million more people access to water that strengthens their teeth, preventing tooth decay and tackling inequality.

This is our Government’s plan to recover and reform dental care: dental training places up by 40%; 2.5 million more appointments; dental vans treating more patients; more dentists in remote areas; more dentists taking on NHS patients; better support for families and better care for children; patient access up and inequity coming down. It will make life simpler for staff, and treatment faster and fairer for patients and staff. We have taken the difficult decisions, and we have now delivered a long-term plan to make dental care faster, simpler, and fairer for people across the country. We are going to get on with the job and put our plan into action, and I commend this statement to the House.

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[Wes Streeting]

Don’t worry, Mr Speaker: I will come back to the Parliamentary Private Secretary shortly. Tooth decay is the No.1 reason for children aged six to 10 being admitted to hospital. Unbelievably, there have been reports of Ukrainian refugees booking dentist appointments back home and returning for treatment, because it is easier to fly to a war-torn country than it is to see an NHS dentist in England. Well, at least one Government policy is getting flights off the ground—and it is certainly not the Government’s Rwanda scheme failure.

Let us look at the human consequences of this Conservative tragedy. Labour’s candidate in Great Yarmouth, Keir Cozens, told me about Jeanette, a young woman in her 30s who has struggled with gum and mouth problems all her life. She used to be able to get treatment; now she cannot find an NHS dentist in all of Norfolk to take her. She cannot afford to go private. It hurts to smile, it hurts to laugh, and the pain is so great that Jeanette does not go out anymore. Just this week, she resorted to trying to remove her tooth herself. That is not right for anyone of any age, but Jeanette should be in the prime of her life. Will the Secretary of State apologise to Jeanette and the millions like her for what the Conservatives have done to NHS dentistry?

After 14 years of neglect, cuts and incompetence, the Government have today announced a policy of more appointments, recruiting dentists to the areas most in need and toothbrushing for children. It sounds awfully familiar. They are adopting much of Labour’s rescue plan for dentistry. Does that not show that the Conservatives are out of ideas of their own, and are looking to Labour to fix the mess they have made? I say: next time Conservative Ministers say that Labour does not have a plan, or that Labour’s plan is not credible, don’t believe a word of it.

There are some differences between our two parties’ approaches. Labour is pledging an extra 700,000 urgent and emergency appointments, which are additional to the appointments announced today. Can the Health Secretary confirm that the Government’s plan does not provide any additional emergency support? Labour proposed supervised early-years toothbrushing, and Conservative MPs accused it of being “nanny state”. Does the Health Secretary stand by that label, or does she now support children under five being supported in brushing their teeth?

The key difference is that we recognise that our plan is a rescue plan, and that to put NHS dentistry back on its feet, immediate reform of the dental contract is needed. Without that, the Government’s plan is doomed to fail. Do not just take my word for it; the British Dental Association has said that the plan will not stop the exodus of dentists from the NHS, will not provide a dentist for every patient who needs one, and will not put an end to this crisis.

I come to the Parliamentary Private Secretary, the hon. Member for North Norfolk (Duncan Baker), and the miserable script that the Whips are spreading out on the Table. If Labour’s contract is to blame, why have the Government not reformed it in 14 years, and why are they not reforming it now? In 2010, the Conservatives promised in their election manifesto to reform the dental contract. They are bringing back not just Lord Cameron, but his broken promises. People have been desperately trying to get dental care for years, but there was nothing from the Conservative party. Now that we are in an election year, the Conservatives are trying to kick the can down the road, and are scrambling for a plan. They only discover their heart when they fear in their heart for their political futures, and the consequences have been seen: queues around the block in Bristol.

Finally, the Secretary of State is promising reform after 2025 and after the next general election. Who is she trying to kid? After 2025, the Conservatives will be gone, and if they are not, NHS dentistry will be. How many more chances do they expect? How many more broken promises will there be? We had 2010, 2015, 2017 and 2019. Their time is up, and it is time for Labour to deliver the change that this country needs.

[Victoria Atkins]

I tried to help the hon. Gentleman by giving him an advance copy of my speech yesterday, yet that was his speech. This Government are focused on delivering for patients. Perhaps I can help him understand the difference between the Opposition’s proposals and the Government’s fully funded dental recovery plan. The Opposition’s ambitions reach only as far as 700,000 more appointments. Our plan will provide more than three times that number of appointments across the country—that is 2.5 million, to help him with his maths. We are offering golden hellos to 240 dentists who will work in hard-to-reach and under-served areas; their proposals cover only 200. They have no plan for training more dentists; we set out in the long-term workforce plan last year, and again in the dental recovery plan, that we will increase training places for dentists by 40% by 2031.

Then we have the centrepiece of the Opposition’s proposals: making teachers swap their textbooks for toothbrushes—an idea that is hated by teachers and that patronises parents. We believe that most parents do a great job of looking after their children. I know that the Labour party does not agree with that; the hon. Gentleman called our children short and fat on a media round. We believe that most parents do a great job, and that is why we support pregnant mums-to-be, and support parents in family hubs and nurseries. We will not wait until reception class, by which time children have already got their teeth.

I want to dwell on the experience of anybody living under Labour in Labour-run Wales. Health services in Wales are devolved, and the Leader of the Opposition has called Wales “the blueprint” for how the Opposition will run our health system. Welsh Labour has the highest proportion of NHS dental practices not accepting new adult patients, and the joint highest proportion of those not accepting new child patients. In Wales, 93% of NHS dental practices are not accepting new adult patients. That is a higher figure than for any other nation in the UK. Some 86% of practices there are not accepting new child patients, which is the joint highest figure with Northern Ireland. Our plan is fully funded, but how will Labour pay for its plan? By using the magical money tree. The list of policies funded by the non-dom policy is as long as my arm. In 2022, it promised to fund a workforce plan. Last September, it became breakfast club meals. By October, it morphed into 2 million appointments and scanning equipment. By Christmas, it was funding a dentistry plan. It is the same old Labour: it has no plan.

[Mr Speaker]

I call the Father of the House.

[Sir Peter Bottomley (Worthing West) (Con)]

The House enjoyed the words of the Opposition spokesman, the hon. Member for Ilford North (Wes Streeting), although I am not sure how many he wrote himself; some may have seemed rather familiar to anyone who read Matthew Parris this morning on going to Ukraine to have a filling fixed.

In West Sussex, in Worthing and Arun, we want the same situation found in parts of London, where dentists have a sign saying, “New NHS patients welcome”. Has the Secretary of State been working with the British Dental Association and the General Dental Council to bring forward registrations, to get incentives right, and to make sure that dentists are no longer told, “You can’t serve any more patients because you will go above your limits”? Can she confirm that we are taking limits off, so that dentists, especially the young ones, can do as much work as they can, and can help as many patients as possible, so that we can get back to the situation that we were in before Labour changed the rules about 20 years ago?

[Victoria Atkins]

We have focused this plan on introducing the new patient premium—a bonus for new patients. Having discussed this carefully with professionals, we think that is one way that we can incentivise people into NHS practice. Dentists can already work up to 104% of the contract. Many do that, but some sadly do not, so we are trying to encourage those dentists who already have NHS contracts to go the extra mile and use the full slot available to them.

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

The Health and Social Care Committee took months gathering evidence and putting together a recovery plan, which the Government should have adopted. Dentists wanted that plan put in place. Central to it was reform of the NHS dental contract. However, the Secretary of State has completely failed to even mention reform of that contract. As a result, dentistry in my constituency in York, where constituents are waiting seven years to see a dentist, will not have the recovery that she talks about. Why did she not adopt our plan?

[Victoria Atkins]

I hope the hon. Lady will, as usual, be the help that I expect her to be to her constituents in publicising this plan. We are getting graphics and information out to all Members of Parliament, so that they can help their constituents understand what will be available in their area, because each and every one of us wants the very best for our constituents. She will be interested in the new patient premium, which is encouraging dentists back into NHS practice, or into NHS practice for the first time, and in the increased price for units of dental activity. Reform of the dental contract is part of our agenda, but we realised that we needed to give immediate help to communities such as hers.

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[Steve Brine (Winchester) (Con)]

I welcome the plan. Recovery and reform is right, and the Select Committee will study the plan carefully. The dental Minister, my right hon. Friend the Member for South Northamptonshire (Dame Andrea Leadsom), has already been invited to come before us, so that we can talk it through with her to see whether it reflects our aforementioned report on the subject. The golden hellos, the toothbrushing for pre-schoolers—as long as the workforce can handle it—and the mobile vans are good, but even a day longer of a contract focused on units of dental activity is a problem. Can the Secretary of State say how she plans to entice professionals into returning to NHS dentistry? So many have left, and that is key.

[Victoria Atkins]

Very much so, and that will be primarily through the patient premium, which will mean that from next month dentists will be able to turn their signs from “closed” to “open” for NHS patients. We wanted to use levers that could be deployed immediately in order to help our constituents.

[Daisy Cooper (St Albans) (LD)]

It is estimated that more than 12 million people are waiting for dental treatment, but the Government’s announcement says that it will help just 1 million. The Government’s underspend last year was £400 million, and it is expected to be the same this year, but only £200 million has been announced. This plan is a drop in the ocean. In St Albans, my dentists are desperate to provide NHS care, and my constituents are desperate to see a dentist. At the heart of the problem is the broken contract. Will the Government take up the Liberal Democrats’ plan to reform the contract and provide guaranteed access to an NHS dentist for everybody needing urgent and emergency care?

[Victoria Atkins]

I heartily recommend the recovery plan to the hon. Lady, because it offers 2.5 million more appointments and has a long-term ambition for the prevention of tooth decay in children. In addition, it has that long-turn vision about increasing training places for our dental professionals by 40% by 2031.

[Sir Paul Beresford (Mole Valley) (Con)]

As you are aware, Mr Speaker, I have a declared interest in this particular topic.

As my right hon. Friend the Secretary of State is aware, dentistry in England is a seller’s market. It is estimated that there are 5,000 dentist vacancies in England. When I came here in the early ’70s with my dental degree, like very many colleagues from Australia, New Zealand and so on, I presented at the General Dental Council, who said “welcome” and stamped my hand, and I went off and worked on the national health service the next day.

Now, and for decades, the General Dental Council has required graduates from world-class dental schools—every bit as good as the ones we have here—to wait, to pay and to sit what is called an overseas registration exam. Currently, the waiting list for the exam is 2,000 overseas dental graduates, many of whom are every bit as good as those we produce in this country. The GDC could change that overnight by accepting graduates automatically from known and trusted international schools. Will my right hon. Friend please have a small chat with the chairman of the General Dental Council?

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[Victoria Atkins]

I thank my hon. Friend and recognise the enormous expertise he brings to the Chamber on this matter. He knows—he has genuinely talked to me about this on many occasions—the important role that the General Dental Council plays to ensure that we get international dentists registered as quickly as possible. I very much look forward to discussing that with the GDC so that we can get more international dentists on to our register and working in our practices.

[Judith Cummins (Bradford South) (Lab)]

I welcome much in the plan, which mirrors many of my ideas over the years, and indeed much in Labour’s plan. However, on access, the Government claim that the recovery plan will deliver care for up to 2.5 million people, but Government data shows that 12 million people in England have unmet dentistry needs, which leaves about 9.5 million people without an NHS dentist. That includes my constituent Beverley Kitson, who has osteoporosis and takes alendronic acid as treatment. The drug has damaged her teeth, and she now requires a check-up every three months after four of her teeth have decayed to such an extent that they need to be extracted. Beverley has been with the same dental practice for 50 years, but she has just been told that it is going fully private, leaving her without an NHS dentist. Will the Secretary of State guarantee Beverley that she will be able to access an NHS dentist under these plans?

[Victoria Atkins]

We have very much tried to ensure that dentists who already hold NHS contracts will keep them and keep working them. That is why we have fallen upon the new patient premium to make it more in their financial interests to take on new patients. I appreciate the hon. Lady’s point about retention, which, again, we are looking to address through the increase in the UDA. But we all acknowledge that dentists are independent contractors, so we must ask them—and particularly those who are new dental graduates—to do their bit and help our NHS out.

[Maggie Throup (Erewash) (Con)]

A number of NHS dentists across Erewash have recently retired, leaving a cohort of my constituents without access to NHS dentistry. Unfortunately, practices are finding it really difficult to recruit replacements for the retirees. How will the plan help speed up that recruitment so that my constituents are not without NHS dentistry for much longer?

[Victoria Atkins]

May I thank my hon. Friend for all the work she did in the Department and has done on this subject? We are taking a long-term view with training dentists. As I said, last year, through the long-term workforce plan, we set out an ambition to train up to 40% more dentists by 2031. As we also begin the consultation on a tie-in with those graduates, we are confident that we will see a greater supply of dentists to our NHS services.

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

The £200 million pledged today is less than half last year’s record-breaking underspend. The plan says that any underspends will be ringfenced for dentistry. That was promised by a Minister last year, but it did not happen because integrated care boards were using that underspend. Why should the 73% of dentists in the west midlands who cannot and are not accepting any new patients believe it will be any different this year?

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[Victoria Atkins]

The hon. Lady alights on an important fact that is sometimes lost in this debate: although an NHS dentist may have an NHS contract, they may not work the whole of that contract. Some NHS dentists very much do so; others work a fraction of it. We are trying to encourage dentists who do not use their full contract to do so, because that in itself will bring in more patients. We are confident that alongside the new patient premium, that will help constituents such as hers to get the treatment they need.

[John Redwood (Wokingham) (Con)]

Wokingham has a fast-growing population based on building a lot of new homes. So as the Secretary of State rolls out her new plans, will she also ensure that there are incentives to provide dental services on the NHS in areas where a population is moving in and needs them?

[Victoria Atkins]

My right hon. Friend raises an interesting point. Indeed, that is exactly the sort of discussion I am having with my right hon. Friend the Levelling Up Secretary, because I am really interested in having that connected and joined-up approach between planning and health. I think it could bring dividends for us all.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

I do not believe that what the Secretary of State has described will deal with the complexity of dental problems out there. I have a constituent who was referred to the Manchester Dental Hospital for a possible abscess and was told that even an urgent referral would take a month. In fact, the dental hospital did not get back to her for five months after the referral; it offered her a telephone consultation. The amount of pain and infection meant that she had to seek private treatment at a cost of £4,000, but many cannot afford that, including the young man wheeled into Royal Bolton Hospital in great pain, leaking blood on the floor after trying to remove a painful tooth with pliers. What does the Health Secretary say to patients who have long-standing and complex dental problems and are paying the price by waiting in pain, paying for private treatment or trying to remove their own teeth?

[Victoria Atkins]

I take that constituency case very seriously. I am really keen to urge the hon. Lady that if a constituent contacts her in future with that level of discomfort and pain, she should advise that constituent to contact 111 and, if necessary, go to accident and emergency—[Interruption.] Labour Members are shaking their heads, but what she has just described is a serious situation. That constituent needs medical attention, and the NHS is there, ready and willing to help. That is the advice that she should be giving her constituents, and I hope that she takes it as seriously as I do. [Interruption.]

[Madam Deputy Speaker (Dame Eleanor Laing)]

Order. The Secretary of State was giving an answer to a question. We do not need all this shouting. People might not agree with the answer, but you have to listen to the answer.

[Sir John Hayes (South Holland and The Deepings) (Con)]

In congratulating my right hon. Friend—my personal friend—on this welcome, excellent statement, may I ask her to forgive the ferocity with which my right hon. Friend the Member for Gainsborough (Sir Edward Leigh) and I made the case for NHS dentistry when we met her recently? In that spirit, will she ensure that some of these new dentists come to rural Lincolnshire, where we desperately need good dental care? She has today irrigated the dental desert.

[Victoria Atkins]

I give my very sincere thanks to my right hon. Friend. The House can imagine the advocacy I have received from both him and my right hon. Friend the Member for Gainsborough (Sir Edward Leigh). On reaching rural and coastal areas, as a proud Lincolnshire MP myself I wanted to bring about a set of plans that will address those underserved areas. I am delighted that the plan meets with my right hon. Friend’s approval.

[Sir George Howarth (Knowsley) (Lab)]

The Secretary of State will be aware that the NHS dentistry crisis has been 14 years in the making. She will also be aware that it is impossible for anybody in Knowsley today to sign up with an NHS dentist. The measures the Secretary of State has described may, over time, help to meet the problem, but what advice would she give today to my constituents who cannot get an NHS dentist?

[Victoria Atkins]

The advice and guidance to dentists will be going out today, while the new patient premium that I have told the House about will come in from March—it is weeks away.

[Dr Thérèse Coffey (Suffolk Coastal) (Con)]

I thank my right hon. Friend the Secretary of State for an excellent statement and an excellent plan. It is exactly what patients in Suffolk have been waiting to hear—the rural payment, the bonus there and the mobile service. I am conscious that many dentists have chosen not to have more patients, and they might blame the contract—this, that or the other. That is why I welcome her plan about potentially tying in graduates to the NHS. My hon. Friend the Member for Mole Valley (Sir Paul Beresford) has already referred to the General Dental Council, which, in my view, has not taken full advantage of the regulations that came into force last March. Will the Secretary of State also look at the NHS’s own rules that further restrict the rapid supply of dentists into the NHS for our constituents?

[Victoria Atkins]

I thank my right hon. Friend for all the work she did on dentistry in the Department. I am conscious that many people have contributed to this plan; I am grateful to her and others. Again, I hear the observations on the General Dental Council, and will ensure that the GDC hears them as well. That is a fair challenge to the NHS. Colleagues will see that the plan is co-signed by NHS England, which shares our ambition to deliver those 2.5 million more appointments and set up the future of NHS dentistry for our country.

