Draft Mental Health Bill 2022

Will Quince Excerpts

Thursday 26th January 2023 Commons Chamber

[Dr Poulter]

On behalf of the Committee, I thank the hon. Lady for all her work. We were lucky that we had her professional expertise as a frontline clinician, which added to our important scrutiny work. Given that it has been 40 years since there were any changes to the Mental Health Act, I certainly agree that the time has come to make those changes through a Bill. We urge the Government to take on board our well-intentioned recommendations and concerns to strengthen the Bill, and I hope we will continue to see a cross-party, collaborative process to improve mental health care for the patients who most need it.

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

I sincerely thank my hon. Friend and the Committee for all the work that has been put into this constructive and important report, and I also thank all those who gave evidence to the Committee. The Government are now considering the Committee’s recommendations on how we can further improve the Bill and modernise the Mental Health Act. The Minister for mental health, my hon. Friend the Member for Lewes (Maria Caulfield), gave evidence to the Committee in November, alongside the Minister for prisons, parole and probation, my right hon. Friend the Member for East Hampshire (Damian Hinds).

I am grateful to see that the final report reflects the support that these reforms have on both sides of the House. The Committee has clearly engaged fully with the complexities involved in this work. It is the Government’s intention to take the next steps in getting this legislation right, so that people with severe mental health needs get the help and support when they need it, with their rights and dignity better respected. It is vital that we continue to progress the work we have started with NHS England and others to address the racial disparities that have for too long been associated with the use of the Act. Does my hon. Friend agree that the reforms proposed in the Mental Health Bill provide for an improved framework in which people experiencing the most serious mental health conditions will have far more choice and influence over their treatment?

[Dr Poulter]

I agree with the Minister. He is right to suggest that this is an important step forward and this piece of legislation will make a significant difference to patients, but it is part of a process, not the end of the journey. In particular, I draw the Government’s attention to the potential unintended consequences of some of the well-meaning changes being proposed in relation to patients with learning disabilities and autism and to changing the grounds for detention; for example, it might be harder to detain patients who are the most unwell, with chronic and enduring mental illness and psychotic conditions. I hope the Government will take on board those concerns and ensure that what comes back to this place is a stronger Bill that works in the best interests of patients.

Oral Answers to Questions

Will Quince Excerpts

Tuesday 24th January 2023 Commons Chamber

[Paul Bristow (Peterborough) (Con)]

10. What recent progress he has made on tackling the covid-19 backlog in elective care.

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

Since the publication of the elective recovery delivery plan, the NHS has virtually eliminated two-year waits for treatments and is making progress on tackling the next ambition of ending waits of over 18 months by April. To support those efforts, NHS England recently wrote to providers mandating action on 18-month waits. We agreed that appointments must be scheduled as soon as possible to enable that target to be met.

[Paul Bristow]

The people of Peterborough are looking forward to their new NHS community diagnostic centre supplying an extra 67,000 tests, scans and checks each and every year, but that will shine a light on the need to power through our covid elective backlog. At the Royal Free Hospital, many cases that were previously treated as elective overnight stays are now treated as day cases, improving patient experience and increasing capacity. How will the Minister ensure that such innovation is spread across the NHS?

[Will Quince]

My hon. Friend is absolutely right to raise this issue, and to highlight the difference being made by the 89 community diagnostic centres that have already been rolled out and the importance of getting up to 160 centres as quickly as possible. He is right that such innovations, including CDCs, surgical hubs, telemedicine and, of course, using spare capacity in the private sector, are helping us to tackle the longest waits and reduce the covid backlogs, and I very much thank him for his support in that endeavour.

[Stephanie Peacock (Barnsley East) (Lab)]

There are almost 20,000 people on the waiting list for treatment at Barnsley Hospital, but at the beginning of this month, 98% of the hospital’s beds were occupied. How does the Government expect that hospital to solve the treatment backlog when it simply does not have the resources?

[Will Quince]

We are increasing capacity by introducing an additional 7,000 beds and the £500-million discharge fund. In addition to that, an extra £250 million was announced in January. Over and above that, alternative capacity is being created through the independent sector, we are engaging with patients on choice, and we are working with the most challenged trusts. Of course, I understand the impact that this has on patients, and we are working hard to address the backlog.

[Mr Speaker]

I call the shadow Minister.

[Liz Kendall (Leicester West) (Lab)]

Ministers will never deal with the record waits for NHS treatment until they stop older people being stuck in hospital because they cannot get decent social care in the community or at home. Does the Minister understand that this is not just about getting people out of hospital, but about preventing them from being there in the first place? Is he aware that more than half a million people now require social care but have not even had their needs assessed or reviewed? Where on earth is the Government’s plan to deal with this crisis, which is bad for older people, bad for the patients waiting for operations and bad for taxpayers?

[Will Quince]

As I said, we are creating 7,000 additional general and acute beds. We are investing £500 million in adult social care specifically for discharge, and that goes up to £600 million next year and £1 billion the year after. There is also an extra £250 million. The hon. Lady asks specifically about adult social care. That is exactly why the Chancellor announced £7.5 billion in the autumn statement—the largest investment in social care ever.

[Mr Toby Perkins (Chesterfield) (Lab)]

11. If he will make an assessment of the adequacy of GP appointment availability in (a) Chesterfield constituency, (b) Derbyshire and (c) England.