[Christine Jardine (Edinburgh West) (LD)]

Today’s statement by the Health Secretary will have been listened to with great interest by my constituents in Edinburgh West, who share a lot of the same concerns, face the same difficulty getting NHS dental treatment and will be looking for the same sort of solution as constituents in England. Could the Secretary of State clarify for me, and for all those who come to me, whether there will be Barnett consequentials? If there are, will she impress upon the Scottish Government the need to ringfence the money and actually invest it in dental services? If not, would she be willing to share with the Scottish Government how she is approaching the problem in the hope that they might actually respond and do something?

[Victoria Atkins]

I hear the frustration in the hon. Lady’s question. This is a devolved area—as it is in Wales—and is therefore a matter for the Scottish National party. I assume the hon. Lady will continue her usual advocacy on behalf of her constituents to ensure that the SNP looks at what is happening in England and tries to do better for Scotland.

[Neil O’Brien (Harborough) (Con)]

I really welcome this plan; I welcome the extra £200 million, the new patient bonus, the measures to get dentists into areas that do not have them and the minimum UDA. These are all good things that will help people in Harborough, Oadby and Wigston to get a dentist. Can I ask the Secretary of State to press on with two things? The first is the move to a proper national funding formula. Dentistry is the only part of the NHS without a funding formula, which disadvantages shire and coastal areas with older populations. The second is the next round of contract reform—the move to band 2b is working, and dentists are using it, but there are patients with complex cases for whom a capitation-like payment would be much better, as the British Dental Association pointed out. I encourage the Secretary of State to start working on that difficult group so that we can get extra help for them too.

[Victoria Atkins]

I must thank my hon. Friend for all his work. I know how much how much effort and commitment he has put into these plans, and it shows the genuine—[Interruption.] Sorry; the hon. Member for Ilford North (Wes Streeting) is being a little ungracious. My hon. Friend the Member for Harborough (Neil O’Brien) has been part of the united work across Government to deliver these plans. I very much take on board his recommendations and encouragement. As I say, we see this plan as delivering 2.5 million more appointments for our constituents, but of course we want to look to the long term as well.

[Mr Barry Sheerman (Huddersfield) (Lab/Co-op)]

Is the Secretary of State aware that Rip Van Winkle fell asleep for 20 years? This Conservative Government have been asleep for even longer than that, as far as dentistry is concerned. Will the Secretary of State now wake up and talk to real working dentists, such as Phil Lucitt—one of my excellent NHS dentists in Huddersfield, who is in the Gallery with his wife today—and get something done about this crisis? It is a crisis in Huddersfield, as in every town in this country, such as Bristol, as we heard yesterday. People are in pain, people are suffering, and for 14 years her Government have done little about it.

[Victoria Atkins]

I must admit that I did not know quite where that question was going, but I think the hon. Gentleman is urging me to speak to dentists. I am delighted to reassure him that my ministerial officials and I do of course speak to dentists. In fact, only today I was at a practice in the heart of Westminster, speaking to a dental manager who welcomes this plan. I will veer away and resist the temptation to comment on Rip Van Winkle.

[Peter Gibson (Darlington) (Con)]

I welcome this dental recovery plan, which will help to deliver dentistry in Darlington. Can my right hon. Friend the Secretary of State provide me with advice on what more I can do to get my integrated care board to get on with the commissioning at Firthmoor community centre, which lost its dentistry practice 10 months ago? In looking to expand the number of dental training places, I urge the Secretary of State to look at Teesside University, which has ambitions to build on its existing dental technology provision and train the Tees Valley dentists of tomorrow.

[Victoria Atkins]

Thanks to the work of my hon. Friend and others, Tees Valley is a powerhouse of growth industries, as exemplified by the Chancellor in his Budget and autumn statements recently. I will take away my hon. Friend’s words of advice about his university. On the point about encouraging ICBs to take part in this work, as this plan is a joint document with NHS England, the expectation will be on ICBs to deliver the plan, because they exist to look after our constituents. This plan is one of the ways we will be able to secure that help.

[Mohammad Yasin (Bedford) (Lab)]

In Bedford and Kempston, like many areas in the country, we have a dental crisis. I have raised the matter of dentistry previously, including in a Westminster Hall debate. There can be no question but that under this Conservative Government there is a dentistry crisis and the people of this country have been failed. Why does the Health Secretary refuse to admit that 14 years of neglect and underspending have led us to this?

[Victoria Atkins]

Says the script. I assume the hon. Gentleman will welcome the 2.5 million more appointments that this dental recovery plan will deliver for all our country.

[Mrs Heather Wheeler (South Derbyshire) (Con)]

I thank my right hon. Friend the Secretary of State for this brilliant statement, and thank all the team for their huge amount of hard work. Today is dentist day—yesterday was dentist day for me, as I had an appointment with the Minister and an appointment with a real dentist from South Derbyshire. This news is absolutely superb. Will the Secretary of State get dentists to move to South Derbyshire, and ensure more free NHS dentistry there?

[Victoria Atkins]

I have no doubt that with my hon. Friend’s characteristic joy and as an irresistible force of nature, she herself will be an advert for dentists to come to work in her constituency.

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

A constituent recently told me that when she tried to register members of her family with an NHS dentist, she was told that there was an eight-year wait. We know that workforce is a really big issue. On that basis, will the Secretary of State meet me and a cross-party group of Members of Parliament to talk about how we could develop a dental school at the site of the excellent Hull York Medical School to grow our own dentists for the future?

[Victoria Atkins]

The right hon. Lady will know that part of the focus of the long-term workforce plan is to train people where they are most needed. I will happily arrange for her to meet the relevant Minister. On registration, the current system is not like a GP practice where, once a family is registered, they can only go to that GP. The whole reason that we have been encouraging dentists to update their details on the NHS website is so that people can move around to visit different dentists to get the treatment they need. Today’s plan will help turbocharge those efforts.

[Peter Aldous (Waveney) (Con)]

I welcome this recovery plan, which provides the foundation for putting NHS dentistry on a sustainable long-term footing. I urge my right hon. Friend to continue her negotiations to replace the existing NHS dentistry contract as soon as possible, and to provide funding to the Norfolk and Waveney integrated care board so that the University of Suffolk can open a new treatment and training facility in our area, to replicate the innovative service that is about to open in Ipswich.

[Victoria Atkins]

I understand my hon. Friend’s point, and I commend him for his work to ensure that his constituents receive the care and help that they deserve. On training, I hope he has drawn out from the plan the emphasis that we are putting on long-term ambitions. We understand that we need to train more dentists and get internationally trained dentists registered in our system. We recognise the critical role that dental hygienists and therapists can play as well.

[Clive Efford (Eltham) (Lab)]

If the Tories cared about the NHS, we would not have 7.6 million people on the NHS waiting list and dentistry in crisis. The answer that the Secretary of State gave to my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley) demonstrates why we are in this situation. It is not about people turning up at A&E; the inability to access NHS dentistry services leads to people being in a crisis situation and needing emergency care. After 14 years of the Tory Government, why do we need a recovery plan for dentistry?

[Victoria Atkins]

The hon. Gentleman was obviously asleep at the beginning of my statement, because I set out what I hope is a fact agreed across the House about the pandemic—the real problem. People who had a relationship with a dentist before the pandemic do not face quite the same pressures as people who may have moved home or whose dentist may have moved practice. That is the cohort of people who we are trying to help. It really would help if Labour Members focused their arguments a little more on the facts, rather than on the scripts that their Whips have given out.

[Andrew Lewer (Northampton South) (Con)]

I very much welcome this statement and the meetings I have had with my neighbour, the Under-Secretary of State for Health and Social Care, my right hon. Friend the Member for South Northamptonshire (Dame Andrea Leadsom). The Secretary of State said that Northamptonshire will be included in a dental van roll-out, which is welcome, but the rest of the statement had a very rural focus. She will recall that my Prime Minister’s question focused on shortage in Duston. Is it at least a possibility that vans will go to suburban areas as well as rural ones?

[Victoria Atkins]

The criteria that will apply to the areas covered by vans are clearly set on dental need and other factors such as distance from an NHS dental practice. We have been able to identify areas of particular need, where we want to get that help as quickly as we can through the dental van initiative and the other ways detailed in the plan.

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

Last year, about half of my constituents were able to access dental services—well below pre-pandemic levels. Under the plans, what proportion of my constituents can now hope to access NHS dental services within the next six months?

[Victoria Atkins]

The dental recovery plan sets out immediate-term, medium-term and long-term plans. In the immediate term, we have the new patient premium that will be live from next month, the increase in UDA value to £28 and the golden hellos that I have described to under-served parts of the country. There is a batch of measures throughout the plan to address the concerns from colleagues across the House.

[Paul Bristow (Peterborough) (Con)]

I have a plan to open a brand-new NHS dentistry practice in Peterborough. New financial incentives, increased UDA rates and recruitment of overseas dentists to Peterborough are all part of that plan. Will my right hon. Friend meet me and those who want to open new NHS dental clinics in Peterborough, so that we can take advantage of every part of her excellent plan?

[Victoria Atkins]

I commend my hon. Friend for his excellent work as a constituency MP. It is exactly that sort of drive and ambition that will deliver results for his constituents. I would be delighted to meet him to discuss his plans, and I am pleased that our national dental recovery plan will fit well with his own local delivery plan.

[Jonathan Edwards (Carmarthen East and Dinefwr) (Ind)]

I regret to inform the House that the situation in west Wales is quite catastrophic, and recent reforms by the Welsh Government have probably made matters far worse. However, my constituents and I would like to know how much of what the Secretary of State has announced today is new money, resulting in Barnett consequentials for the Welsh Government.

[Victoria Atkins]

The hon. Gentleman articulates the case against Labour-run Wales with great power. There is £200 million on top of the £3 billion that we already spend on NHS dentistry in England

[Siobhan Baillie (Stroud) (Con)]

I have raised dentistry a lot, because Stroud constituents and dentists have been really worried, so I welcome the Government’s plans with NHS England. I give credit to Gloucestershire ICB, which recognised the complexity of this issue. Post pandemic, it set about raising provision and we have decent take-up so far. My plea to the Secretary of State and to the Under-Secretary of State for Health and Social Care, my right hon. Friend Member for South Northamptonshire (Dame Andrea Leadsom) is to continue their relentless focus on prioritising children’s appointments, and not to let parents off the hook, because we can all do better even if it is hard to get a toothbrush in a three-year-old’s gob every night. Will the Secretary of State say more about how ICBs will be supported to deliver the plans and integrate the work that they are already doing? The local areas that are prioritising this are making a difference.

[Victoria Atkins]

My hon. Friend was probably summing up this morning’s toothbrushing ahead of the school run for many mums and dads up and down the country. That is the point—we want to work with parents. We do not want to patronise them. The overwhelming majority of parents do a great job looking after their kids’ teeth. Our plans are to support those who are struggling. The expectation on ICBs is clear. The plan is a document between NHSE and us. We want to deliver this plan at local level. Expectations will be set on ICBs to make sure that they fulfil the potential of this great plan.

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

I welcome this long overdue focus on dental access. I am particularly interested in the 240 golden hellos that will be available. Clearly, they will be inadequate to deal with the scale of the challenge. I am also concerned that the focus of the statement seems to be on putting those golden hellos in rural areas. Visibility and transparency are needed about where they are allocated, because places such as Ellesmere Port have exactly the same issues as other areas in the country. We get phone calls every week from constituents asking where they can see an NHS dentist. We are not able to send them anywhere at the moment. Is the Secretary of State able to guarantee that in future we will be able to send them somewhere?

[Victoria Atkins]

I hope the hon. Gentleman will publicise the new patient premium, because that is one of the levers through which we will unlock places for new patients. I remember that he has taken an interest in this issue. I very much understand the point about location. We have set strict criteria for how dental vans will be deployed, but the new patient premium is across the country. We want as many people as possible to see NHS dentists and fill those 2.5 million more appointments.

[Martin Vickers (Cleethorpes) (Con)]

I particularly welcome the initiative to improve services in coastal and rural areas. The Health Secretary and I are constituency neighbours, and she will know the complexities of delivering local services in what we know as greater Lincolnshire, because her constituency is in the east midlands and mine is in Yorkshire and the Humber. Can she guarantee that the whole of greater Lincolnshire, from the south of the county up to Barton-upon-Humber, will receive the benefits of the new proposals?

[Victoria Atkins]

I am delighted to inform my hon. Friend and neighbour that the new patient premium applies across England, and of course people can move to the dental practice that can offer them the services they need, so I trust that his constituents will be as happy as mine.

[Hywel Williams (Arfon) (PC)]

Is the £200 million additional, in the sense of being diverted from other parts of the NHS in England, or is it new money from the Treasury that would attract the Barnett consequentials for Wales, Scotland and Northern Ireland? Which is it?

[Victoria Atkins]

We have finite resources. As I have said, this is additional money. I have prioritised dentistry across the board, but this is £200 million of additional money—in addition to the £3 billion that we spend in England.

[Sir Jeremy Wright (Kenilworth and Southam) (Con)]

I welcome what my right hon. Friend has said, and I understand why some of the new resources that she has announced are directed at particular types of intervention and particular groups of patients, but does she agree that one of the downsides of such an approach, at least potentially, is the extra administration that will obstruct dentists in the effective delivery of that resource? Will she therefore ensure that the funds are easily accessible, and that there is no such extra administration that would make that more difficult? Does she accept that longevity and consistency of funding matters, because it enables dentists to plan properly for their patients?

[Victoria Atkins]

My ethos is to make our NHS and social care system faster, simpler and fairer, and not just for patients but for practitioners. We do not want bureaucracy to get in the way of the delivery of these services, and I am impatiently keen to get them up and running in Members’ constituencies, so we will ensure that we make it is easy as possible for dental practices to use them.

[Alistair Strathern (Mid Bedfordshire) (Lab)]

I am sure that fellow former teachers who are here today will have memories of the disappointment they felt when, after repeated delays and excuses, a student finally handed in some work, only for it to turn out to be not just a copy of someone else’s work, but a pretty poor one at that. After so much delay and uncertainty, dentistry is at breaking point, so any progress, however late, has to be welcomed. But every local professional network I have met has stressed the need for fundamental reform of the dental contract so that things can get done. Given that this Tory Government have been in place for 14 years, why will the Minister not commit herself to finally reforming the contract and providing the boost to dentistry that my constituents so desperately want to see?

[Victoria Atkins]

I think it is very courageous of any Labour Member of Parliament to talk about education, because we know just how dire the education results are in Labour-run Wales. Yes, I have committed to reform of the dental contract, and we will deliver these services immediately because we want to deliver results for the hon. Gentleman’s constituents as well as ours.

[Selaine Saxby (North Devon) (Con)]

I thank my right hon. Friend for securing this vital plan, and I also thank her team for their ongoing engagement in what has been a difficult issue in my constituency since long before the pandemic. I cannot wait to see a dental van in South Molton and Ilfracombe, and to welcome new dentists to Barnstaple, Braunton and beyond. However, I recognise that this will take time. We have recruitment challenges despite our staggeringly beautiful surf beaches, which extend far beyond my right hon. Friend’s Department. Given her success in securing today’s announcement, might she be able to help me to promote these new dentistry opportunities to attract those who may not have previously considered spectacular, if remote, North Devon to be their future?

[Victoria Atkins]

My hon. Friend is exactly right. She is a wonderful constituency Member who speaks up for her constituents, and I can assure them that she has been talking to me since the moment I was appointed. As for advertising the new services, this is an opportunity for Members across the House—and I do hope that Opposition Members will be gracious—to ensure that their constituents are aware of them. We all want the best for our constituents, and the more we encourage local dentists to take up the new patient premiums and units of dental activity as well as the golden hellos, the sooner we will all see benefits in our constituencies.

[Imran Hussain (Bradford East) (Lab)]

For nearly a decade, I have stood in this Chamber and told numerous Ministers that there is more chance of finding gold bricks on the streets of Bradford than there is of getting an NHS dentist when you need one. For 14 years, Ministers have made a political choice to ignore our calls, but now, in a general election year, the Government suddenly want to take part of Labour’s plan and present it as their own—frankly, it is shameless. Will the Minister at least accept that unless there is proper reform, our NHS dentistry will remain rotten to the core?

[Victoria Atkins]

Again, we have heard a very loud performance from the hon. Gentleman—a typically loud performance. If only it had been as factual as it was loud. I have already set out, in response to the hon. Member for Ilford North (Wes Streeting), the difference between Labour’s plan and our fully funded plan to secure immediate and long-term changes. After 14 years of opposition, is this it?

[James Sunderland (Bracknell) (Con)]

As the Health Secretary will recall, we met recently to discuss dentistry in Bracknell, so I really welcome the plan that she has announced today. Will she please confirm, for the sake of absolute clarity, that a cornerstone of the recovery plan will be quicker and easier access to NHS dentists, and also that they will be properly incentivised to absorb all the patients who need support?

[Victoria Atkins]

Indeed, and it was a pleasure to meet my hon. Friend to discuss the issues facing his constituents. I hope he recognises that we will have those aims very much in mind in the delivery of the recovery plan. We will begin to see the roll-out of those 2.5 million more appointments in the coming weeks as the new patient premium takes hold.

[Richard Burgon (Leeds East) (Lab)]

Last month, Healthwatch Leeds submitted evidence to the Health and Social Care Committee—testimonies from people at the sharp end of the NHS crisis. One said:

“I am really struggling to find an NHS dentist that is accepting new patients at the moment. I am an apprentice and get paid minimum wage and cannot afford a private dentist.”