--- Later in debate ---

[Mr Speaker]

Order. The hon. Gentleman may be the Chair of the Select Committee, but I have to get other people in—it is not just his show.

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

I thank my hon. Friend for his question. National NHS guidance is absolutely clear: providers are expected to facilitate visiting for patients in hospital wherever possible and to do so in a risk-managed way. It is up to individual providers—they do have discretion—but I understand the benefit that this brings to patients. It is a very important factor, and I will meet NHS England to discuss this further.

[Kim Johnson (Liverpool, Riverside) (Lab)]

T5. According to a recent Care Quality Commission report, black people experiencing mental health crisis are 11 times more likely to be sectioned and to receive restrictive and violent community treatment orders. How will the Minister tackle these inequalities and implement the recommendations in the report?

--- Later in debate ---

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

Current plans for community diagnostic hubs in North Staffordshire would see only a single facility, which is meant to serve over half a million people. That is totally insufficient, so will the Secretary of State look at my suggestion that there should be two of these facilities in North Staffordshire?

[Will Quince]

I am very happy to meet my hon. Friend to discuss that further.

[Richard Burgon (Leeds East) (Lab)]

Will the Secretary of State for Health—today, on the record—condemn the call from his predecessor to impose charges on visits to the GP or to A&E?

[Mr Philip Hollobone (Kettering) (Con)]

How many operations have been lost to strike action in the NHS so far?

[Will Quince]

On an average strike day, I believe it is about 2,500.

[Charlotte Nichols (Warrington North) (Lab)]

The most recent figures published by the UK Health Security Agency show that, last year, the rate of syphilis cases reached its highest since 1991 and the total number of cases hit its highest since 1948. That shocking increase in syphilis transmission is just one reason why we need the Government to set out their vision for sexual and reproductive health in their long-overdue sexual and reproductive health action plan. Can I therefore ask the Minister to set out when the plan will be published and what she is doing to stop the spread of syphilis?

Draft National Health Service (NHS Payment Scheme - Consultation) (No. 2) Regulations 2022

Will Quince Excerpts

Monday 9th January 2023 General Committees

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

I beg to move,

That the Committee has considered the draft National Health Service (NHS Payment Scheme—Consultation) (No. 2) Regulations.

It is a great pleasure to serve under your chairmanship this afternoon, Sir Graham. Last year, the Government set out their ambitious health and care agenda through the Health and Care Act 2022, which established systems and structures to reform how health and adult social care work together. By introducing integrated care systems on a legislative basis, there was an opportunity to review and therefore tailor an integrated approach to how the financial frameworks in the NHS worked.

The Act replaces the NHS national tariff payment system with the NHS payment scheme by inserting new sections 114A to 114F into the Health and Social Care Act 2012. As with the tariff, the NHS payment scheme will set rules around how commissioners establish the amounts to pay providers for healthcare services for the NHS, but it will allow NHS England to have a more flexible approach in setting the rules. It does not set the amount of money available, but it intends to ensure that the resources available are used effectively and efficiently.

Before a new payment scheme can be published, NHS England has a duty under the 2012 Act to consult on the proposals for the new scheme. The consultation was as much a requirement with the tariff as it is with the new scheme. NHS England is required to consult each integrated care board, each relevant provider and other such persons it considers appropriate. It opened the consultation on the proposals for the 2023 to 2025 payment scheme on 23 December last year, and the consultation is scheduled to close on Friday 27 January. That brings me on to the purpose of these regulations, which is relevant to how those consulted respond and what it means for NHS England.

The regulations will set the required objection percentage thresholds for responses to the consultation at 66%, which will be reached if the requisite percentage of ICBs or providers object to the proposals. Laying these regulations is a relatively administrative process. The objection percentages are not changing compared with the previous consultations on the tariffs, so we are maintaining the status quo at 66%, which is a proportionate level to ensure that a qualified majority can require NHS England to reconsider its proposals, while minor objections will not stop it. I commend the regulations to the Committee.

--- Later in debate ---

[Will Quince]

I thank the hon. Member for Enfield North for her constructive comments and broad support. Several of the issues raised did not actually relate specifically to this debate. We are of course here to discuss the objection percentages. I am conscious that she would like to push further on items including payment by results, but I will just say—not wanting to test your patience, Sir Graham, given the strict parameters of this statutory instrument—that I would be very happy to write to her. Alternatively, there are health oral questions coming up. I stress that if there are proposals that relevant commissioners disagree with, I encourage them to make representations as part of the consultation, which is open until 27 January.

Let me turn specifically to why I believe the 66% is proportionate—I covered that in my opening speech. The 66% is made up of either integrated care boards or providers, and I will happily write to the hon. Member for Bristol South on that. I think the point that she was making was whether there is weighting towards an ICB versus a provider. Is that right?

[Karin Smyth]

To be clear, the two or three trusts in my patch could all object, but the ICB could support this. Do the trusts have to come within the totality, or will the trusts be counted separately, without getting too mathematical about it? Every trust in the country could oppose this, but the 44 ICBs could support it, for example, in extremis.

[Will Quince]

I thank the hon. Lady for clearing that up. I think the answer to the question is that if an integrated care board or a provider hits the 66%, that threshold is triggered.