Others spoke of the way in which, according to Healthwatch Leeds,

“having no access to treatment is impacting on their general well-being and mental health.”

One of them said:

“ I just don’t know what to do, who to turn to, how to get help. I just want to be able to smile again”.

Is it not the case that this Government’s plan is too little too late, and that the queues snaking around dentists’ surgeries are testimony to the failure of 14 years of Conservative government and a deliberate undermining of our valuable public services?

[Victoria Atkins]

The hon. Gentleman has quoted Healthwatch. I presume that he will also be gracious enough to acknowledge that the move to introduce 15 dental vans has, in fact, been welcomed by Healthwatch.

[Bob Seely (Isle of Wight) (Con)]

We need more NHS dentistry on the Isle of Wight. I welcome this recovery plan, but can the Secretary of State tell me by when my constituents will see its benefits?

[Victoria Atkins]

By 1 March, because that is when the new patient premium comes into force. Other aspects will take a little longer, but we are clear about the immediate benefits, and we want to get those out to people as quickly as possible.

[Richard Foord (Tiverton and Honiton) (LD)]

In Devon and Cornwall last year, 57% of dental surgeries had at least one vacancy. Before 2016, more than 500 dentists registered in the UK had trained in European countries, and they made up a quarter of the workforce. Will the Secretary of State heed the call from the Association of Dental Groups for it to be made easier for qualified European dentists to practise here in the UK?

[Victoria Atkins]

That is exactly what we are doing, and not just in relation to other European nations but in relation to other countries around the world. We want the General Dental Council to ensure that qualified dentists from overseas are recognised and supported, and get on to our registers as quickly as possible.

[Julian Sturdy (York Outer) (Con)]

Like many others, I very much welcome the recovery plan, and I thank the Secretary of State for meeting me earlier to discuss the issues that we face in York. However, may I press her on the subject of integrated care boards? Will she ensure that they are held to account? Will they face increased monitoring to ensure that they spend the allocated money on dentistry and on the target areas in the recovery plan, and will that money remain ringfenced?

[Victoria Atkins]

I well understand why my hon. Friend has asked that question, about a matter that other Members have also raised. We are exploring ways in which we can make the expenditure of the dentistry budget more transparent, because it is right for ICBs to reflect the needs of local residents and deliver the services that should be available under this dental recovery plan.

[Tom Hunt (Ipswich) (Con)]

I very much welcome these interventions, particularly as I raised a question just a few weeks ago in Prime Minister’s questions about the time period. I am particularly pleased about that. On international dentists, I completely agree with what many colleagues have said. I have a close friend whose husband is Mexican and fully qualified as a dentist. The period between him getting the right to be in the UK and becoming a dentist in the UK is two or three years—it is far too long and there is far too much bureaucracy. I appreciate the announcement on therapists. We have 24 new ones on the new course in Suffolk, but 400 applied so I think there is room for even more therapists to play a key role. Can we also make sure that the consultation period is rapid? This is a common-sense policy and I think we should just get on with it. Finally, will the Secretary of State visit Ipswich to see the new dental centre and hear the case we are making for a dental school? We are the obvious place in the east of England, now that we have a dental centre.

[Victoria Atkins]

My hon. Friend will appreciate that I get a lot of invitations, but I will do everything I can to meet him. His passion and ambition for his local area shine through, and not just in the question he asks today but in the question he asked the Prime Minister a few weeks ago. He is absolutely right: we need the General Dental Council to work with us—I think it will—to ensure that we can get more international dentists registered as quickly as possible, for the benefit of our constituents.

[Andy Carter (Warrington South) (Con)]

I welcome what the Secretary of State has said today. I also pay tribute to the ICB in Cheshire for the work that it has done to make additional appointments available in Warrington, where it has been incredibly difficult to access NHS dentistry despite there being many dentists on the high street, because so many have decided to move away from the NHS. Can she explain how the changes announced today will incentivise dentists to return to providing NHS services, so that constituents in Warrington South can get the NHS appointments they want?

[Victoria Atkins]

As I have said, dentists are independent contractors but we want to encourage them back into the NHS if they have left it, and we believe that the new patient premium and the work on the UDA are just two of the levers that we can deploy to achieve that. We also have a longer-term vision for our NHS, and through the long-term workforce plan we will be training 40% more dentists by 2031. That is real ambition and a plan for the long-term future of our country.

[Anna Firth (Southend West) (Con)]

I completely welcome this plan, and particularly my right hon. Friend’s focus on underserved areas and coastal communities. This is something I have raised before in the Chamber. Southend is a coastal city with over 180,000 residents but only three dentists currently accepting NHS patients, so we qualify on both counts. Please could she confirm for Southend and Leigh residents that we will also get either a van or better dental care, preferably within months, not years?

[Victoria Atkins]

I am delighted to tell my hon. Friend that those dental surgeries already operating under NHS contracts will have the benefit of new patient premiums and the increased rate of UDA. On the dental van, she will appreciate that we are having to apply strict criteria to this, but I am delighted to see how enthusiastic she is about this recovery plan.

[Holly Mumby-Croft (Scunthorpe) (Con)]

I thank my right hon. Friend for this really welcome plan. Can she give any advice to patients who are registered with an NHS dentist but have not been seen in the last two years? Should they contact the dentist if they want an appointment or should they wait to be contacted? For those who are not registered, where will they find a list of dentists that they can contact to register their interest in becoming a patient?

[Victoria Atkins]

I thank my hon. Friend and fellow greater Lincolnshire MP for her question. In terms of the mechanics of this being delivered, the new patient premiums will come into force and patients can already look at the NHS website to see which practices have places available in their area. They can go there; they do not need to have had an existing relationship with that dental practice. We will also be setting out for constituents and Members of Parliament how, once the new premium comes in, people can get in contact and get the appointments we all want them to get.

[Ben Everitt (Milton Keynes North) (Con)]

More dentists, more appointments, more incentives for NHS work and a focus on underserved areas—this is exactly what Milton Keynes needs. I would like to thank the Secretary of State and, in particular, her dental Minister and my constituency neighbour, my right hon. Friend the Member for South Northamptonshire (Dame Andrea Leadsom), for all the work they have done, and in particular for listening to me banging on about dentistry in Milton Keynes for so long. I seek just one more clarification, please. Will the mobile dentist vans be serving hard-to-reach rural areas, such as my beautiful market towns and villages in Milton Keynes North?

[Victoria Atkins]

I join my hon. Friend in his praise for our right hon. Friend the Member for South Northamptonshire (Dame Andrea Leadsom). As I say, we are having to apply strict criteria to the dental vans. We want to get them out as quickly as possible to the most underserved areas, but we do not want dental vans to be the limit of our ambitions. The idea behind them is very much to revitalise those parts of the country that do not have NHS dental practices within a reasonable distance, and we are convinced that dental vans are just one of the levers by which we will achieve that.

[Matt Vickers (Stockton South) (Con)]

As my right hon. Friend knows, I am extremely concerned about access to dentistry for residents in Stockton South, so I hugely welcome this unprecedented investment and the places it will create locally. Can she confirm that the Government are committed to tackling the situation as quickly as possible and also for the long-term, and that they will continue to consult on broader workforce and contract reform?

[Victoria Atkins]

I am delighted to confirm that. We have wanted to deal with the issues as quickly as we can, but also with an eye to the future. This is the way in which the Government set out our plans for the NHS and for our social care system. I am confident, for example, about the introduction of golden hellos for new dentists. We know that that works with GPs and we now want to try it with dentists to see whether we can get dentists into those areas that do not have the service they need at the moment.

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

According to the National Audit Office, North West Norfolk has one of the lowest numbers of dentists per population. Can my right hon. Friend confirm that my constituents will benefit from the £20,000 incentives and from the mobile dental vans? On training, will she look closely at the proposal from the University of East Anglia for a dental training school? That is the obvious place to have it in the east of England.

[Victoria Atkins]

My hon. Friend will not be surprised to learn that I have received rather a lot of lobbying about the location of future dental schools. He will see in the plan that we are very open to the idea of training people with a view to their remaining in those areas. This is where golden hellos come in, and they will most definitely apply in the hardest-to-reach and underserved areas. As I say, we are taking very careful criteria-driven decisions about where the dental vans will be supplied, but we understand the problem that Norfolk has.

[Andrew Jones (Harrogate and Knaresborough) (Con)]

I welcome the statement and also thank my right hon. Friend for meeting me recently to discuss dental care in Harrogate and Knaresborough, where we have recently seen two practices hand back their NHS contracts, causing significant patient concern. I was pleased to hear her comments earlier about the retention of dentists within the NHS. Does she agree that good oral health is a critical part of good overall health, that establishing best practice early in life is essential and that that involves the very earliest years and supporting parents?

[Victoria Atkins]

Very much so. The truth is that teeth appear long before reception class, and this is why we want to focus not just on babies and toddlers in early years settings but, importantly, on pregnant mums because their oral health while pregnant can have ramifications for their baby. The dental recovery plan is seeking to address this through a long-term sweep from the very beginning of life to adulthood, with 2.5 million more appointments and a long-term plan for NHS dentistry in our country.

[Madam Deputy Speaker (Dame Eleanor Laing)]

I thank the Secretary of State for answering for more than an hour. We will now proceed, but first I will take points of order.

Pharmacy First

Victoria Atkins Excerpts

Wednesday 31st January 2024 Commons Chamber

[Dame Andrea Leadsom]

Well, the very first appointment under Pharmacy First happened at 8.30 this morning.

[The Secretary of State for Health and Social Care (Victoria Atkins)]

It was 8.31!

[Dame Andrea Leadsom]

Oh, was it 8.31? I thank the Secretary of State. When will the services be available? I should think that many more are taking place already.

I am afraid that, while welcoming this, the hon. Lady is being a little pusillanimous with her praise. A lot of her suggestions, as she will know, are simply not true: already, well over 2,000 new GPs and tens of thousands of nurses are working in our NHS. Many thousands of additional practice staff are working in GP practices, and, as she will know, our brilliant GPs have made 50 million more appointments available each year ahead of the target in our manifesto. Good on them. They are doing an amazing job, and Pharmacy First will ease the ever-increasing burden on them.

The hon. Lady talks about technology. I am pleased to tell her that ensuring that the technology was in place was key in deciding when we could go live. There is a very short window in which some systems will have elements of manual intervention, but only for a few weeks. The whole system will be fully automated and will provide the ability to inquire into GP records and to swap advice, which is important for pharmacists to deliver the excellent service that they are already delivering.

Finally, the hon. Lady will know that community pharmacists have for some time now been delivering blood pressure checks, which in some cases are truly lifesaving. This is amazing patient access and patient convenience. The Labour party should, for once, simply praise it and be glad that the Government have stuck to our plan and got on with it.

CQC Review: Nottingham Healthcare NHS Foundation Trust

Victoria Atkins Excerpts

Tuesday 30th January 2024 Written Statements

[The Secretary of State for Health and Social Care (Victoria Atkins)]

I have requested that the Care Quality Commission (CQC) conduct a special review of mental health services in Nottinghamshire under section 48 of the Health and Social Care Act 2008.

Like many of my Parliamentary colleagues, I was appalled by the horrendous and tragic killings of Barnaby Webber, Grace O’Malley-Kumar and Ian Coates in Nottingham in June 2023. I would like to place on record my deepest sympathies and condolences to the families of Barnaby, Grace and Ian.

The CQC special review will focus on reviewing the care provided by Nottinghamshire Healthcare NHS Foundation Trust and identifying where things may have gone wrong. This will give the families much-needed answers and will help identify how to improve the standard of mental health care in Nottinghamshire.

Any concerns regarding patient safety, quality of care, or public safety will be reported by the CQC, who will consider carefully the available relevant evidence, including witness and other oral evidence made public during the criminal trial of Valdo Calocane.

It is essential we move quickly to get the answers we need. This is why I am asking the CQC to conclude their investigation by the end of March at the very latest.

This special review will proceed alongside the Trust’s own internal investigation and NHS England’s Independent Mental Health Homicide Review, which is standard practice in these cases. I expect all parties to share information to avoid duplication and make sure that we receive as full a picture as possible. The CQC review will focus on this case and on wider issues in mental health care provision in Nottinghamshire, including at Highbury Hospital and Rampton Hospital.

I would also like to take this opportunity to update the House on the next steps of the Health Services Safety Investigations Body (HSSIB) investigation into mental health inpatient settings, which my predecessor announced in June 2023, in response to a number of tragic incidents that had taken place across the country.

Since June, the HSSIB, and its predecessor, the Healthcare Safety Investigation Branch (HSIB), has undertaken significant preparatory work, including holding over 30 meetings as part of the process of determining the scope of the investigation, and have reviewed the research evidence on safety.

The terms of reference for the investigation have today been published on the HSSIB website at https://www.hssib.org.uk/patient-safety-investigations/. There will be four investigations, which will focus on the themes of:

Learning from inpatient mental health deaths, and near misses, to improve patient safety.

The provision of safe care during transition from children and young person to adult inpatient mental health services.

Impact of out of area placements on the safety of mental health patients.

Creating the conditions for staff to deliver safe and therapeutic care (the workforce, relationships, and environments).

The investigations will identify risks to the safety of patients, and the HSSIB will seek to address those risks by making recommendations to facilitate the improvement of systems and practices in the provision of mental health care in England. This will include consideration of patient and staff safety with regard to allegations of sexual assault and rape. The investigations will conclude by the end of 2024.

Patient voice will be integral to the HSSIB’s investigation and report. They have been in touch with patients and families who have experienced poor care, as well as their parliamentary representatives, and are working with patient advocates and the charitable sector to arrange focus groups to support these investigations.

The HSSIB can also be contacted directly by any patient, carer or family member who wants to share their experiences of the mental healthcare they or their loved ones have received by emailing enquiries@ hssib.org.uk. I would strongly encourage all Members to highlight this opportunity to their constituents who may feel they would like to engage with this process and have their voices heard.

[HCWS226]

Oral Answers to Questions

Victoria Atkins Excerpts

Tuesday 23rd January 2024 Commons Chamber

[Sara Britcliffe (Hyndburn) (Con)]

1. What steps she is taking with Cabinet colleagues to support the children of alcohol-dependent parents.

[The Secretary of State for Health and Social Care (Victoria Atkins)]

May I start by wishing the hon. Member for Ilford North (Wes Streeting) a speedy recovery?

We are taking a wide-ranging approach to alcohol harms. Some £27 million has been invested in specialist alcohol care teams in a quarter of hospitals with the highest need, and we have published the first ever UK-wide clinical guidelines on harmful drinking and alcohol dependence, as well as providing around £300 million in funding to 75 local authorities through the family hubs and Start for Life programme. Family hubs funded through that programme are encouraged to provide full wrap-around support for families, which may include alcohol support services.

[Sara Britcliffe]

To the Government’s credit, they are currently putting money into addiction services. However, at the same time, there is no national strategy for children of alcohol-dependent parents. That has not always been the case. Between 2017 and 2021, there were local and national helpline services funded through a national strategy. Will the Secretary of State meet me to discuss this matter, as the children in these awful situations are some of the most vulnerable in society?

[Victoria Atkins]

May I thank my hon. Friend for her care and also for sharing her experiences on this subject? Through the drugs strategy, we have committed an extra £532 million of funding over three years to improve alcohol and drug treatment services, with £15.7 million invested in Lancashire. Last year, we saw a further £2.8 million invested nationally in line with guidance for the extra drugs strategy funding, which allows local authorities to fund targeted services for parents in need of treatment and support for their children and families. I will, of course, be happy to meet my hon. Friend to discuss this further.

--- Later in debate ---

[Mr Sheerman]

I have turned over a new leaf, Mr Speaker.

May I urge the Secretary of State to take this issue very seriously, to direct much more social media at young people and to get into schools the message about the real damage that can be done to the entire life of a child if the mother is drinking alcohol during pregnancy?

[Victoria Atkins]

I thank the hon. Gentleman for bringing some insight into how we can best reach families. Of course, it is not just mums, but fathers or carers who can have a huge impact on our children. That is why the Under-Secretary of State for Health and Social Care, my right hon. Friend the Member for South Northamptonshire (Dame Andrea Leadsom), is investing so much energy and commitment in our family hubs. We believe that they can be the centre for families to make the very best start to a child’s life.

[Sarah Green (Chesham and Amersham) (LD)]

2. What recent progress her Department has made on supporting the timely discharge of patients from hospital into social care.

--- Later in debate ---

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

5. What steps her Department is taking to help reduce pressure on NHS services in winter 2023-24.

[The Secretary of State for Health and Social Care (Victoria Atkins)]

Our plan includes opening 5,000 more beds, increasing ambulance capacity, expanding innovative services such as virtual wards and bringing forward covid and flu vaccinations for the most vulnerable. Thanks to the hard work of staff, NHS performance this winter has improved on last year, despite the impact of industrial action.

[Simon Lightwood]

I am sure the caveat to that was the word “shortly”. I have had constituents contact me in desperation regarding delays at Pinderfields Hospital in my constituency. They tell me they have waited hours in emergency care this winter for routine blood tests—literally all day in some cases—even while in extremely poor health. The Tories’ patchwork reforms and sticking-plaster politics are not fooling anyone. Does the Secretary of State not think that those dangerously long waiting times are a damning indictment of 14 years of Conservative mismanagement? What does she say to my constituents who are suffering right now?