Perhaps it would be helpful if I set out what would happen if the threshold is triggered. Unlike the previous scheme, where the Competition and Markets Authority would be involved, under the new proposals, if the objection threshold is reached, NHS England must discuss the objections with representatives of all organisations that objected. It is in the interests of both them and NHS England to reach a conclusion that is workable for both.

Following the discussion, NHS England must decide whether to amend the proposed payment scheme and reconsult on the amended payment scheme, or to proceed with the scheme, as published, that was consulted on. If it decides to proceed with publication, it must also publish a notice explaining its reasons for doing so and send a copy explaining with the notice to all organisations that objected and therefore met the threshold.

I thank Committee members for their contributions to today’s debate, and I would be very happy to write to or meet any hon. Member who has further questions. I genuinely believe that the objection percentages that we have discussed strike the right balance in allowing real collaboration between NHS England and those that it is consulting on. I commend the regulations to the Committee.

Question put and agreed to. 

Genome UK: England Implementation Plan

Will Quince Excerpts

Tuesday 13th December 2022 Written Statements

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

This is a joint statement with the Secretary of State for Business, Energy and Industrial Strategy.



In 2020, the Government published Genome UK, the UK’s genomic healthcare strategy, setting out a vision to create the most advanced genomic healthcare system in the world, underpinned by the latest scientific advances, to deliver better health outcomes at lower costs. The strategy made 45 commitments to be delivered over 10 years to achieve this vision. Delivering this vision will help people to live longer, healthier lives, reduce the burden of illness on the NHS and make the UK a world leader in data-driven healthcare research and innovation.



I am delighted to inform the House that we are today publishing the “Genome UK—England Implementation Plan 2022 to 2025”, which sets out how we will further progress delivery of Genome UK in England during the current spending review period, taking us to the halfway mark of our ambitious 10-year strategy. In order to allow us to reflect advances in this fast-moving field, we have adopted a phased approach to implementing the strategy, with implementation plans published in line with spending review periods.



This publication follows the previous “Genome UK: 2021 to 2022 Implementation Plan” in May 2021, and “Genome UK: shared commitments for UK-wide implementation 2022 to 2025” in March 2022. Through extensive collaboration with partners across the genomics community we have set out our priority actions, showcasing the outstanding research and policy work that will take place across England to develop, evaluate and implement new genomic technologies across the health and care system and life sciences sector. As part of this, I am pleased to announce:



The £105 million of Government funding for a landmark research programme, led by Genomics England in partnership with the NHS, to study the effectiveness of using whole genome sequencing to speed up diagnosis and treatment of rare genetic diseases in newborn babies, potentially leading to life-saving interventions for thousands of babies.

The £22 million of Government funding for Genomics England to tackle health inequalities in genomic medicine through tailored sequencing of 15,000 to 25,000 participants from diverse backgrounds by 2024-25, as well as extensive community engagement work to build trusting relationships with traditionally excluded groups of people.

The £26 million of Government funding for an innovative cancer programme, led by Genomics England in partnership with NHS England and the National Pathology Imaging Co-operative, to evaluate cutting-edge genomic sequencing technology and use artificial intelligence to analyse genomic data alongside digital histopathology and radiology images to improve the accuracy and speed of diagnosis for cancer patients.

Up to £25 million Medical Research Council-led funding for a four-year functional genomics initiative, working across UK Research and Innovation and other stakeholders to establish an industry-partnered world-class offer on functional genomics, building on already existing infrastructure and UK research expertise

These are just a few of the many actions that are set out in the implementation plan, which also covers how we will engage with patients and the public; develop the genomics workforce; support industrial growth and explore a possible UK model for how to apply ethical standards in genomic healthcare and research.



Together, these actions will pave the way to bringing improved approaches to disease prevention, diagnosis, and treatment to people and patients, transforming healthcare and improving the health of the nation. Through these actions we will also increase private sector investment, by ensuring that the UK is the best location globally to conduct genomic research and grow new genomic healthcare companies.



Patients and the diverse UK population are at the heart of our journey to the world’s most advanced genomic healthcare system. Equally, this vision cannot be achieved without the support our talented healthcare workforce. I therefore want to emphasise that open engagement with the public, patients and workforce will continue to be central in the delivery of our 10-year vision.



This implementation plan has been agreed with the Genome UK Implementation Co-ordination Group and the National Genomics Board, which are made up of senior life sciences stakeholders and delivery partners from across the NHS, the charity sector, research, and industry. The devolved Governments will be publishing their own implementation plans, to ensure that genomic healthcare is able to flourish across the UK. Over the next three years we will continue to work with our partners, including the devolved Governments, via the Genome UK Implementation Co-ordination Group and the National Genomics Board, to ensure that we can continue to create the most advanced genomic healthcare system in the world.

[HCWS439]

NHS Industrial Action: Government Preparations

Will Quince Excerpts

Monday 12th December 2022 Commons Chamber

[Wes Streeting (Ilford North) (Lab)]

(Urgent Question): To ask the Secretary of State for Health and Social Care if he will make a statement on Government preparations for industrial action in the NHS.

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

I am grateful to the hon. Member for his question, which I am taking on behalf of the Department as the Secretary of State is attending a Cobra meeting on contingency planning for industrial action in the NHS. He also came before the House on the subject twice last week: at departmental questions and for the Opposition day debate.

We are all hugely grateful for the hard work and dedication of NHS staff, so we deeply regret that some union members have voted for industrial action. Our priority must be to keep patients safe. That begins with keeping the door open. The Secretary of State wrote to the Royal College of Nursing on Saturday asking for further discussions as a matter of urgency. At the same time, we are working with the NHS to minimise the disruption to patients if the strikes do go ahead. We are engaged with providers, professional bodies and trade unions to agree safe levels of cover should any action take place.

In addition, this afternoon, Ministers—including the Secretary of State—are attending a Cobra meeting focused on our contingency plans. Our plans draw on extra support from a range of places, including service personnel and the private sector. While we aim to minimise disruption, with the NHS already under significant pressure from the covid pandemic and winter pressures, we remain deeply concerned about the risk that strikes pose to patients.

I want to be clear that, even at this moment of uncertainty, people must keep coming forward to get the care that they need. People should continue to use NHS 111 if they need medical help and dial 999 in the event of an emergency. For more routine treatment, hospitals will do everything they can to ensure that planned procedures go ahead, but it is inevitable that any strike would mean some patients would have their treatment delayed. People will be contacted if their appointments need to be changed.

It is our hope that patients can be spared from unnecessary and unjustified strikes. Industrial action is in no one’s best interests, especially in this difficult winter. We have had constructive meetings with the leadership of several unions, including the RCN, Unison, Unite and the GMB, and we look forward to further discussions to find a way forward together that is in the best interests of the patients we all serve.

[Wes Streeting]

Thank you, Mr Speaker, for granting this urgent question. The power to stop these strikes likes squarely with the Government and the Secretary of State. The Royal College of Nursing and Unison have said that they will call off strikes this week if the Government are willing to negotiate with them seriously on pay. That reasonable offer of compromise is surely too good to refuse, so what on earth are the Government playing at? After 12 years of Conservative government, patients can no longer get seen on time and staff have been pushed to breaking point—and the Government cannot even be bothered to try to negotiate to prevent strikes from going ahead, at the worst possible time for patients and the NHS. The Government should ask themselves why, under a Conservative Government, nurses feel they have to take industrial action for the first time in more than 100 years and why ambulance workers are set to follow them for the first time since 1989.

It should be obvious by now what the Conservative agenda is. The Government know that patients are going to suffer this winter and they have no plan to fix the problems of their own making, so instead of taking responsibility for their failure they want to use nurses and paramedics as scapegoats to avoid the blame. It is a disgusting plan, it is a dangerous plan, and it is a plan that will not work. The public know that the power to stop these strikes is in the Government’s hands. If they fail to act now, patients will never forgive them.

How many operations have already been cancelled? How does the Minister expect those on the waiting list to feel if their operations are cancelled because of the Government’s gross negligence? Can he tell patients which services will be impacted if these strikes go ahead? Is the Secretary of State not embarrassed at Cobra today, asking the Army to come in to clean up the Government’s mess?

Even at this last minute, it is not too late to prevent strikes from going ahead. Perhaps the Minister can tell us whether the meeting with the RCN later today will involve discussions on pay. And if not, why not? Because that is all it takes: just a few minutes or a few hours of talk can avoid strike action. Why will they not do it?

[Will Quince]

The fact is that Labour is all over the place when it comes to strikes. They criticise Ministers while admitting that the unions’ pay demands are unaffordable. The hon. Gentleman and his party leader are too tied to their union paymasters to be on the side of patients. He knows that we have an independent pay review body, and is important that both sides respect that independent body. We accepted the independent body’s recommendations for this year’s increase in full, meaning that over 1 million NHS staff have been given at least a £1,400 increase in their pay. That is on top of a 3% pay rise last year at a time when pay was frozen across the wider public sector. The RCN, one of the unions taking action, is asking for an increase that is 5% above the retail prices index. Based on latest figures, that is an increase of 19.2%, or the equivalent of 6.5% of the NHS budget. To meet such demands, we would have to take money away from clearing the elective backlog that the hon. Gentleman referred to, something no responsible Government would wish to do.

Throughout this period, we have always sought to have a balanced process. Those in the private sector will not be getting a 19% uplift, and there is a clear need to be fair to the wider economy. We have to avoid inflationary pressures that would make us all poorer in the end.

We will continue to listen to colleagues’ concerns, not just about pay but many other issues affecting the working lives of those in the NHS. We will work with them to make improvements in a range of areas, from working conditions to patient safety, because we believe there is so much that we can agree on. Strike action is in no one’s best interest. We will keep working so that the NHS continues to be there for those who need it most.

[Mr Speaker]

I call the Chair of the Health Committee, Steve Brine.

[Steve Brine (Winchester) (Con)]

With your indulgence, Mr Speaker, may I send our heartfelt sympathies to the parents of the little boys who have lost their lives in the west midlands overnight and say thank you to the emergency service workers, many of whom will have been from the NHS? I am sure they have done their best for those they pulled out and those they were unable to save.

The Minister is right that we have an independent pay review process, but it seems that we are coming to an interesting junction point: either we believe in an independent pay review process, or we do not. We cannot be in a situation where everything is agreed until it is simply not, and then Ministers are negotiating pay. That is not what Ministers do.