[Victoria Atkins]

I am sure that the hon. Gentleman is a fair man, and that, being so, he will point out to his constituents, when they call him with their issues, that ambulance response times for category 2 emergency incidents in his local area have in fact been over 30 minutes faster than last year. However, we accept of course that this is a two-year plan and will take time to meet our full ambitions. Interestingly, the latest figures show that we have provided £6.9 million from the community diagnostic centres fund for the development of a community diagnostic centre at Wakefield. Presumably he welcomes that Conservative innovation.

[Mr Speaker]

I call the Chair of the Health and Social Care Committee.

[Steve Brine (Winchester) (Con)]

The pressure on services is acute this winter, as it is every year. So far, we have heard very little mention in these 20 minutes of the biggest headache facing trusts, integrated care boards, patients and, of course, the Prime Minister’s pledge to cut the waiting lists further. Given that the British Medical Association ballot on consultants’ action closes today, and that the dispute among doctors in training continues, can the Secretary of State update the House on her message to those voting today, and on where we are in wider industrial disputes, which are a drag anchor on the NHS right now?

[Victoria Atkins]

My hon. Friend is right to point out that we are in the final few hours of the consultants’ ballot on the pay reform programme that we have offered the British Medical Association. I very much hope that consultants will feel able to support that programme, because it is about bringing together the frankly quite bureaucratic system that they have to deal with at the moment, so that they are assessed in a shorter time with less bother and paperwork, while respecting their need to train and keep up their education and supporting professional activities commitments. I hope that they will agree with us on that. As I have said to the junior doctors committee from this Dispatch Box, should they return with reasonable expectations, we will, of course, reopen negotiations.

[Mr Speaker]

I call the shadow Minister.

[Karin Smyth (Bristol South) (Lab)]

The Secretary of State has said that preparation for winter started last January, but 54% of A&E departments were still rated inadequate or needing improvement in December, exacerbating the winter crisis. What will she do differently this year to ensure that we do not have another winter crisis in 2024-25?

[Victoria Atkins]

Again, the plan that we laid out last year is having a real impact at local level on the services being deployed through our accident and emergency services. We have seen discharge rates improving, for example. We appreciate that there can be local differences, but the importance that we put on maintaining that flow through hospitals is critical to ensuring that the waiting lists and waiting times that the hon. Lady describes are reduced. However, I gently remind the Labour party that it has been running the NHS in Wales for some time now, and it is a great shame that the good people of Wales—[Interruption.] The good people of Wales are waiting longer for their treatment—[Interruption.] They are almost twice as likely—

[Mr Speaker]

Order. I am a little bothered, because we have a long way to go on the Order Paper. I call the SNP spokesperson.

[Amy Callaghan (East Dunbartonshire) (SNP)]

We cannot discuss winter pressures in the NHS without acknowledging workforce shortages. The Secretary of State is having to contend with new immigration policies from her Cabinet colleagues that prevent dependants from coming to the UK, meaning that we are asking people to come and care for our loved ones while they leave behind theirs. I imagine that she is frustrated that that is now another barrier to recruiting staff to our health and care sectors. Has she expressed those frustrations to her Cabinet colleagues?

[Victoria Atkins]

I genuinely want to work with the Scottish Government, because I am troubled, to put it bluntly, that Scotland has some of the worst health outcomes in western Europe. It has the worst level of drug death rates in Europe, the highest alcohol death rates in 14 years, and there was a fall in life expectancy for three years in a row. We offered to allow Scottish patients to receive lifesaving operations in England, but sadly, that offer has been declined. I remain genuinely willing to work with the Scottish Government to help them with their health service.

[Sarah Edwards (Tamworth) (Lab)]

6. What steps she is taking to increase access to child and adolescent mental health services.

--- Later in debate ---

[Kerry McCarthy (Bristol East) (Lab)]

10. What steps she is taking to increase the recruitment and retention of NHS midwifery and maternity staff.

[The Secretary of State for Health and Social Care (Victoria Atkins)]

We are investing an additional £165 million a year to improve maternity and neonatal care, rising to £186 million a year from April. This will increase the number of midwifery posts and improve the quality of care that mothers and babies receive. As of October last year, there were 23,100 full-time equivalent midwives working in NHS trusts and other core organisations in England, which is more than 1,000 more than a year ago and 3,500 more than in 2010.

[Kerry McCarthy]

I thank the Secretary of State for that response. The Royal College of Midwives estimates that there is a shortage of around 2,500 full-time midwives working in the NHS. I know that at first hand from Cossham Hospital in my constituency, which has a wonderful birth centre, but it has been closed for most of the last few years, because it simply cannot get the midwives to staff it—they have to go elsewhere where more serious cases need to be dealt with. What is she doing specifically about the retention of midwives? I know that student numbers are, thankfully, coming up, but a lot of midwives are choosing to leave the profession because there is not enough flexibility in their work.

[Victoria Atkins]

I think we all agree that a career as a midwife is just one of the most rewarding and fulfilling careers that one can hope for. That is why we have placed such priority on retention in the long-term workforce plan that we launched last year. The national retention programme for midwifery and nursing has prioritised five actions to support staff retention, including menopause guidance, because we know that that can be an issue for midwives, and valuing them and their contribution is also a key objective of NHS England’s three-year plan for maternity services.

[Vicky Ford (Chelmsford) (Con)]

As well as recruitment and retention, training matters. Anglia Ruskin University has a campus in Chelmsford and is the provider of the largest number of health and social care degrees in the country, training midwives, nurses and, since the medical school opened, doctors. Will the Secretary of State back the campaign to expand the medical school in Chelmsford so that we can train even more local people to work in our local NHS?

[Victoria Atkins]

I thank my right hon. Friend for raising her local college, which does amazing work for the whole of the NHS as well as in her local area. I may have to retain a discreet silence over that particular application but I know that if any Member is sure to advocate effectively for their local area, it is my right hon. Friend.

[Mr Speaker]

I call the shadow Minister.

[Abena Oppong-Asare (Erith and Thamesmead) (Lab)]

Recruiting and retraining more NHS staff is crucial if women are to get gynaecology, obstetric and maternity care. I would like to share the story of Sandy Simmons. She was told 11 months ago that she needed surgery for a uterine prolapse; today, after nearly a year of pain, she is still waiting. Labour candidates such as Keir Cozens in Great Yarmouth are speaking up for women like Sandy and the 905 women waiting more than a year for treatment in Norfolk and Norwich University Hospital. Will the Secretary of State apologise to these women—or, like the Prime Minister, will she just walk away?

[Victoria Atkins]

I was genuinely delighted to welcome the hon. Lady to the Government’s women’s health summit last week to announce the consolidation, and indeed the improvement, of the women’s health strategy that this Government have launched. We saw significant success last year with hormone replacement therapy improvements and she knows, because she attended the summit, that I have just announced a £50 million research fund looking at maternity disparities and also research into female-specific conditions. Any concern she has about operation times she should take up with the local trust and it will perhaps tell her what impact industrial action has had, sadly, on elective surgery.

[Theresa Villiers (Chipping Barnet) (Con)]

11. What steps she is taking to support the early diagnosis of cancer.

--- Later in debate ---

[Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (Con)]

15. What recent progress her Department has made on reducing the number of people with a learning disability in in-patient units.

[The Secretary of State for Health and Social Care (Victoria Atkins)]

We have made progress against our target to reduce learning disability and autism in-patient numbers in England by 50% since 2015. For people with a learning disability without an autism diagnosis, there has been a 58% net reduction; for people with a learning disability who are autistic, the net reduction is 35%.

[Dr Cameron]

I thank the Secretary of State for that comprehensive answer. As chair of the all-party parliamentary group for disability, I have been hearing from organisations such as Mencap that remain concerned that people with learning difficulties are disproportionately detained for five to 10 years and for over 10 years. Will she reassure those organisations that the “Building the right support” action plan will continue to progress the great work that is being done?

[Victoria Atkins]

I thank my hon. Friend for her interest and, of course, her many years working as a clinical psychologist. She brings that experience to the Chamber. National commissioning guidance to integrated care boards was published in November. It sets out that a mental health in-patient stay for a person with a learning disability

“should be for the minimum time possible, for assessment and/or treatment which can only be provided in hospital”.

In overseeing implementation of the action plan going forwards, the “Building the right support” delivery board will maintain focus on quality of care and on reducing long stays.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

It is vital for the Government to do more to move autistic people and people with learning disabilities out of in-patient units and back to their communities. Recently, in the trial of staff at Whorlton Hall, we saw staff who were cruel and uncaring. Delivering sentences, the judge said that Whorlton Hall was an

“unpredictable and…frightening place to live”.

Is it not time for the Government to close down those units and move the majority of people into the community?

[Victoria Atkins]

I thank the hon. Lady for raising that point. We were all dismayed and upset to see the experiences of residents in those units, and we saw the correct criminal outcomes—if I am allowed to say that—for those involved in those assaults. A review is going on as to how those issues are affecting the estate as a whole, but we are clear that in-patient stays should happen only when they are strictly necessary. We must be mindful that clinicians will be taking many situations into account, including not just the safety of the patient but the safety of the wider community.

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

T1. If she will make a statement on her departmental responsibilities.

[The Secretary of State for Health and Social Care (Victoria Atkins)]

Women’s health needs are often overlooked and under-researched. Through our women’s health strategy, the Government are changing that. Last year, we made menopause a priority, helping almost half a million women get hormone replacement therapy for less than £20 a year. This year, we are building on that work and will have a women’s health hub in every integrated care board area in England. We will promote research into conditions that only affect women, such as endometriosis and lobular breast cancer, and those that affect women differently from men, such as heart attack symptoms.

We have also launched the first research challenge—worth £50 million—to tackle maternity disparities that have no place in modern Britain. Following the brave campaigns of my hon. Friends the Members for Hyndburn (Sara Britcliffe) and for Stafford (Theo Clarke), by March we will make dedicated maternal mental and physical healthcare available to every woman in England.

[Ruth Cadbury]

I recently met two constituents with experience of invasive lobular breast cancer. Invasive lobular carcinoma is the second most common form of breast cancer, but it is not generally picked up by mammograms, and it behaves differently from other breast cancers. However, lobular breast cancer has been understudied and underfunded, and it urgently needs research funding. Will the Secretary of State tell the House what specific actions her Government are taking to address those gaps? Will she also reply to the Lobular Moon Shot Project, to which she—

[Mr Speaker]

Order. This is topical questions.

[Victoria Atkins]

I gently remind the hon. Lady about the statement that I just gave. Last week we held the women’s health summit, at which I announced that we are encouraging research into conditions such as lobular breast cancer. I made that announcement because of two amazing women I met recently who were living with the condition. They were introduced to me by my right hon. Friend the Member for Horsham (Sir Jeremy Quin) and my right hon. Friend—

[Mr Speaker]

Order.

--- Later in debate ---

[Andrew Jones (Harrogate and Knaresborough) (Con)]

T6. I have been carrying out a health survey of thousands of residents in Harrogate and Knaresborough, to ask them for their experiences and views of the NHS. I will share the results with local healthcare professionals, to support them and their work. When the results are in, will the Secretary of State meet me to discuss how they will help inform and shape our local healthcare planning ?

[Victoria Atkins]

I would be delighted to meet my hon. Friend to discuss that. As always, he is an excellent advocate for his constituency, and I will enjoy listening to the results of his survey.

[Mr Speaker]

I call the shadow Minister.

--- Later in debate ---

[Andrew Lewer (Northampton South) (Con)]

T7. What steps is the Minister taking to ascertain the cause of ongoing problems affecting access to riluzole, the only licensed drug for the treatment of motor neurone disease in the UK, to provide clarity to the MND community and ensure that normal supply is restored as soon as possible?

[Victoria Atkins]

We understand how worrying the possibility of medication shortages can be. There is a supply issue with riluzole 50 mg tablets, caused by a supplier experiencing manufacturing issues. We have a well-established procedure in place to deal with such issues, and are working with the industry, the NHS and others to resolve it as quickly as possible. We have contacted alternative suppliers and have secured sufficient volumes of stock.

[Mr Speaker]

I call the Scottish National party spokesperson.

[Amy Callaghan (East Dunbartonshire) (SNP)]

Cancer Research UK has found that too much UV radiation is the third biggest cause of cancer across these isles. Does the Secretary of State recognise that cost is a barrier for people wishing to protect their skin from the sun, and will she commit to having conversations with Cabinet colleagues to remove VAT on sun protection products, which will help protect NHS budgets and ultimately save lives?

[Victoria Atkins]

We see that as part of a much wider campaign to ensure that we treat the sun safely, by reducing the amount of time we spend in the sun, particularly during peak hours of the day in summertime. I keep all these discussions in play with my Treasury colleagues.

[Mrs Sheryll Murray (South East Cornwall) (Con)]

T10. Rural constituencies such as mine are seeing a growing number of dentists withdraw from NHS provision. What steps is the Department taking to ensure that vital dental care is provided for everyone, particularly in rural communities?

--- Later in debate ---

[Victoria Atkins]

I thank my hon. Friend sincerely for her question. The good news is that community diagnostic centres have now delivered over 6 million additional tests and scans since July 2021 thanks to the hard work of NHS staff, but I will of course be delighted to meet her to discuss her plans for her local constituency.

[Derek Twigg (Halton) (Lab)]

T3. New British Heart Foundation analysis shows that the number of people dying before the age of 75 in England from heart and circulatory diseases has risen to its highest level in over a decade. The rate of premature deaths from cardiovascular disease has now increased in England for three years back to back. Why are the Government taking such a long time to get to grips with this crisis?

--- Later in debate ---

[Victoria Atkins]

Yes, happy to.

[Sarah Dyke (Somerton and Frome) (LD)]

T5. I recently met the staff of a pharmacy in Bruton in my constituency to hear about some of the challenges it is facing. Community pharmacists are dispensing some of the country’s most widely prescribed drugs at a loss, therefore subsidising the NHS. What steps is the Secretary of State’s Department taking to prevent the closure of community pharmacists?

[Victoria Atkins]

We are ensuring that community pharmacists have an even greater role in primary care than they have already. For example, we saw the first stage of the roll-out of Pharmacy First in December, with blood pressure checks and contraceptive care being rolled out. I am very pleased that we are on track to deliver the full roll-out of Pharmacy First by the end of the month.

[Sir Sajid Javid (Bromsgrove) (Con)]

The colour of someone’s skin should not have an impact on the reliability of medical devices, but we know that that is what happened during the pandemic for many black and Asian patients. When I was the Health Secretary, I commissioned an independent review of the equity of medical devices from Professor Dame Margaret Whitehead. Her report was handed to the Department in June last year, but the Department has not yet published it or responded to it. I know that my right hon. Friend cares about health inequalities as much as I do, so may I ask her to publish the report, along with a full Government response, as a matter of urgency?

[Victoria Atkins]

I thank my right hon. Friend for commissioning that vital piece of work. I am giving the matter my closest attention, and I hope very much to be in a position to respond to his points in due course.

[Kerry McCarthy (Bristol East) (Lab)]

T8. This week the Riverside unit in my constituency, which treats young people with severe eating disorders, had to close temporarily because of concerns about its ability to provide safe care. What are the Government doing to ensure that young people who, in many cases, go through mental health crises as a result of their eating disorders receive the care that they need as close to home as possible?

--- Later in debate ---

[Victoria Atkins]

I am delighted that the House is as happy about that expansion as the hon. Gentleman and I are. I will meet him to go through his plans, because I know how carefully he has campaigned for this important asset in his constituency.

[Cat Smith (Lancaster and Fleetwood) (Lab)]

T9. In the early hours of Friday morning, I arrived at the Royal Lancaster Infirmary with my sick son in an ambulance. As we walked past trolleys in the corridor, the nurse who was treating him said, “Our A&E unit is too small. We were promised a new hospital four years ago, but I think they have forgotten about us.” Can the Secretary of State tell that nurse, my constituent, whether we have indeed forgotten about that new hospital?

[Victoria Atkins]

The hon. Lady is aware of my knowledge not only of that hospital, but of her local area. I will look into this matter for her, because I want to ensure that the good people of Lancashire, Mr Speaker, are looked after as we would all hope and expect.

[Sir Jeremy Quin (Horsham) (Con)]

I warmly welcome what my right hon. Friend said last week about encouraging research on lobular breast cancer, and I look forward to meeting the Under-Secretary of State for Health and Social Care, the hon. Member for Lewes (Maria Caulfield), shortly to work out how we can operationalise what is her clear ambition.

[Victoria Atkins]

I thank my right hon. Friend and my hon. Friend the Member for Bishop Auckland (Dehenna Davison) for bringing two amazing women to talk to me about the impact of lobular cancer. For the benefit of Members on both sides of the House, last week we sent out a “Dear colleague” letter and graphics about the women’s health strategy so that we can all help our constituents to understand what this Conservative Government are doing to ensure that the healthcare of women is faster, simpler and fairer.

Women’s Health Strategy

Victoria Atkins Excerpts

Wednesday 17th January 2024 Written Statements

[The Secretary of State for Health and Social Care (Victoria Atkins)]

After a successful first year implementing the women’s health strategy for England, I am pleased to update on our priorities for 2024.

Improving care before, during and after pregnancy

We will continue to deliver NHS England’s three-year plan for maternity services and empower women with information on the improvements that they should expect and deserve during pregnancy and after giving birth.

We will work to prevent and improve support for women who have experienced physical and mental birth trauma. By March, new services to avoid tears during childbirth and to improve maternal mental health will be rolled out across England, alongside updated guidance for GPs.

We will improve post-natal contraception provision and awareness of hyperemesis gravidarum during pregnancy. We will also continue to support for women and their partners who have experienced pregnancy loss, including through the baby loss certificate service that will be available shortly.

Improving care for gynaecological conditions and menstrual problems

Guidance will be updated this year for gynaecological conditions such as endometriosis and we will work to improve women’s experiences of gynaecological procedures including hysteroscopy. Access to contraception will also be improved through Pharmacy First, which will play a vital role in managing menstrual problems.

The Office for National Statistics will carry out work to improve our understanding of endometriosis diagnosis times and the impact on women in the workforce.

Expanding women’s health hubs

We are investing £25 million in women’s health hubs to improve women’s access to care, improve health outcomes and reduce health disparities.

We are working closely with NHS England and the network of women’s health champions to support the establishment of women’s health hubs, and we expect all 42 local systems in England—each integrated care system—to have at least one hub operating this year.

Tackling disparities and improving support for vulnerable women

We will focus on improving support for patients and staff who are victims of domestic abuse and sexual violence. NHS trusts and local systems will review their policies, training and support systems for domestic abuse and sexual misconduct this year.

The new acquired brain injury strategy coming later this year will consider the needs of victims of domestic violence with acquired brain injuries. We will implement the recommendations in the NHS England and HM Prison and Probation Service joint national women’s prison health and social care review.

We will also work to reduce maternal disparities, given that data continues to show that black women are almost three times more likely to die during or shortly after pregnancy than white women. Women of Asian ethnic backgrounds are 1.67 times more likely to die than white women.

Boosting research on women’s health

Through the first ever National Institute for Health and Care Research—NIHR—challenge fund of its kind, we will provide £50 million to unite researchers, policy-makers, and women, to tackle maternity disparities. The NIHR will continue to encourage bids for better representation of women in research and more research into under-researched women’s health issues such as lobular breast cancer as well as conditions that affect women and men differently, such as heart attacks.

The NIHR recently published a statement of intent for developing policy and practice which sees sex differences fully accounted for in research.

Continuation of existing priorities

Since my the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Lewes (Maria Caulfield) wrote to parliamentarians in summer last year outlining the significant achievements made so far, we have made further progress in other areas:

We have published a tool to help people find local fertility commissioning policies in England. We have recently announced changes in the law to remove financial barriers to female same-sex couples accessing IVF, and will continue to work with NHS England to improve access to NHS-funded fertility treatment.

We launched our new women’s health area on the NHS website, a new HRT hub and for the first time new pages on conditions such as adenomvosis.

NHS England announced its aim to eliminate cervical cancer by 2040 by making it easier to get the lifesaving human papillomavirus—HPV—vaccination and increasing cervical screening uptake.

The NHS England Pharmacy Contraception Service relaunched to enable community pharmacies to initiate oral contraception. Almost 3,000 contractors have already signed up to the expanded service.

Between its launch on 1 April and 31 December 2023, 484,082 hormone replacement therapy prescription prepayment certificates were purchased, saving women millions of pounds in ongoing prescription charges.

NHS England will continue its work to improve menopause care by piloting new guidance for nurses, GPs and other staff in the midlands to better recognise and treat symptoms.

Helen Tomlinson, the Government’s Menopause Employment Champion, published a plan for the next six months in her role. The Government also launched online resources for employers.

In autumn we ran a reproductive health survey, which received 52,000 responses from women telling us about their experiences across all areas of reproductive health.

The upcoming major conditions strategy will consider the differences between men and women in conditions such as osteoporosis and dementia.

I am delighted to announce the reappointment of Professor Dame Lesley Regan as Women’s Health Ambassador for England for a further two years to December 2025. She will provide expert clinical leadership and support implementation of the strategy.

[HCWS192]

NHS Dentistry

Victoria Atkins Excerpts

Tuesday 9th January 2024 Commons Chamber

[The Secretary of State for Health and Social Care (Victoria Atkins)]

I beg to move an amendment, to leave out from “House” to the end of the Question and add:

“recognises the impact of a once-in-a-generation pandemic on NHS dental services, with 7 million fewer patients seen in England across 2020 and 2021; notes these challenges were reflected in both Scotland and Wales; acknowledges the steps already taken to recover services in England including the introduction of a minimum rate and increased payments for complex dental activity to better reward dentists for their work; welcomes the publication of the Long Term Workforce Plan which committed to expanding dental training places by 40 per cent; and supports the upcoming publication of the Government’s plan to further recover and reform NHS dentistry and promote good oral health throughout life.”

It is a pleasure to update the House on the work the Government are doing to strengthen NHS dentistry across the country. We are reforming our NHS and social care system to make it faster, simpler and fairer. Dentistry is a vital part of our NHS and improving dentistry is one of my top priorities. The hon. Member for Ilford North (Wes Streeting) represents a deeply urban seat, so I am pleased that he has presented me with an excuse to boast about the fact that I represent, and am very proud to represent, a rural and coastal constituency. That is why fairness is one of my three priorities for our NHS. I know the challenges that rural and coastal communities face when it comes to accessing an NHS dentist appointment, and the disparities in health that we see between rural and coastal communities and city centres. I will come to some statistics in a moment.

I am determined to fix these issues, and the other problems facing NHS dentistry, so that anyone who needs to can always see an NHS dentist, no matter where they live. Indeed, one of my very first acts as Secretary of State was to respond to the Health and Social Care Committee’s recommendations on dentistry. We agreed to the majority of those recommendations, and we stand firmly behind the ambition that NHS dentistry should be accessible and available to all who need it.

[Helen Morgan (North Shropshire) (LD)]

rose—

[Richard Foord (Tiverton and Honiton) (LD)]

rose—

[Victoria Atkins]

I am going to make a little progress, but I promise to give way later.

The whole House understands that the pandemic placed a long-lasting and heavy burden on NHS dentistry. [Interruption.] I hear groans from Opposition Members, but they cannot ignore the fact that some 7 million people did not come forward for appointments during that long period of the pandemic because dentists had to shut, and we were unable to accommodate those needs within the system because of the severe strictures under which we were all placed as a society. We shepherded the sector through the pandemic with £1.7 billion of direct support to compensate for NHS activity that could not be delivered. As we recover from the pandemic there are no quick fixes, but our recovery is well under way. Let me give the latest statistics, because the hon. Member for Ilford North missed them out in his speech. The Government delivered 6 million more courses of NHS dental treatment in 2022-23 than in the previous year. [Interruption.] In the two years to June 2023, the number of adults seeing a dentist increased by 1.7 million compared to the number in the previous year, and 800,000 more children saw a dentist in the year to June 2023.

Opposition Members cannot have it both ways. While I was reading out those statistics they were saying, “You cannot make those comparisons because of the pandemic”, but that is the point: people did not come forward during the pandemic, so, as we must all know from experience in our own constituencies, there is a backlog that dentists around the country are having to work through—and they are making progress.

[Dame Angela Eagle (Wallasey) (Lab)]

rose—

--- Later in debate ---

[Victoria Atkins]

In fairness, I will give way to the hon. Member for North Shropshire (Helen Morgan) first, because she rose earlier.

[Helen Morgan]

Like the Secretary of State, I represent a rural community, and the reason dentists are handing back their NHS contracts where I live is that they cannot recruit another dentist to come and help them. They have not had a day off, they cannot meet their commitments under their contracts, and they cannot recruit. They have offered golden hellos of 25%, but they have not been able to get anyone to come and work with them. What will the Secretary of State do to recruit the dentists whom we need to see the people in dental deserts such as North Shropshire?

[Victoria Atkins]

As I have explained, in relation to dentistry but also in relation to wider healthcare, the long-term workforce plan, which was requested by NHS England and by clinicians, is the means of laying those foundations for the future of the NHS. I will now give way to the hon. Member for Wallasey (Dame Angela Eagle).

[Dame Angela Eagle]

I thank the Secretary of State. I wanted to intervene earlier when she was talking about the pandemic. In my constituency many people were thrown off their dentists’ lists during the pandemic, often with no notice, and then found that they could not register anywhere else. That is what happened, I believe, all over the country. Can the Minister explain what she is going to do about it? It was not that people were not visiting their dentists; they were denied access.

[Victoria Atkins]

The hon. Lady has raised an interesting and important point, because, of course, dentists are independent contractors to the NHS, and I have to work with the levers that are available to me. As I have said, we have already invested £1.7 billion to try to help with the recovery, and the House will, I hope, look forward to our dentistry recovery plan when it comes to other ways in which we can improve that. The important point, however, is that because those dentists are independent contractors, we must work with the profession to encourage them back to the NHS to offer the services that we all want to see.

[Sir John Hayes (South Holland and The Deepings) (Con)]

Is not the root of the problem the contracts that the NHS has with dentists? The roots of that, of course, lie with the previous Government, a Labour Government, rather as they do with the GP contracts. Does my right hon. Friend not need to revisit the genesis of this problem, as well as training more dentists here in the UK?

[Victoria Atkins]

I thank my right hon. Friend, and indeed my friend, my Lincolnshire neighbour, who knows as well as I do the pressures that we face in ensuring that our constituents receive the same quality of care that we expect across England. He was right to draw attention to the—I would argue—badly drafted contract of 2006, but he also touched on the complexity involved in finding systems that would work better.

[Wes Streeting]

rose—

--- Later in debate ---

[Victoria Atkins]

I cannot wait to reach the part of my speech that will deal with the hon. Gentleman’s suggestions, but first I will allow him to intervene, because I enjoy this back and forth.

[Wes Streeting]

So do I. The Secretary of State is far more entertaining than her predecessor. Given that she is painting a picture of improvement, how does she explain the story in The Times which revealed that NHS dentistry activity is now falling in 2023-24 compared with 2022-23? Is it not the case that things are going backwards rather than forwards? How does the Secretary of State explain that, and when are we going to see her plan?

[Victoria Atkins]

I am grateful to the hon. Gentleman for raising that point, because according to the latest statistics available to me, 18.1 million adults were seen by an NHS dentist in the 24 months up to 30 June 2023. That is an increase of 10%, and what does it mean in reality? It means that over 1.7 million more adults were seen than in the previous year. I know that we are all concerned about the health of children; some 6.4 million children were seen by an NHS dentist in the 12 months up to 30 June 2023, an increase of 14%, which means, in real terms, an increase of 800,000 on the previous year.

I accept, of course, that there is more to do, and we will be setting that out in our dental recovery plan shortly, but this is not just about big numbers. [Interruption.] The hon. Gentleman asks when “shortly” will be. As he knows full well, “shortly” is a little shorter than “in due course” and a little longer than “imminently”.

We have introduced several simple and effective measures to improve the nation’s dental health. The Health and Care Act 2022 made it simpler to expand water fluoridation schemes, because raising the fluoride level to 1 mg per litre is a straightforward way to prevent tooth decay. It has proved effective in parts of England as well as Canada, the United States, Ireland and Australia, and the chief medical officer has concluded that there is “strong scientific evidence” that water fluoridation can drive down the “prevalence of tooth decay”.

[Anthony Mangnall]

I congratulate the Secretary of State on the progress that has been made, while, obviously, recognising that there is more to be done. I wonder if she will help me to ask the shadow Minister to correct the record. He said that in 2010 and 2015 Labour had a plan for dental practice, but there is no mention of that in the Labour manifestos. I will come back and correct that if necessary, but the hon. Gentleman is out there stating that Labour has had a plan for dental recovery since 2010, and that is not in those manifestos.

[Victoria Atkins]

My goodness me! My hon. Friend has identified a “cavity” in the shadow Minister’s so-called plans.

[Several hon. Members rose—]

[Victoria Atkins]

I am going to make some progress.

I am very pleased that, subject to a public consultation which will be published shortly, we have secured funding to expand water fluoridation schemes across the north-east of England. [Interruption.] The hon. Member for Ilford North may be interested to know why we have identified the north-east, given that he read out so many constituency names in his speech. The north-east was chosen because natural fluoride levels there are among the lowest in the country, and the proportion of five-year-olds with teeth extracted because of tooth decay is among the highest. We have wanted to address that very real health inequality to ensure that more than 1.6 million people in the area can benefit from this expansion, subject, as I have said, to a public consultation.

Supervised tooth brushing has been raised. That has indeed been proven to drive down oral health inequalities, which is why we have already introduced a toolkit that local authorities are using to introduce supervised tooth brushing across schools, nurseries and family hubs. We have been clear that we want to see that happening in more areas. I would encourage any colleague who is concerned about that, rather than waiting for some mythical date in the future, to ask our local authorities whether they are using these toolkits, because they are freely available, and they can and should put them in place.

[Catherine West]

The Secretary of State rightly talks about prevention, but what about the opposite, where rates of oral cancer have gone up because prevention has not been in place? What assessment has she made? If she does not have the data to hand, will she write to me with the assessment that the Department of Health and Social Care has made of the link between failure on prevention and cancer?

[Victoria Atkins]

I thank the hon. Lady, and particularly for the constructive tone of her intervention, because she is right. This is not simply about teeth health; it is also about the conditions that dentists check for—probably without anyone quite realising that they are doing so. I will take the hon. Lady up on her invitation to write to her on the figures, but that is why we are looking at health inequalities across the country and, importantly, focusing on encouraging dentists to re-register with the NHS if they have left, because it is vital for tackling much wider health conditions in addition to the pain and discomfort that tooth decay can bring.

[Ashley Dalton (West Lancashire) (Lab)]

Will the Secretary of State give way?

[Victoria Atkins]

No, I will give way to my hon. Friend the Member for North West Norfolk (James Wild) and then I will make some progress.

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

My right hon. Friend mentioned levers. One issue facing recruitment in North West Norfolk is the time involved in getting on to the NHS performers list. Newly in post, will she look at that issue and bring forward proposals as part of the plan to speed up that process and boost recruitment?

[Victoria Atkins]

I am extremely grateful to my hon. Friend. His intervention shows the level of detail that colleagues on the Conservative Benches have gone into in trying to address the understandable concerns that local NHS providers are voicing. I will look into that. I am very keen on my three words: faster, simpler, fairer. I want to make it as simple as possible for dentists to rejoin and join the NHS. I will say more on that later.

The choice of whether patients are offered NHS exams and treatment lies with the dentists, who are independent contractors to the NHS. As well as making simple, common-sense changes, in July 2022 we announced a package of far-reaching reforms to make NHS work more attractive to dentists. We have created more bands for units of dental activity, so that dentists are properly rewarded for taking on more complex care, and the best-performing practices can see more NHS patients.

Previously, regardless of the amount of time the dentist took on each patient, they received the same payment for every individual treatment package in band 2, which covers fillings and tooth extraction. Perversely, that meant they received the same payment for doing one filling as for three. That left many dentists unable to afford to take on patients who had not seen a dentist for some time and therefore needed extensive treatment. That needed to be put right for the sake of both patients and dentists. Thanks to our reforms, dentists now receive five units of dental activity when they treat three or more teeth, which is a significant increase from the old maximum of three. Root canal treatment on molar teeth is now rewarded with seven units of dental activity, as opposed to three, meeting one of the British Dental Association’s key demands.

We also recognise the barriers that too many communities have faced when accessing NHS dentistry, with people left phoning around practices to see who was taking on NHS patients. That is why we have made it a contractual requirement for dentists to update the NHS website regularly, making it clear whether their practices are taking on new patients, as well as explaining the services that they offer, thus making it easier for patients to find a dentist that can deliver the care they need. These reforms have improved access to dentistry and ensured that the system better supports dentists and their teams, so they were well received by dentists, their representatives and patient groups across England, with Healthwatch’s national director recognising that these reforms show that the Government are listening to patients and taking action, and these reforms can help ensure that dental care is accessible and affordable to everyone who needs it.

[Wera Hobhouse]

I am pleased to hear about some of the reforms that we have raised in this Chamber many times, particularly on changing the dental contracts and units of dental activity, but may I raise another point? In official workplace data, dentists who do just one NHS check-up a year are counted the same as an NHS full-timer. Does the Secretary of State recognise that that is a problem, because that workplace data hides the scale of the problem?

[Victoria Atkins]

I am extremely grateful to the hon. Lady, who makes a fair point about measuring within the system how much work NHS dentists are doing. As I say, we are looking at all of this in the work that we are doing on the dentistry recovery plan. I repeat that I want to make it as simple as possible for dentists to register with the NHS, to continue offering the care that we all want them to, so I am grateful to the hon. Lady for her intervention.

[Seema Malhotra (Feltham and Heston) (Lab/Co-op)]

rose—

[Victoria Atkins]

I am going to plough on, I am afraid.

Earlier, Labour Front Benchers—perhaps not understanding that they were doing so—set out the philosophical difference between our two parties on how to grow the economy. As our economy grows, we on the Conservative side of the House want to attract the best and the brightest from around the world to work in our NHS, in our tech sector, in our life sciences industry, in our movie industry—hon. Members may know that it filmed “Barbie” this year—and in many other thriving industries. Labour, however, apparently wants to shut the door by taxing such people on earnings they make outside the UK. I speak, of course, of non-domiciled tax status.

If I may correct the hon. Member for Ilford North, because I appreciate that he has not spent any time on the Front Bench, last year alone non-domiciled taxpayers paid £8 billion in UK taxes on their UK earnings. That is equivalent to more than 230,000 nurses. Labour wants to put that at risk and put the UK at a disadvantage in the highly paid, highly competitive, highly mobile international labour market. This really is yet another branch of the magic money tree that Labour has always been looking for, to which they apparently want to add £28 billion a year of taxes or increased borrowing and increased inflation.

How they want to spend this money is interesting as well, because in 2022 Labour promised that their non-domiciled taxation would fund a workforce plan. Last September, it became breakfast club meals. Then, by October, it had morphed into 2 million hospital appointments and MRI and CT scanners. Now, apparently, it is funding a dentistry plan. One wonders how all these magic branches on the magic money tree will add up to all the promises made so far.