I am glad the Minister mentioned patients them at the end of his remarks. We must keep them as our focus. I have more information about my train services over the next few weeks than I do about health services. Is the Minister satisfied that patients have enough information about what is being affected and when, and how much it will impact on the backlog? I suspect none of this will help the workload pressures that are impacting our NHS.

[Will Quince]

I thank my hon. Friend for his question, and I echo his comments on the tragic events in Solihull, the boys who lost their lives and the heroic actions of those in the emergency services.

My hon. Friend is also right to say that we have an independent pay review body, and we either agree and accept that that is the process, or we do not.

On advice to the public, my hon. Friend is right that we have more to do in this space. Derogations are still being worked through with both individual unions and trusts. Patients should continue to call 999 as normal if it is an emergency and someone is seriously ill or injured. If they do not have life-threatening conditions, they should use NHS 111. Ambulances will still be responding to 999 calls. If patients have appointments, they should please turn up unless advised not to do so. He is right to make the point about communications, and I will be ramping this up when we know more about derogations.

[Mr Speaker]

I call the SNP spokesperson.

[Steven Bonnar (Coatbridge, Chryston and Bellshill) (SNP)]

Scotland’s First Minister has managed in one day to do what the Tory Government could not—agree with the nursing unions to call off strikes planned for this month. NHS workers are the backbone of these countries. If they do not work, the country does not work, and if the country is not working, it is broken. Britain is broken, is it not? And Brexit has broken Britain, has it not? The Tories will not negotiate and the Labour Opposition spokesperson has branded the British Medical Association as “hostile”, while in Scotland the strikes are off, and they are off permanently. An offer of 7.5% has been negotiated and agreed, with an 11.24% pay rise for the lowest paid across the board in NHS Scotland. Why are the UK Government refusing to give public servants a decent pay increase when they have all the financial power to do so?

[Will Quince]

I thank the hon. Gentleman for his question. My understanding is that the industrial action in Scotland has been suspended, not cancelled, as the hon. Gentleman suggested. The Scottish Government have made a considerably higher offer, partly because a politician has got involved in pay negotiations, directly in contrast to the independent pay review body, and it will be interesting to see whether the First Minister of Scotland is going to do this every single year and go against the recommendations of their pay review body.

Would the hon. Gentleman like to confirm—I appreciate he cannot do it now—whether the Scottish Government have also looked at things such as leave and working times? I think it is important to stress that every 1% increase for the “Agenda for Change” workforce equates to about £750 million. That is £750 million that will come out of the NHS budget and that we will not be able to spend on things such as tackling the elective backlog, which is so important to people up and down the country.

[Mr Tobias Ellwood (Bournemouth East) (Con)]

Our military actually enjoy stepping in when a Government Department occasionally cannot manage, such as with flooding and so forth, or on rare occasions when a strike takes place. However, what we are seeing this month is unprecedented, with so many sectors choosing to strike exactly at the same time, and this places a huge burden on our armed forces. Could I ask the Minister, first, whether all the units that may be required to mobilise have been informed already, and whether, if we are going to see strikes at this level, it is now time for Departments to introduce minimum service levels to make sure that our armed forces are not overwhelmed?

[Will Quince]

Representing the garrison city of Colchester, I have nothing but the utmost respect for our armed forces. It has not escaped my notice that many of them are on lower pay than NHS staff and will be giving up their time over Christmas to cover strike action. My right hon. Friend is right that to mitigate the impact of planned industrial action in the ambulance sector, NHS England has explored a range of measures, which include engaging with the Ministry of Defence on military support. As a contingency, a MACA request—a request for military aid to civil authorities—for a limited number of personnel has been submitted to the MOD. It was submitted at the end of last week, and the plan is that MOD personnel will be trained to drive ambulances, but only deployed where they are needed across the country.

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

The Government need to stop hiding behind the pay review body. The pay review body sorts out the distribution of the funding, while it is the Government who determine the size of the envelope, and it is the envelope that is in dispute. Why will the Minister not get a Treasury Minister alongside him and make sure they negotiate on the size of the envelope? If they can afford the right hon. Member for South West Norfolk (Elizabeth Truss), they can afford a nurse.

[Will Quince]

The average pay settlements in the private sector range between 4% and 6%, and we want to have a fair deal for both NHS staff and the taxpayer. The hon. Lady makes reference to the pay review bodies, but it is important to stress that they are made up of independent experts. They recommended the uplifts for NHS staff, and in formulating their recommendations, the review bodies carefully considered evidence from a wide range of stakeholders, including NHS system partners and trade unions. The independent pay review body is a respected mechanism, and we should accept its recommendations, which we have.

[Mr Simon Clarke (Middlesbrough South and East Cleveland) (Con)]

May I commend my hon. Friend on his response to the urgent question, and say how much I agree with him? Can he set out his thoughts on how things would be likely to proceed in the NHS if we ended up in the scenario which the shadow Secretary of State appears to want, in which Ministers negotiate directly with unions on pay every winter? Does he think that that would lead to upward pressure on pay at the expense, crucially, of the public, whom we serve and who need those operations and the elective care for which we have budgeted, and that that should not be eroded by unrealistic pay demands of 19%?

[Will Quince]

My right hon. Friend is right. We have an independent pay review body mechanism for a reason, and it has worked for a number of years. That is why I made reference to the First Minister in Scotland. Is this a procedure we are going to go through every single year when a pay review body recommendation is made and unions do not like it, and politicians have to get involved? The point of the independent pay review body is that it depoliticises the issue, and Ministers do not negotiate directly with unions. The independent pay review body looks at the issue in the round, along with the wider economy and a number of other factors, then forms a recommendation which the Government can choose to accept or refuse. It is important to stress that in this case the Government accepted the recommendations in full.

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

I was a nurse for 25 years. Nurses work long hours, day in, day out, to support people all over the country, often on very low pay. I know from experience how tough it can be, and it is shameful that many hospitals have opened food banks specially to feed their staff. Let us be absolutely clear: the power to stop these strikes, which nurses themselves do not really want, lies squarely with the Government. How can Ministers justify refusing to talk to the unions?

[Will Quince]

I thank the hon. Lady for her question and for her service as a nurse. We value hugely and appreciate all our NHS staff. We have given them a pay rise this year, on top of 3% last year, when pay was frozen in the wider public sector. As I have said a handful of times, we accepted in full the recommendations from the independent pay review body. Of course, I do not want to see anybody needing to use a food bank, let alone a member of our NHS. That is exactly why the Government have a broader package of support in place.

I have to take issue with one of the hon. Lady’s comments. She asked who held the power to call off these strikes. There is only one answer: the unions.

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

I have been out on shift with my local ambulance service, and have seen how hard it works and how important that work is. We are really grateful for what it does, and my constituents are worried. If the ambulance strikes go ahead, will the Minister explain which categories of call we will ensure are responded to?

[Will Quince]

We are currently having those derogation discussions with the unions, and they will also happen at an individual trust level. As my hon. Friend will know, having been out with her trust, 999 calls are triaged and categorised from category 1 to category 4, and on days of ambulance strike action it is likely that category 1 and category 2 calls, where there is an immediate threat to life, will be responded to. We are looking at ways in which we can provide additional support for category 3 and category 4, including things such as block-booking taxis and support through community healthcare, local authority fall services and community support.

[Karin Smyth (Bristol South) (Lab)]

What we have got is a Government who refuse to govern. Retention and sickness rates were reported to the Health and Social Care Committee in June 2019 as higher than average by Health Education England, and if retention rates were kept at 2012 levels we would have 16,000 more nurses in the system. The Minister has talked about safe levels of cover during the strike, but the unions have told us that when they look at staffing levels, in some places, they are currently below what is safe. The issue for us as Members of Parliament and for our constituents is that none of us knows whether our local systems are safe or not. Can he tell us which hospitals across the country are currently operating at safe staffing levels, and which are below those levels, before the strike even starts?

[Will Quince]

The hon. Lady talks about NHS staffing levels; we have 1.2 million staff within our NHS, and compared with last year, we have 3,700 more doctors and 9,100 more nurses, and compared with 2019, we have 29,000 more nurses and 2,200 more GPs, but we do have high vacancies. That is why it will not have escaped her notice that we have commissioned NHS England to publish a long-term workforce plan, and that will be independently verified as set out by the Chancellor in the autumn statement.

[Jerome Mayhew (Broadland) (Con)]

Inflation is the real enemy here, because it makes us all poorer. We have a political and economic choice: we either tackle it, or we give in to an inflation pay spiral. The Minister was right to mention that the Royal College of Nursing pay demands are in excess of three times greater than the average private sector payment at the moment. Does my hon. Friend agree that public sector pay demands of almost 20% would embed inflation for years to come and make us all poorer?

--- Later in debate ---

[Will Quince]

My hon. Friend is absolutely right: granting double-digit pay rises would sustain higher levels of inflation and have a bigger impact on people’s income in the long term, as well as eroding the value of savings, which is important to many of our constituents.

[Margaret Greenwood (Wirral West) (Lab)]

These strikes are not just about pay levels; they are also about patient safety. NHS workers care deeply about their patients, and I stand in solidarity with them. Members of the Royal College of Nursing have told me how stressed and burned out they are because they do not have enough colleagues to work alongside them. That is dangerous and extremely unfair on both patients and staff, and it is the result of the failure of consecutive Conservative Governments to provide enough resources and training places and to carry out the necessary workforce planning. The Minister mentions the independent pay review body, but he knows full well that there is a role for Government in ending this dispute. Will his Government get around the table with the unions and avert the strike action?

[Will Quince]

The hon. Lady is right that this issue is about more than just pay. That is what the unions are telling us. It is about things such as staffing levels and working conditions. If that is indeed the case, let me repeat: my door is always open, and I would be happy, as would the Secretary of State, to discuss those issues with the unions at any point they would like.

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

Would there not be more money available for relatively poorly paid frontline NHS staff if there were fewer layers of management bureaucracy paid at substantially higher rates within the NHS?

[Will Quince]

I thank my right hon. Friend for that question. I am sometimes staggered by the number of people on six-figure salaries within our NHS, but in an organisation of its size, management is also important. It is about getting the balance right, but we always continue—[Interruption.] The hon. Member for Ilford North (Wes Streeting) chunters from a sedentary position. The balance may not be right, and we always continue to look at the ratio of management to frontline staff to make sure we are getting that right.

[Karl Turner (Kingston upon Hull East) (Lab)]

The Government will blame anybody and everybody for these avoidable strikes, but he knows full well that the RCN is not even affiliated to the TUC, let alone the Labour party. If these strikes go ahead, the Secretary of State is to blame, because he has the power to sort out this mess. Why does he not just get on with it?