[Wes Streeting]

Will the right hon. Lady give way?

[Victoria Atkins]

I will resist, but only because I am going to ask the hon. Gentleman to intervene in a moment—he should be careful what he wishes for. I also notice that he talked about reform of the dental contract but did not give any detail. Government is not as easy as selling a book. It cannot be cut and pasted from Wikipedia, as some on the Labour Front Bench seem to like to do. It is about being clear on what you would do differently. Now, Labour in Wales is of course running the Welsh NHS. They do like to do things differently. People there are almost twice as likely to be waiting for health treatment as in England.

[Virginia Crosbie (Ynys Môn) (Con)]

The Leader of the Opposition states that the Labour Government in Wales is a blueprint for what Labour can do in the UK. Given that 97% of high street dentists in Wales state that Labour’s reforms are not working, does the Secretary of State agree that NHS dentistry is being destroyed by Labour in Wales, and that if Wales is their blueprint for UK dentistry, we should all be very afraid?

[Victoria Atkins]

I thank my hon. Friend, who represents a Welsh constituency. The chair of the British Dental Association wrote to the Labour Welsh Government to complain about their plan and, I understand, used words such as “toxic mix of underinvestment” and “untested targets.” The picture in Wales, if it is the Leader of the Opposition’s blueprint, is perhaps not as convincing as the shadow Health Secretary would have us believe.

The fundamental difference between the current systems in England and Labour-run Wales is that Wales has a capitated list system for dentistry. I am willing to give way so that the shadow Health Secretary can clarify whether he wants to bring in that system.

[Wes Streeting]

I cannot believe that is meant to be the right hon. Lady’s big “Gotcha.” She cannot even tell us when she will bring forward her plan, let alone what is in it. They have had 14 years to come up with a plan. This is absolutely astonishing. As much as I enjoy these partisan knockabouts at the Dispatch Box, the sight of the Health Secretary giggling and laughing at her own jokes will be of small comfort to people who are literally pulling out their own teeth.

[Victoria Atkins]

Just to cut through all the froth, the hon. Gentleman has not, in fact, answered my invitation. Does he wish to have a capitated list system, as they have in Wales, or does he have other plans? Could he please answer?

[Wes Streeting]

Like any responsible Government, we would consult the dentistry profession, the BDA, and come up with a serious programme for dentistry reform. If the right hon. Lady wants to ask me questions and have me answer them, the Government should call a general election and I will happily oblige.

[Victoria Atkins]

Again, cutting through the froth, the hon. Gentleman called this debate and has not set out his plan. He knows full well that this is an Opposition day debate and I am responding to Labour’s motion by moving an amendment. He has no plan on dentistry. When I asked him to clarify whether he will follow the capitated system in Wales, he declined to answer. I assume that is because he knows we tested a prototype system based on the Welsh capitation approach here in England, and the results were clear. It worsened access and widened oral health inequalities.

The hon. Gentleman quoted the Nuffield Trust, placing great emphasis on it, in his opening speech. As he agrees so much with the Nuffield Trust’s report, does he also agree with its former chief executive who said that his ideas on general practice represent

“an out of date view”

and “will cost a fortune”?

It is becoming increasingly clear that the Labour party’s approach to our NHS is empty words about reform followed by the phrase “funded by non-doms.” We are very lucky in this country—on this side of the House we consider ourselves blessed—to have incredible dentists working across the NHS.

Here are some facts for Opposition Members. There are now 1,352 more dentists working in the NHS than 14 years ago, thanks to the stewardship of this Conservative Government. I thank them and their colleagues for everything they do, and we are backing them to build a brighter future for NHS dentistry by taking concrete steps to improve recruitment and retention. That is why our long-term workforce plan, the first in NHS history, will expand dentistry training places by 40%, providing more than 1,100 places by 2031, which will be the highest level on record under any Government.

Over the same period, this Government’s plan will also increase training places for dental therapists and hygiene professionals to more than 500. The importance of the long-term workforce plan to dentistry’s future was recognised across the sector, and Professor Kirsty Hill, who chairs the Dental Schools Council, backed our plan:

“Expansion is a significant and positive development, and we commend the government for recognising the importance of increasing dental hygiene and dental therapist positions. These roles play a vital role in enhancing capacity and improving care.”

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

I find it absolutely extraordinary that the Health Secretary lectured the shadow Health Secretary on calling a debate to hold this Government to account. Twelve million people are not able to access dental care, including thousands in my Oldham constituency.

--- Later in debate ---

[Madam Deputy Speaker (Dame Rosie Winterton)]

Order. The hon. Lady knows that she must not refer directly to other Members.

[Victoria Atkins]

I think the hon. Member for Oldham East and Saddleworth (Debbie Abrahams) was raising her voice at me, but it was not me who heckled her. I recognise the passion she brings to her intervention, and I simply made the point that this is an Opposition day debate. The hon. Member for Ilford North understandably set out some of his plans, which is his job, and I was merely questioning him on the detail of those plans. Sadly, he was not able to provide that detail.

The long-term workforce plan is about not just training more staff but delivering value for hard-working taxpayers. Currently, around a third of dentists do not carry out any NHS work. This simply is not fair on the taxpayers who fund their training, which is why, through the long-term workforce plan, we are exploring the introduction of a tie-in period that encourages dentists, after they graduate, to spend a minimum proportion of their time delivering NHS care. We have also made it easier for experienced dentists from around the world to come to the UK to ply their trade, which is apparently something with which Labour Members do not agree.

Last year, we brought forward legislation to give the General Dental Council greater flexibility in administering the overseas registration exam. The Government welcome its decision to triple the capacity of the next three sittings of part one of the ORE, from August last year, and to increase the number of sittings of the second part of the exam from three to four, creating an additional 1,300 places. Ministers will continue to meet the GDC to discuss how we can make these flexibilities as effective as possible, to get more dentists into the NHS workforce delivering care for patients.

[Seema Malhotra]

I thank the Secretary of State for giving way. It is worth repeating that the Nuffield Trust has warned that NHS dentistry is at its most perilous point in its 75-year history. That goes alongside recent Healthwatch polling suggesting that one in 10 people in England have ended up paying for private dental treatment in the last 12 months because they could not find an NHS dentist. It has been the same in my constituency, where the majority of dental surgeries are not taking on new patients. Can the Secretary of State explain how on earth things have got this bad?

[Victoria Atkins]

I trust that the hon. Lady has been listening to the whole debate, because I set this out in some detail at the beginning of my speech. I will not repeat the impact of the pandemic, but I hope she has taken on board the £1.7 billion of investment that has already seen a sizeable increase in the number of adults and children being treated by NHS dentistry.

I do not pretend that this is the full stop at the end of the sentence. We have a plan and I look forward to our debate when that plan is published, because I suspect it will be welcomed across the House.

[Dominic Raab (Esher and Walton) (Con)]

I commend my right hon. Friend for her powerful speech. The plan will improve financial incentives for NHS dentists and support practices to take on new patients, but to what extent will she and the plan take on board high operating costs and, indeed, the high cost of living in areas where there is high demand for NHS dentistry?

[Victoria Atkins]

I thank my right hon. Friend for his intervention. I can imagine that the concerns he outlines are very pressing in his constituency, and one important priority behind the dental recovery plan work is addressing health inequalities. Although I have spoken about rural and coastal areas from a constituency perspective, we also understand, of course, that there are differing cost of living pressures in different parts of the country. He makes an important point about the costs for NHS dentists operating in very expensive parts of the country, such as his constituency, and I thank him for doing so.

Our workforce is not just made up of dentists; dental care in England could not function without the vital contribution of dental and orthodontic therapists, dental hygienists, dental nurses and clinical dental technicians. We recognise the importance of harnessing the skills and knowledge of all those professionals. They can support dentists to carry out first-class care, and we must empower them to take on more responsibility and to work at the top of their licences. That is why last year we issued guidance to NHS practices, supporting them to make the most of everyone in the dental team and make a difference to patient care. Since then, NHS England has made it clear that dental therapists and dental hygienists can provide patients with direct care, provided they are appropriately qualified, competent and indemnified. We have also run a consultation to enable dental therapists and hygienists to deliver more treatments. That will boost access to care for patients and support dentists, and we will be setting out our next steps shortly.

[Grahame Morris (Easington) (Lab)]

rose—

[Victoria Atkins]

I am conscious that Opposition Members will want time today, so I am going to bring my remarks to a close. It is my mission, as Health and Social Care Secretary, to build an NHS that is faster, simpler and fairer, and of course I include dentistry in that work. We have taken the long-term decisions that will improve access to dental care. Delivering 6 million more courses of treatment, expanding dentistry training places by 40% and making it easier for patients to find a dentist to deliver the care they need are just some of the ways in which we are going to achieve that. Of course, we must make sure that dentists are properly rewarded for all the work they do. Through our soon-to-be-published dentistry recovery plan, we will go further, to make NHS dentistry accessible and available for everyone who needs it, no matter where they call home in this great country.

[Several hon. Members rose—]

NHS Winter Update

Victoria Atkins Excerpts

Monday 8th January 2024 Commons Chamber

[The Secretary of State for Health and Social Care (Victoria Atkins)]

With permission, Mr Deputy Speaker, I would like to make a statement on the winter pressures facing the national health service and social care, as well as the impact of the ongoing junior doctors’ strikes. The NHS employs 1.3 million people and the social care system a further 1.5 million people. Together, they treat and care for tens of millions of people every day. We all know that winter is the most challenging time of the year for the NHS and social care, as our workforce have to tackle the pressures created by cold weather and seasonal viruses.

To put our health and social care system in a strong position heading into winter, this year we started preparing earlier than ever before. In January last year, we published our recovery plan for urgent and emergency care and provided £1 billion of dedicated funding to boost emergency capacity. The plan committed to delivering 5,000 new permanent staffed beds. I am pleased to update the House that more than 3,000 were already in place in December, and in the coming weeks NHS England will meet the 5,000 pledge and make sure that it has almost 100,000 core beds ready when covid and flu peak.

Our recovery plan also pledged 10,000 virtual ward beds so that more patients can be monitored safely at home, away from hospital. I am pleased to update the House that we have delivered more than 11,000 virtual ward beds, and they have been a vital service for eligible patients over the festive period.

We have boosted our ambulance service with £200 million of additional funding, putting new vehicles on the road, improving response times and getting crews out and about for more hours. In recognition of the importance of patients being discharged promptly from hospital when it is safe to do so, we have made sure that every acute hospital in England has access to a care transfer hub, bringing together teams from the NHS and social care to speed up discharge, backed by an extra £600 million for social care. To help prevent the spread of winter viruses, we brought forward flu and covid vaccinations, protecting the most vulnerable and making them less likely to require hospital treatment.

But no matter how thorough our preparations are, winter will always be the most challenging time of the year for our NHS. That is why it is extremely regrettable that the British Medical Association’s junior doctors committee has chosen to strike not once, but twice at this time of year. It has also chosen to strike for an unprecedented length of time, putting profound pressure on hospitals and GP surgeries throughout the country.

Before Christmas, the BMA’s strike caused the cancellation of almost 90,000 appointments, some of which will have to be rescheduled for a second or even third time. That is in addition to the 1.1 million appointments that have already been affected since strikes began in December 2022. This is not just another statistic; there is a person behind every one of these appointments, who may be in pain or distress and who now must wait longer for the care they deserve.

Last week, a member of the BMA leadership said

“strike action benefits absolutely nobody.”

They were absolutely right on that. The ongoing strikes are causing more appointments to be cancelled and more worry for patients, and are putting a significant strain on staff.

During December’s and this week’s strikes, the NHS’s priority has been to protect patient safety. Resources have been channelled into urgent and emergency care, including vital neonatal and maternity services. Huge efforts were made to make the most of the working days between Christmas and new year, because throughout any strike action, it is crucial that every patient who needs urgent medical care comes forward as normal. We continue to face challenges, and strikes have stretched emergency care, but thanks to the meticulous hard work in local trusts in preparing for strikes, as well as to the huge personal sacrifices that clinicians and staff are making to pick up the slack, emergency care has largely held up and the system has coped under the circumstances.

Staff across the NHS deserve our sincerest thanks for the heroic efforts they have made throughout the unprecedented strikes. I thank the doctors, nurses, paramedics and all frontline staff who have come into work to support each other, deliver care and protect patients; the consultants, including Members of this House, who are working extra hours, cancelling their holidays or even coming out of retirement to safeguard patient safety; the managers, administrators and NHS leaders who are working day and night to make sure that the right staff are in the right place to protect patient safety; and all those working in social care, from local authority staff to care workers and carers, who have rallied round to support hospitals.

I know that work does not stop when the strikes stop. NHS staff will begin turning their attention to recovering from the impact of the industrial action, restarting elective treatment and improving the flow of patients through emergency departments. The junior doctors committee’s choice to strike at this time of year means that that work must now be done under additional pressures, as staff move to catch up from industrial action as well as tackling the impacts of cold weather, covid, flu and norovirus.

I want to find fair and reasonable solutions to industrial action. One of my first acts as Health and Social Care Secretary was to bring in the British Medical Association for talks to end these long-running disputes, as well as meeting representatives for Agenda for Change unions who speak for frontline staff, including nurses. We have reached agreements with unions that represent consultants and specialty doctors on offers to be put to their members. Those offers will modernise contracts, realign pay scales and improve doctors’ career progression, while delivering value for the taxpayer and protecting the hard-won progress we have made to halve inflation. Consultants and specialty doctors are pausing strike action while members vote on the offers, with the results of both ballots expected shortly. The Government and BMA agree that they are the best deals available to us, and I very much hope that members will vote in favour so that those positive changes can be made and we can move the NHS forward.

On junior doctor negotiations, the talks that began in November had been progressing with the BMA junior doctors committee. The talks were constructive, exploring a range of proposals that would improve the working lives of doctors across the NHS. I was therefore extremely disappointed when the BMA turned its back on the negotiations before they had concluded to call the damaging strikes that we face today. The Government will not negotiate with the BMA while strike action is under way and patient safety is at risk. Every strike is hugely disruptive for our NHS. The NHS and patient safety cannot be switched on and off on a whim. I do not believe it right to negotiate with unions while they are being unreasonable and some of their members are walking out of hospitals at the busiest and most challenging time of year for patients.

I remind the House that the junior doctors committee’s headline demand of a 35% pay rise is simply unaffordable for taxpayers. Last summer, we accepted the recommendations of the independent pay review body in full. That meant that junior doctors received average pay rises of almost 9% in their September pay packets—some of the most generous increases across the entire public sector. Meeting the 35% demand would stoke inflation just as we as a country have halved it, burning a hole in the pockets of families up and down the country, and it would be totally out of step with the pay rises awarded to other dedicated public servants and employees throughout the private sector. Staff across the public sector have agreed fair and reasonable deals on pay; only the junior doctors committee has repeatedly walked away from talks.

Let me address the issue of NHS leaders asking some junior doctors to return to work when patient safety is at risk, in what are known as patient safety mitigations or derogations. As of 9.30 this morning, 40 patient safety mitigations have been submitted during the current round of strikes, and two have been accepted by the BMA. NHS leaders, many of whom are themselves members of the BMA, have decades of combined experience. They know their patients and they know their rotas, and they would ask for mitigations only if they were absolutely necessary—in, for example, a children’s emergency department. They are wholly independent of Government: it is for them to make those decisions. I trust them and I trust their judgment. That is the reality, and that is the truth about patient safety mitigations.

One of the reasons why I came into politics was the NHS and what it had done for me and my family. That is also one of the reasons why I am a Conservative. This is a Government who have delivered record NHS funding, the first ever NHS long-term workforce plan, and 50,000 more nurses for our NHS. We are providing the NHS with the doctors it needs for the future by doubling the number of medical school places, opening five new medical schools and pioneering one of the world’s first medical apprenticeships. We have also supported doctors by making changes to pensions for those at the very top of their career path—at that point, that was the BMA’s No. 1 ask, and a policy that the Opposition seemed to oppose.

Those are not the actions of a Government who are turning their back on the NHS, as some have declared. They are the actions of a Government who are building a health and social care system that is sustainable for the long term. To do that, we must put the strikes behind us and move forward together, because the NHS belongs not just to the junior doctors committee: it belongs to us all. It belongs to the millions of people who rely on its being there when they need care, as well as the millions of taxpayers who pay for it. For their benefit, it is time for the members of the junior doctors committee to show that they are serious about doing a deal. They have legitimate concerns about their working lives, and a fair and reasonable deal can be reached, but calling damaging strikes is not the way in which to achieve that. Earlier this week I said that if they called off their damaging strike action, I would get round the table with them in 20 minutes. I am, of course, extremely disappointed that they refused my offer, and continue to refuse it—the strikes are ongoing as we speak—but if they come to the negotiating table with reasonable expectations, I will sit down with them.

This Government have a clear, long-term plan for the NHS. Our recovery plans in elective, emergency and primary care can improve access to treatment, transform services, and give patients more choice in and control over their care. Our long-term workforce plan will give the NHS the staff it needs to thrive for decades to come, our social care reforms will build a better care workforce to support our growing number of older people, and by creating the first smoke-free generation we will reduce long-term pressure on our health service. We have eliminated the longest waits, but we have not yet made a significant enough reduction in waiting lists. To do that, we need the junior doctors committee to come to the table and do a deal that is in the interests of patients, in the interests of our NHS, and in the national interest. Then we can build an NHS that is not only stronger today, but stronger for our children and grandchildren.

I commend this statement to the House.

[Mr Deputy Speaker (Sir Roger Gale)]

I call the shadow Secretary of State.

--- Later in debate ---

[Wes Streeting]

Patients are sick and tired of waiting—waiting for ambulances, waiting for a GP appointment, waiting for their operation and waiting for a general election that cannot come soon enough. Why do the Conservatives not get out of the way and let Labour fix the mess they have made?

[Victoria Atkins]

I welcome the hon. Gentleman back from his world tour promoting his book. It is very nice to meet him for the first time across the Dispatch Box. While he was away in sunnier climes, he may have missed what is actually happening in Wales, which interestingly has been described by the Leader of the Opposition as the “blueprint” for how Labour will run the NHS, were it ever to come into government. Interestingly, in the Labour-run Welsh NHS, people are almost twice as likely to be waiting for treatment, and they are waiting an average of five weeks longer for NHS treatment under Labour in Wales than they do in England. Indeed, the number of patients in Wales seeking treatment in England has increased by 40% in two years because of the experiences that people are having in Wales.

I will just correct the hon. Gentleman on a couple of other things, too. Just to help him understand, we are delivering the 800 new ambulances—those are new ambulances—at pace at the request of the NHS, just as we are putting in 5,000 extra beds in hospitals across England, because we understand the point about capacity and we want to help the NHS look after people in a timely and efficient manner.

I will also just correct him again on the doctors in training point. I am surprised he has come on to that at this point, but had he spoken to his friends in the BMA, he would have understood that that is the phrase that the BMA is using. It has passed a motion to stop using the phrase “junior doctors”. [Interruption.] Yes, the BMA passed a motion. The hon. Gentleman referred to doctors, but he perhaps does not understand the complexities of contractual negotiations. The phrasing is used to denote those professionals who are still on formal training pathways who are not specialty doctors or consultants. That terminology has been agreed with the BMA.

In terms of the strikes themselves, I note—I know that those sat behind me on the Government Benches noted it, too—that the hon. Gentleman did not condemn the strikes. I am happy to give way, if he would like to confirm whether he condemns the strikes. Unfortunately, he has missed his chance to do so, but I suspect that everybody, including the patients at home waiting for appointments, will see the Labour shadow Minister’s failure to condemn these strikes. That is because, in line with public sector strikes more generally, the Labour movement will always prioritise union harmony over patient safety. That is not what we as Conservatives do; we will always put patient safety first.

[Mr Deputy Speaker (Sir Roger Gale)]

I call the Chair of the Health and Social Care Committee.

[Steve Brine (Winchester) (Con)]

Happy new year. The Secretary of State will know that it is far from all doctors in training who have taken part in this strike. In my trust, Hampshire Hospitals, it was just over 60%, and the average across the south-east was little more than 50%. Many doctors were hard at work this past week caring for their patients. Does my right hon. Friend share the concern of many in the health service that the longer this dispute drags on, the more we lose the good will of the consultants who have been filling in and the more we do serious damage to the career pipeline that sees today’s doctors in training become tomorrow’s consultants?

[Victoria Atkins]

I thank my hon. Friend for asking that question and for noting the enormous efforts that clinicians across the NHS have gone to in order to cover these strikes. We are conscious of the personal impacts that has had for many, and clinicians have had a very tough few Christmases. We were all collectively hoping that this Christmas would be just a little bit easier for them, but sadly these strikes have a real impact on people who are working to pick up the slack from junior doctors not turning up. I am grateful to everyone who has gone into work, who has worked extra shifts and who has cancelled time off with their families. We must find a fair and reasonable solution to this industrial action, which is precisely why I was so very disappointed that the BMA junior doctors committee chose to walk away from these discussions.

[Mr Deputy Speaker (Sir Roger Gale)]

I call the Scottish National party spokesperson.

[Amy Callaghan (East Dunbartonshire) (SNP)]

A very happy new year to you, Mr Deputy Speaker. Our NHS faces an unprecedented winter of pressure, with inflationary costs, increasing viral infections and staff shortages. While the SNP Scottish Government have acted with £300 million to cut waiting lists and negotiated with NHS staff, preventing even a day of strike action, NHS England is undergoing a junior doctors strike—the longest in the history of any NHS in the UK. No one wants strike action, but it works, which is exactly why the Tories want to ban it. In fact, this Tory Government appear to be working to make this winter harder by cutting NHS capital funding, undercutting attempts to recruit new staff and not getting round the table with trade unions, instead blaming the BMA and junior doctors. Is the decision to underpay NHS staff and stoke strikes the policy of this Health Secretary, or is she being forced down that path by a Chancellor who is continuing his decade-long war on junior doctors?

[Victoria Atkins]

I imagine that the hon. Lady has seen that we accepted in full the pay review body’s recommendations last year and, as of September, junior doctors and doctors in training have received on average an 8.8% increase on their basic salaries—they also earn money on top for antisocial hours, working overtime and so on. In addition, they have pension contributions of some 20%, which is a rare employment benefit across both the public and private sectors. In the future, I want to find a fair and reasonable settlement with the junior doctors, as we have been able to reach with consultants and specialty doctors, but we cannot do that if junior doctors are on strike. That is why it is so very disappointing that they walked away from the discussions.

[Mr Deputy Speaker]

I am sure that we all wish to welcome Sir David Evennett back to the House in rude health.

[Sir David Evennett (Bexleyheath and Crayford) (Con)]

Thank you, Mr Deputy Speaker. I welcome my right hon. Friend’s factual statement on the state of the NHS in her winter update. Will she confirm that she would return to the negotiating table immediately were the BMA to call off these very damaging strikes?

[Victoria Atkins]

I welcome my right hon. Friend back. I have said throughout this that I was extremely disappointed that the committee chose to walk away from discussions. I also think that there is a lot more to discuss apart from pay—I have made it clear that I would like to look at other aspects of their working conditions—but, unfortunately, the junior doctors committee walked out. The strike action has had a real-terms impact on patients. We need to find a fair and reasonable solution, but I will not do that while the junior doctors committee maintains strikes. It will have to come to the table with reasonable expectations and change their minds on the validity of strike action.

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

We have had 14 Tory winters. One would have thought that they would learn by now that the real crisis in our NHS is that social care is not up to scratch. A quarter of patients in my local hospital are waiting for social care. As a result of jamming the back door, the front door becomes inaccessible to so many patients. After all these years, when will the Secretary of State publish a proper plan for social care, or will she leave it to my right hon. Friend to take over?

[Victoria Atkins]

I am so sorry, I do not know who the hon. Lady is referring to. On the Conservatives’ plans, at the 2022 autumn statement we announced up to £7.5 billion of additional funding—an historic increase—and we did not stop there. This summer, we announced an additional £600 million, which brings it up to £8.1 billion of additional funding over two years. That will support our care workforce, and the majority of the funding will end up in the pockets of the amazing people who provide care and support to the patients we are all concerned about.

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

I declare my interest as a member of the BMA and an NHS consultant who has worked during the industrial action. Let us make no mistake that these strikes are causing suffering to patients, both adults and children. The derogation process has not worked because, as the Secretary of State said, the BMA has not returned junior doctors to work when they have been asked to—where there has been a risk of dangerous harm to patients. The first duty of any Government is to protect their citizens, so when will the Secretary of State bring forward the minimum service levels to protect patients from these dangerous strikes?

[Victoria Atkins]

First, I sincerely thank my hon. Friend. I was in contact with her over the weekend when she had come off a very long shift in emergency care, looking after patients locally. I have nothing but admiration for her and the many, many other people who stepped in at short notice to cover urgent and emergency care in our NHS during the strikes. On minimum service levels, she will know that we have already introduced them for ambulance services—something that was opposed by the Labour party—but we have just closed the consultation on minimum service levels in hospitals and we are, of course, carefully analysing the responses. Again, the point that 40—four zero—patient safety mitigations were made by NHS leaders yet only two were granted by the BMA, is very, very worrying when it comes to how seriously the BMA is taking concerns about patient safety.

[Daisy Cooper (St Albans) (LD)]

A few weeks before Christmas, NHS bosses were here in Parliament briefing MPs that, notwithstanding their preparation for the winter crisis, the one thing that would push them to the brink would be a rise in respiratory illness. Now here we are: cases of flu, covid, RSV—respiratory syncytial virus —and whooping cough are all rising rapidly. A strong public health intervention by the Government could have prevented that from happening. When will the Government get serious about public health interventions such as vaccine uptake, air filtration and protecting the immune compromised to stop people getting so ill so often for so long?

[Victoria Atkins]

I thank the hon. Lady for re-emphasising the critical timing of the strike actions and the impact it has on patients. We know that winter is difficult. It is not just difficult for our healthcare system. Around the world, when cold winter strikes, it has physiological impacts on people with underlying health conditions. We also have a rise in infectious conditions, too. As she will appreciate, that is precisely why, on the advice of clinicians, we brought forward the flu and covid vaccination programme to try to protect the most vulnerable in our society. But again, the timing of the strikes is so very cynical, because their impact and tail will, I am sorry to say, have consequences beyond tomorrow’s stop date.

[Dr Thérèse Coffey (Suffolk Coastal) (Con)]

I was really concerned when my right hon. Friend mentioned the number of requests made to the BMA for certain duties in hospitals and that only two had been responded to positively. That is really concerning for patients. Contrast that with the behaviour of Nick Hulme, the acting chief executive at Norfolk and Norwich University Hospital, who has transformed its A&E in terms of waiting times. We need to promote such leaders, but we also need to unreservedly condemn the actions of the BMA junior doctors committee and get the strikes over and done with.

[Victoria Atkins]

I thank my right hon. Friend for her work in the Department. She knows only too well the difference an inspirational leader can make to a local NHS trust, and at regional or national level. Managers who are good and committed to their local area, who work with their clinicians and other healthcare staff to try to look after patients all year round, have been put under the most enormous pressure over the last few weeks because of the strikes. I thank every single one of them for doing what they can to safeguard patient safety. As I say, I trust their judgment. If they have put patient safety mitigations in, it is because they consider, in their professional judgment, that they are needed.

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

The public health director in Hull published her report recently. She talked about the double jeopardy that my constituents face: from the most disadvantaged communities, they have shorter lives in far poorer health. At the end of last year in A&E, patients were less likely to be treated within the four-hour target than anywhere else in England. Why is that after 14 years of a Conservative Government who are committed, apparently, to levelling up?

[Victoria Atkins]

I am extremely grateful to the right hon. Lady, who will know that our constituencies, albeit not necessarily in the same region, nevertheless share similarities, being relatively close to each other. The work and the progress made on urgent and emergency care is precisely because we were concerned about, for example, ambulance response times and hospital discharges. We worked with NHSE to bring together the urgent and emergency care plan and, for example, bring about 800 new ambulances on to our roads and about 5,000 more core beds into the NHS to try to address those needs. Unfortunately, the strike action that we have seen over recent days has very much militated against those efforts. We all accept that winter is a very difficult time for the NHS, and through the urgent and emergency care plan we have worked with NHSE to try to meet the demands that she so rightly puts forward.

[Mr Robin Walker (Worcester) (Con)]

I welcome the Secretary of State’s commitment to reaching a fair and reasonable solution to the strikes. Worcester went into this winter with the delivery of a new emergency department and was able to deliver 21 beds-worth of extra capacity over the winter, but I have heard from the hospital today that it is still facing intense pressure. Will the Secretary of State join me in paying tribute to the staff who are working around the clock to meet that pressure, and will she support the South Warwickshire University NHS foundation trust as it works to address some of the key transport bottlenecks on its site, in the interests of patients and staff alike?

[Victoria Atkins]

My hon. Friend sets out clearly the many pressures and factors at play in running emergency departments and hospitals at the best of times, when we are not in the middle of winter and facing the pressures that it always brings on the healthcare system. I thank not only staff in his trust, but staff throughout the country for the work they have done over recent weeks to support the NHS and to bring treatment to patients. We are working hand in glove with NHSE regional and local leaders to see whether there are practical measures that can be taken to improve the flow through hospitals.

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

NHS winter pressures are having a huge impact on cancer surgery and other cancer interventions. In Cumbria, in the south of the county 25% of those with a cancer diagnosis are waiting more than two months for their first intervention, and in the north of the county 47% are waiting more than two months. We know that every month’s delay in treatment means a 10% reduction in people’s chances of surviving. Some 123 cancer operations have been cancelled in the last year in our area. One reason is the lack of investment by this Government, and their predecessors of all colours, in radiotherapy. Will the Secretary of State agree to meet me and Conservative and Labour members of the all-party parliamentary group for radiotherapy, which I chair, to look at solving the problem by investing in the kit that Britain desperately needs to save lives?

[Victoria Atkins]

I hope the hon. Gentleman will be interested to know that we have made cancer treatment waiting times a key focus of our elective recovery plan, which has been backed by an additional £8 billion in revenue funding across the spending review period. We have made progress by delivering record numbers of urgent cancer checks, with more than 2.9 million people seen in the 12 months to October last year. Of course there is more to do, and I would be very happy to meet him and colleagues across the House to discuss the practical ways by which treatment can reach our constituents. He will not be surprised to know that cancer is a priority not just for me personally, but for the Government as a whole.

[Will Quince (Colchester) (Con)]

I welcome my right hon. Friend’s statement; there is a lot in it to welcome, but I particularly welcome the additional 11,000 virtual ward beds. Hospital at home is hugely popular and we know it takes pressure off our hospital. I thank all of the clinicians who helped to make that possible. Can she confirm that it is her intention now to go further and roll it out to more hospitals and more specialties, so that more patients can recover at home?

[Victoria Atkins]

I thank my hon. Friend for all his work in making that happen. He worked very hard on virtual wards when he was a Health Minister, and they represent a real step change in how we treat people with long-term conditions who can be monitored safely at home. They mean that people do not have to spend time in hospital, with all the pressures that can mean for us as individuals. Importantly, that also frees up beds for other patients who need them. I am keen to roll the scheme out further. Indeed, we have not just met but exceeded our initial ambition, which is why I can confirm that we have delivered 11,000 places in the virtual bed ward category.

[Clive Efford (Eltham) (Lab)]

The BMA says that junior doctors’ pay has been cut in real terms by 26% through consistent below-inflation increases. If the Tories really cared about this strike and about the NHS, would they not have avoided creating the circumstances that made junior doctors so angry that they felt the need to go on strike? Does that not just show that you cannot trust the Tories with the NHS?

[Victoria Atkins]

The figure that the BMA relies on is in fact from 2008, when the Labour party was in government for the first two years. The BMA cites a 35% pay rise. Just to clarify, independent organisations such as Full Fact and the Institute for Government rely on the consumer prices index measure, which shows a difference of 11% to 16%. I am sure that the hon. Gentleman will take into account the fact that we have already given graduate doctors, in their first year out of medical school, a rise of 10.3%, and I was willing to negotiate further and consider additional settlements that are fair and reasonable to the taxpayer.

[Steve Double (St Austell and Newquay) (Con)]

Is the Health Secretary aware that the impact of these strikes on the Royal Cornwall Hospitals NHS Trust has seen more than 7,000 appointments and operations cancelled and several million pounds in extra costs to the trust—and that is before the most recent strikes. Does she share my concern that the junior doctors are pursuing an unreasonable pay demand and causing lasting damage to patients and the finances of the NHS?

[Victoria Atkins]

My hon. Friend is a brilliant advocate on the challenges facing his rural and coastal community. We all know that geography is a factor in the difficulties of delivering healthcare in his corner of England, but everything the trust and clinicians do is about trying to improve healthcare for his constituents. I cannot be the only one who felt uncomfortable at the image of some on the picket lines last week singing while our constituents were struggling with cancelled appointments and worried about urgent and emergency care times. I am very keen that we should reach fair and reasonable settlements with junior doctors, but in order for that to happen they must act reasonably, change their minds and call off the strikes.

[Sarah Edwards (Tamworth) (Lab)]

Recently, Tamworth had clarification that mental health provision at the George Bryan Centre would not be invested in. From now on, patients must travel to Stafford for crisis care. Labour has pledged to recruit 8,500 more staff for community-based talking therapies in order to reduce waiting times and crises. Why have the Government not put in place a plan to recruit more NHS mental health staff?

[Victoria Atkins]

We have—in the NHS long-term plan. We have set an ambition to grow the mental health workforce by an additional 27,000 staff between 2019-20 and 2023-24. That is in addition to the at least £2.3 billion of additional funding a year by March this year.

[Holly Mumby-Croft (Scunthorpe) (Con)]

We are delighted to have our new community diagnostic centre, and of course our new A&E, under way in Scunthorpe. However, my right hon. Friend will know that we are fighting incredibly hard to prevent the loss of some of our hospital services. Of the hundreds of local residents who responded to my survey, over 98% agreed with me that we must not lose those services. Does my right hon. Friend agree that, in order for the NHS to provide resilience during the winter and the services that it wishes to provide to patients, hospital bosses need to listen carefully to what patients think?

[Victoria Atkins]

Indeed. I thank my hon. Friend for all the hard work and advocacy she puts in on behalf of her constituents. If I may, I will ask the Minister for Health and Secondary Care to visit my hon. Friend’s hospital to discuss with her the concerns of local residents and to ensure that the trust is aware of them.

[Richard Foord (Tiverton and Honiton) (LD)]

Two GPs from Seatown, in my part of Devon, moved to Australia to practise a little over two years ago. Both are working as full-time GPs, with no gaps in their career, and they now wish to return to east Devon to help ease winter pressures. Retesting someone who returns to England is lengthy, costly and bureaucratic, and it does not take into account practice in similar primary care settings. Can NHS England not make it easier for UK-trained GPs working in Australia, New Zealand or Canada to return to general practice in England?