[Will Quince]

The hon. Gentleman puts it in his usual blunt way. The pay review body process is the established mechanism for determining pay uplifts in the public sector, outside of negotiating multi-year pay and contract reform deals. Despite what he says, industrial action is a matter for the unions, and we urge them to carefully consider the potential impacts of industrial action. The Secretary of State and I have been clear that our door is open. We have already met with the unions, and we would be happy to do so again.

[Lee Anderson (Ashfield) (Con)]

Now then. In 2014, the shadow Health Secretary said that he would support strikes within the NHS, even if there was a Labour Government in power, but he is remarkably quiet today about whether he actually supports the strikes—unlike the RMT strikes, which I am sure that he supports. Does the Minister think that the shadow Health Secretary and Opposition Front Benchers are playing politics with this issue?

[Will Quince]

I am not one to cast aspersions on the shadow Secretary of State, other than to say that I and the Secretary of State refuse to play politics with this issue. This is all about patient safety and ensuring that if industrial action goes ahead—[Interruption.] The shadow Secretary of State again shouts “Negotiate” from a sedentary position, but he knows that we have an independent pay review body, process and mechanism. It is important that we respect that.

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

We simply cannot afford to lose any more nurses and valued NHS staff. We already have huge workforce shortages—40,000 nurses resigned last year and there are more than 130,000 vacancies across the NHS—so cancelling Christmas for members of the armed forces will not fix these problems. Will the Minister explain how paying nurses insufficiently and drafting in military personnel over Christmas serves to attract new recruits to the NHS and the armed forces?

[Will Quince]

That is a bizarre question, because the only reason we have to put in a MACA—military aid to civil authorities—request is that the unions have called strike action over Christmas. As the hon. Member asks about recruitment and retention, let me cover off that issue. As I have set out, we are committed to publishing a comprehensive workforce strategy, which will be independently verified; we have set out new pension flexibilities; we have already recruited about 29,000 more nurses and are on track to meet our 50,000 target; and we plan to boost international recruitment. However, I hope that the hon. Member agrees—in the interests not only of our armed forces, many of whom will have to cancel their Christmas leave, but of patient safety—that we do not want industrial action to take place. I urge the unions to meet us to discuss a way forward.

[Richard Drax (South Dorset) (Con)]

I find it regrettable, as I think most people do, that Opposition Members continue to use the NHS as a political football. This is about the care of patients, and if Opposition Members do not think that Government Members care about patients, they are living in another world. My hon. Friend is doing a great job. We all accept—even the shadow Secretary of State does—that the NHS needs a radical reform. Surely it is time for an independent body to look at that argument and make the NHS run far more efficiently.

[Will Quince]

I thank my hon. Friend for his question. We are constantly looking at how we can improve productivity and increase efficiency in the NHS. We have an acute issue not just with winter, but with proposed strike action. The shadow Secretary of State mentioned that the NHS needs reform, and we are undertaking that. Will further reform need to be undertaken? Yes, and if my hon. Friend the Member for South Dorset (Richard Drax) has particular ideas, I am very happy to meet him to discuss those further.

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

During the dark days of covid, it was the NHS that gave us hope, not Ministers partying in Downing Street. The Tories now seek to demonise the very NHS staff that we clapped from our doorsteps, because they have voted to strike. They are overworked, underpaid, without a proper workforce plan, concerned about the security and safety of patients, and forced to use food banks. Do our NHS staff not deserve at least a face-to-face meeting on pay negotiations with the Government?

[Will Quince]

I do not know where the hon. Lady got the impression that I or anybody else was demonising NHS staff—far from it. The unions have chosen to bring forward this action. As I said, I hugely value and appreciate all NHS staff. That is why we have given them a pay rise this year, on top of the 3% pay award last year, when pay across the wider public sector was frozen.

[Chris Bryant (Rhondda) (Lab)]

I think the Minister knows that there is no clinician in the land who really wants to go on strike. Many clinicians feel that the crisis has been coming for a long time because of the issues around morale and lack of workforce, which I have asked the Minister about on many occasions. He keeps saying that the workforce plan is imminent, but that will not solve the immediate problems.

One nurse said to me the other day that what worries her most is that at any one time, several hundred thousand people in the country are waiting for their test results, particularly in relation to cancer. How will the Minister ensure that people get their cancer results in time to meet all the other cancer plan deadlines?

[Will Quince]

I thank the hon. Gentleman for his question; I know that he has a particular interest in the matter. We are looking to ensure that as many NHS services as possible continue during strike days. On his broader point about pay settlements, the average pay settlements in the private sector are within the range of 4% to 6%.

[Chris Bryant]

Not in the NHS.

[Will Quince]

Within the private sector it is 4% to 6%. The uplifts strike a careful balance in recognising the huge importance of public sector workers while minimising inflationary pressures and, of course, having an eye on managing the country’s debt.

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

The Minister challenged back on who had the power to avert these strikes. Let me reiterate what my hon. Friend the Member for Ilford North (Wes Streeting) said: trade unions have been clear that strikes can be averted if Ministers initiate face-to-face pay negotiations. So far, they have completely failed to do so. The power to stop these strikes lies squarely with the Secretary of State. How can the Government justify refusing to even talk?