[Victoria Atkins]

That is a very fair challenge, and I will look into it, given that the hon. Gentleman has raised it.

[Alun Cairns (Vale of Glamorgan) (Con)]

The Labour party has been running the NHS in Wales for the last 27 years. The shadow Secretary of State, the hon. Member for Ilford North (Wes Streeting), highlighted that he was frustrated with waits for ambulances, GPs and operations. I politely point out to him, and to other Members, that my constituents in the Vale of Glamorgan, and people across the whole of Wales, are waiting much longer for ambulances, GPs and operations. In fact, a quarter of my constituents, and a quarter of people across the whole of Wales, are on an NHS waiting list. I advise my right hon. Friend the Secretary of State that junior doctors and GPs are also in disputes in Wales, despite the claims made by Opposition Members. I therefore ask her to show some caution before taking advice from her shadow.

[Victoria Atkins]

I will follow that advice with great enthusiasm. I have another statistic for my right hon. Friend: the Labour-run Welsh Government were hiding 45,000 patients from their A&E waiting figures in the first half of 2023, and falsely claiming that they perform better than England. If that is the blueprint for how it runs things, we should all be very worried if Labour ever again forms a UK Government.

[Alison McGovern (Wirral South) (Lab)]

Further to the question from my hon. Friend the Member for Tamworth (Sarah Edwards), it was disappointing that the Secretary of State did not mention mental health in her statement. Given the rising levels of destitution and chronic bad housing in our country, mental health services have winter crises too these days. What progress is she making in developing proper waiting times for people in need of mental health services?

[Victoria Atkins]

I reassure the hon. Lady that the impact of mental health patients remaining in A&E for any length of time, let alone beyond 72 hours, is genuinely a metric and factor that we look at very carefully, as we have done throughout the strikes. We appreciate that A&E is not the right environment for most people who are suffering from a mental health illness or a psychotic episode, and we want to move them into appropriate care as quickly and safely as we can. With that in mind, I hope that she will welcome the fact that we are spending some £7 million for up to 100 mental health ambulances over the next two years, to try to ensure that people get the right care they need, when they need it. More than 160 projects are being allocated funding in the community, including crisis cafés and safe havens, so that hopefully people are caught before the crisis happens and they end up in A&E.

[Alberto Costa (South Leicestershire) (Con)]

I welcome the winter update from the Secretary of State. There is actually a winter update going on in South Leicestershire. Will she join local NHS stakeholders there, and me, in encouraging South Leicestershire’s constituents to respond to the consultation on the future of the Feilding Palmer Hospital? The deadline is 14 January.

[Victoria Atkins]

I would be happy to do so. I am pleased to hear of local NHS leaders actively seeking the views of the patients and communities they serve, in order to ensure that their services are what the public expect from their local hospitals, and from primary and secondary care services.

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

I remember a former Conservative Prime Minister promising to fix social care, yet I am still hearing of too many patients who are medically fit for discharge being stuck in hospital. This time last year we had a record high of about 14,000 patients stuck in hospital who were fit for discharge. Will the Secretary of State tell us what the figure is at the moment, and whether she expects it to go up or down before the end of the month?

[Victoria Atkins]

We are making progress. The hon. Gentleman will appreciate that that figure alters not just day by day, but hour by hour. We have been investing in social care packages precisely because we understand the importance of being able to discharge people promptly and safely into the appropriate social care setting, which can have a huge impact on flow through the hospital.

Other factors can also have an impact on flow, such as practical measures for people who perhaps do not need social care help when they leave hospital. We are looking at what we can do to improve those local factors as well. The hon. Gentleman is right to make the point that the social care system goes hand in hand with our NHS and hospital care. That is why we have been so keen this year to inject extra investment into social care—to try to alleviate some of the issues that he rightly raises.

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

The shadow Secretary of State seemed to forget the 50,000 hospital beds that Labour closed when they were in government—the thousands of mental health beds and the large number of wards they closed, including at Goole and District Hospital. But I digress.

I spent Christmas on duty as a first responder at the Yorkshire Ambulance Service—as the Secretary of State knows, the Minister for Health and Secondary Care performs the same role at the North West Ambulance Service—so I can attest to the professionalism and dedication of our ambulance services and of our 999 dispatch centres and the clinical hub that supports us at scene. Ambulance crews bear the strain not only of winter pressures year in, year out, but of this doctors’ strike. I urge the Secretary of State to pay tribute once again to their work and, as I have said before in this place, to consider what we can do to expand community paramedicine, so that, as demography changes and more older people are cared for at home, more people can be treated at scene rather than being taken to A&E.

[Victoria Atkins]

I pay tribute to both my hon. Friend and my right hon. Friend the Minister for Health and Secondary Care for their work as first responders. I would get into a lot of trouble in my own constituency if I did not mention the wonderful LIVES—our community first responders, who get to the scene of road accidents or emergency calls before ambulances and conduct the most extraordinary and complex procedures very safely on patients when they need it.

Recently, I was pleased to visit the London Ambulance Service to see for myself what team work can achieve across an ambulance service and how these highly qualified and experienced individuals can make a real difference to people’s lives and health after recovery. I send my sincere thanks to everyone who has been working in those capacities in recent weeks and over the festive period.

[Janet Daby (Lewisham East) (Lab)]

We have gone from no winter crisis when Labour left office to an annual winter crisis—and now a crisis all year round under this Conservative Government. Patient satisfaction with the NHS is at a record low. Instead of there being a blame culture, when will the Secretary of State accept responsibility for that appalling record?

[Victoria Atkins]

I think the hon. Lady was claiming that there was no winter under Labour, but perhaps that is yet another thing that does not quite stack up. I fully endorse her call for an end to blame culture, but point her to the real and practical measures that we have taken to improve urgent and emergency NHS care. I assume that she joins those on the Government side in condemning the unprecedented strike actions that the junior doctors committee has called at this particular time of year.

[Richard Graham]

Having chaired more than 150 meetings between Gloucestershire MPs and our NHS leaders, this week I am handing over the baton to my neighbour, my hon. Friend the Member for Tewkesbury (Mr Robertson). My two thoughts are, first, to share the Secretary of State’s immense gratitude to everyone in the Gloucestershire Royal Hospital and our other services for all their continuing, amazing work; and secondly, to highlight that the biggest single impediment to reducing the elective surgery backlog—the hips, knees and much more of many of our constituents—is this continued strike by doctors in training. I am sorry, but the continued failure of the shadow Secretary of State to highlight whether he supports patients or strikers shows an absence of leadership. Will my right hon. Friend confirm that the doctors in training, the doctors on strike, have already received, in 2023, a pay rise of between 8.1% and 10.3%?

[Victoria Atkins]

I most certainly can confirm that—those doctors have already received the rise. As I said, I wanted to continue discussions on more fair and reasonable settlements for junior doctors, recognising as I do how tough their job is and the conditions under which they work. May I thank my hon. Friend for the leadership he has shown with his local trusts and clinicians? I agree with him that the one thing we have not heard from the Opposition is that they condemn the strikes. They seem to prioritise union harmony over patient safety.

[Helen Morgan (North Shropshire) (LD)]

Shrewsbury and Telford Hospital Trust has one of the most challenged A&E departments in England, for a number of reasons. In August last year, the Government awarded a grant of £21 million to provide extra beds to ease some of the issues in A&E, but those beds are not online and operational yet. What assurances can the Secretary of State give us that the measures that have been taken to ease winter pressures will be in place to help people before the winter is over?

[Victoria Atkins]

I will ask the Minister for Health and Secondary Care, my right hon. Friend the Member for Pendle (Andrew Stephenson), to liaise with the hon. Lady directly. As I say, the latest figures I have from NHS England, working with local trusts, is that more than 3,000 of the extra 5,000 beds were in situ in December, and we expect the 5,000 deadline to be met very shortly. I hope she will see that at local level in her hospital very soon.

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

Is not the rejection by the BMA of derogation requests made on the basis of patient safety dangerously irresponsible? Rather than Dr Laurenson, co-chairman of the junior doctors committee, saying that the NHS hates doctors, it is past time that they called off this damaging strike action and put patients first.

[Victoria Atkins]

Very much so—the NHS belongs to us all, as I say repeatedly. It goes without saying that doctors are a critical part of our workforce. That is why, since becoming Secretary of State, I have wanted to have a good, constructive working relationship with all of the representatives of doctors and the wider workforce. That was why I called in the BMA and “Agenda for Change” as soon as I possibly could, and I am pleased that I have been able to find fair and reasonable settlements with consultants and specialty doctors. I very much hope that junior doctors will call off their strikes and come back around the table so that we can find solutions for them too.

[Samantha Dixon (City of Chester) (Lab)]

The latest period of strike action by junior doctors has been the longest in the NHS’s history. We have seen trusts declaring critical incidents and A&E departments telling patients not to come in unless their lives are under threat. Can the Secretary of State tell me why the Prime Minister has not stepped in to resolve the dispute? Does he think it is not serious enough?

[Victoria Atkins]

As I said earlier, strikes have very serious consequences for the NHS. We cannot pretend that the NHS can be switched on and off at whim. My one ask of the junior doctors committee was that it stop the strikes so that we can return to the table. As the number of patient safety mitigations has revealed—by the way, it is the highest number of patient safety mitigations that local NHS leaders have ever asked for, because of the unprecedented length and timing of the strike—and because the BMA has refused even those derogations, with the exception of two, we have to get to a place where it returns to a more reasonable frame of mind and comes back to the table with more reasonable expectations, so that we can try to find a solution. I will not put patients’ safety at risk: I have to enable NHS England to make preparations and continue the work it is doing day by day, hour by hour, to safeguard hospitals and patients during this very damaging strike action.

[Mr Philip Hollobone (Kettering) (Con)]

My right hon. Friend the Secretary of State will be as concerned as my constituents in Kettering that, for every three days of junior doctor strikes, the cost to Kettering General Hospital is a staggering quarter of a million pounds, with hundreds of operations cancelled or delayed for patients in pain. In confirming that the 35% pay demand is both unrealistic and unaffordable, will she call for junior doctors to return to their posts so that that money can be better spent on reducing waiting lists and improving patient outcomes?

[Victoria Atkins]

My hon. Friend puts it eloquently; there is a real human cost to these strike actions. It is why I did everything I could when we were in negotiations to try to find fair and reasonable settlements for junior doctors. I was very disappointed when they walked out, but we have to find solutions for the sake of our patients and of all 1.3 million people working in our NHS across England. There have been some brilliant examples of local trusts, local clinicians and other members of staff working really hard and pulling together to cover these damaging strikes, but all we ask of junior doctors is to come back to work, do their jobs and look after our patients.

[Mr Tanmanjeet Singh Dhesi (Slough) (Lab)]

NHS waiting lists have trebled since the Conservatives came to power almost 14 years ago. The Prime Minister’s pledge to cut waiting lists has effectively been abandoned, with the Government choosing to blame NHS staff instead of fixing the problems. Is it not the case that the longer we give the Conservative Government in power, the longer patients in Slough and across our country will, sadly, have to wait?

[Victoria Atkins]

Waiting lists are coming down, but they are still too high. Towards the end of last year, we had a period without any strikes in the NHS. We saw the waiting lists fall by tens of thousands—indeed, by 65,000—over the period of October, which shows the impact of the industrial action. Sadly, we know that more than 1.1 million appointments have been rescheduled in the last 12 months. It is having an impact on waiting lists and, for the sake of patients, we ask the junior doctors to come back to work.

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

May I first thank Tracy Bullock, the chief executive of University Hospitals of North Midlands NHS Trust, who has announced her retirement today due to ill health.

We have been making significant progress in north Staffordshire with improvements to health services. Nursing vacancies have declined significantly over the last year and £13.4 million has been invested in improving urgent and emergency care services, freeing up some beds, but what puts all that at risk are these reckless strikes. Some 867 appointments at the Royal Stoke have been cancelled, as have 38 operations. Does my right hon. Friend agree that all the progress we are making is put at risk by these reckless and unprofessional strikes?

[Victoria Atkins]

First of all, I join my hon. Friend in thanking Ms Bullock for her work and public service, and I wish her a speedy recovery.

On the progress made in my hon. Friend’s local area, he is right: there are some really encouraging signs for the future of the NHS. All the work that we have been doing across all the recovery plans—whether it is for urgent and emergency care, primary care or elective recovery plans—is about embedding progress in the future of our NHS in this year of all years, as we celebrate 75 years of its establishment.

On the impact of the junior doctors’ strikes, my hon. Friend is right to refer to the number of new nurses and the progress that has been made locally. In fact, this year we have been able to announce that we have met a manifesto commitment to recruit 50,000 more nurses. We made that promise in 2019. We have met it early, as well as the commitment to have 50 million more GP appointments than in 2019—two manifesto commitments made, and two manifesto commitments kept.

[Alex Sobel (Leeds North West) (Lab/Co-op)]

Happy new year, Mr Deputy Speaker.

More and more of my constituents are waiting longer and longer for emergency care. In 2010, the target for emergency care was 95% of patients within four hours. The Government watered down that target to 76%, and are not meeting that. When will they meet their own target, and when can we expect to see 95% of my constituents being seen within four hours?

[Victoria Atkins]

I hope the hon. Gentleman is injecting the same anguish into the conversations that I imagine he is having with his local junior doctors, asking them to come back to work. Of course, having junior doctors not working in hospitals across the NHS has an impact—of course it does; they are a vital part of our NHS. The attention of NHS leaders, medical directors and clinicians over past weeks has had to be diverted towards covering the strike action rather than making the sorts of improvements and progress we all want to see across urgent and emergency care, in line with our recovery plan.

[Anna Firth (Southend West) (Con)]

Happy new year, Mr Deputy Speaker. The majority of NHS staff at Southend Hospital are working incredibly hard. Despite winter pressures and industrial action, they have used winter money to open a new ward, adding extra bed spaces. However, the chief executive has written to tell me he is extremely concerned that approaching 40,000 out-patient and in-patient appointments across the Mid and South Essex NHS Foundation Trust have been postponed since this industrial action started. This afternoon, we learned from the Secretary of State that doctors in training have received above inflation average pay rises of 9%, so is it not time that they simply got back to work, delivering the care my constituents deserve and pay for?

[Victoria Atkins]

I thank my hon. Friend. We know the figures for previous strike actions, but sadly we will hear the true extent and impact of the strike action over the last six days later this week, and I suspect we will have even more missed and cancelled appointments to add to the list she rightly sets out.

On the point about pay, the basic pay of a foundation year one doctor has risen by 10.3%. Once one takes into account factors such as overtime and unsocial hours payments, that means the average salary is £40,800, a figure that I hope begins to reflect the importance we put on doctors and their role in the NHS. As doctors progress with their careers, there is a good package of development and progress, culminating in the pay settlement, currently out to ballot with the BMA, that I hope consultants, who are at the end of their career and do so much to help train younger doctors, will vote for. There is much work to be done, but progress has already been made on pay. That is why the decision by the BMA junior doctors committee to call strikes of such length at this time of year was so disappointing.

[Mr Deputy Speaker (Sir Roger Gale)]

I thank the Secretary of State for her statement and for responding to questions, and my thanks also go to those on the Opposition Front Bench.

Government Offer to NHS Specialist, Associate Specialist and Specialty Doctors

Victoria Atkins Excerpts

Tuesday 19th December 2023 Written Statements

[The Secretary of State for Health and Social Care (Victoria Atkins)]

After seven weeks of constructive negotiations with the British Medical Association specialist, associate specialist and specialty doctors committee, I am pleased to inform the House that on 16 December, I made a formal reform-based offer that the BMA SAS committee has agreed to put to its members for a vote.

No strikes will be called by these doctors while the deal is being put to members.

SAS doctors are a vital part of the NHS. They focus predominantly on providing direct patient care by providing clinical expertise in their specialist area and taking responsibility for a full range of patients within their area of practice, making them essential to our efforts to cut waiting lists and deliver the highest quality service to patients.

In 2021, the Government agreed a multi-year deal with the BMA SAS committee. If accepted, this offer will: address the unintended imbalances in the pay scales for these doctors on the 2021 contract and pre-2021 contracts to ensure consistency and fairness across the workforce; speed up the delivery of some of the key objectives of the 2021 deal, such as the roll-out of the new specialist grade; and encourage more existing doctors to take up the new contracts, which offer modernised terms and conditions.

The offer includes plans to set up a £5 million funding pot to encourage and support NHS employers to create more permanent specialist roles where there is a need. This will fund a significant increase in the number of specialist doctors, improving patient care and access, and will create further opportunities for doctors to progress in their careers.

A joint piece of work will also be undertaken to consider how locally employed doctors—doctors who are employed on local terms and conditions as opposed to national—can be better supported to progress in their careers, including the development of a potential process whereby such doctors operating at specialty level for 24 months could be transferred to a specialty contract.

The Government have made further commitments on career development, including the promotion of job planning for all such doctors; the development of guidance to support the career development of SAS doctors; the development of guidance for employers to encourage, establish and embed specialist roles in their organisation; and a research project to understand why specialist roles are not being created.

Both the Government and the BMA SAS committee engaged constructively and in good faith to identify fixes and reforms that address important concerns for SAS doctors. This offer is independent of the headline pay uplift that SAS doctors have already been awarded in 2023-24 through the Government’s acceptance of the independent pay review body’s recommendations.

The BMA SAS committee will now make arrangements to put this offer to a vote of its members in the coming weeks. I encourage them to accept this offer, and I will update the House in due course.

[HCWS162]