[Will Quince]

We have already been clear that we would be very happy to meet the unions, and I understand that a meeting is being organised, but let me reiterate the point about what exactly the Royal College of Nursing is asking for: an uplift that is 5% above RPI inflation. Uplifting pay for all staff—this is based on 19.2%, within the agenda for change—would cost approximately an additional £10 billion. The hon. Member for Rhondda (Chris Bryant) talked about things like test results; the £10 billion that we would spend on such an uplift is £10 billion that would come out of the NHS budget. That is £10 billion that we would not be able to spend on hugely important issues such as tackling the elective backlog.

[Jim Shannon (Strangford) (DUP)]

I was on the picket line with NHS staff in Newtownards in my constituency this morning. I do not expect to be reprimanded for that, by the way—I am quite sure I will be okay.

I want to ask the Minister a positive, constructive question. All the men and women want who were on the picket line at Ards Community Hospital in Newtownards this morning is a wage that helps them to survive. The women and men I talked to this morning are not surviving; they are visiting food banks. It is not just the nurses: it is the porters, it is the ward staff, it is everyone. Will the Minister and the Government go just that wee bit further to get a settlement?

[Will Quince]

I understand why the hon. Gentleman is asking that question, and I am sorry to sound like a broken record, but we accepted the independent pay review body’s recommendations in full. As a result, more than 1 million NHS workers were given a pay rise of at least £1,400. For newly qualified nurses, it was a 5.5% increase. Those on the lowest salaries, whom the hon. Gentleman referred to, are seeing a pay rise of up to 9.3%. Again, that is on top of 3% last year, when public sector pay was frozen.

Nobody wants to see industrial action go ahead. My message to the unions is “It’s good to talk—let’s talk. I know the meeting is being set up. Let’s do all we possibly can to avoid industrial action this winter.”

Draft Dentists, Dental Care Professionals, Nurses, Nursing Associates and Midwives (International Registrations) Order 2022

Will Quince Excerpts

Tuesday 6th December 2022 General Committees

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

I beg to move,

That the Committee has considered the draft Dentists, Dental Care Professionals, Nurses, Nursing Associates and Midwives (International Registrations) Order 2022.

It is a pleasure to serve under your chairmanship, Mr Bone.

I turn first to international professionals. International dental care and nursing professionals form a vital part of the NHS workforce and make an important contribution to the delivery of healthcare in the UK—indeed, over a third of dentists joining the General Dental Council register in 2021 qualified outside the UK. There was a near-even split between domestic and international professionals joining the Nursing and Midwifery Council register over the same period, with 23,000 international professionals joining. The GDC and the NMC are the independent statutory regulators for dental, nursing and midwifery professionals in the UK and nursing associate professionals in England. They set registration standards for healthcare professionals who wish to practise in the UK, which ensures that registered and regulated professionals have the skills, competence, health and attitudes that command public trust and, importantly, patient confidence.

I turn to the international registration process. International professionals who wish to practise in the UK must meet the same rigorous standards that we expect of UK-trained professionals, so we believe it is also in everybody’s interest that such professionals can use registration processes that are a fair test of their professional competence and that provide them with a clear route to registration.

We are reforming the legislative framework for the regulation of healthcare professionals to make it faster, fairer and more flexible. The current UK model needs to change to better protect patients, to support our health services and to help the workforce meet future challenges. Ahead of that, action is required to provide the GDC and the NMC with greater flexibility to amend their international registration processes, and we have worked closely with these regulators, along with colleagues in the devolved Governments, to develop proposals that remove from the legislation prescriptive detail about how such processes should operate. That will help the regulators to ensure that future international registration pathways are proportionate and streamlined, while continuing to robustly protect patient safety.

I turn to the greater flexibility for the GDC, the overseas registration examination, the processes and the fee. The draft order provides the GDC with greater flexibility to apply a range of assessment options for international dentists beyond its overseas registration exam, or ORE. The regulator is provided with the same level of flexibility in relation to processes for international dental care professionals. The GDC will have much greater freedom to update the content and structure of its overseas registration examination now and in the future, as they will no longer be set in legislation that requires Privy Council approval to be changed.

[Taiwo Owatemi (Coventry North West) (Lab)]

I welcome the changes proposed today, but can the Minister elaborate on whether the GDC will be given more support with reviewing the performers list validation by experience, which international dentists will have to go through to be NHS dentists but not for private practice?

[Will Quince]

I thank the hon. Lady for her question, and I will certainly come to that—probably in summing up—because the performers list is a wholly separate issue. The draft order is about the registration of dentists and dental professionals, whereas the performers list is about those providing NHS services.

As I said, the overseas registration exam will no longer be set in legislation that requires Privy Council approval for it to be changed. The requirement that dental authorities provide the ORE is removed, allowing the GDC to explore alternative providers, so candidates who were affected by the suspension of the exam during covid will also be provided with extra time to sit it.

We know that the GDC plans to increase OR fees to cover its costs for providing the assessment. A more cost-effective model is likely to be achieved over time as additional providers are identified. I understand that the GDC will first consult on new rules for its international registration process before they come into force.

I want to touch on consultation responses, because Committee members will have had a barrage of emails overnight on the subject. We plan to take forward all the proposals that we consulted on, and we made an amendment to the draft order in the interests of patient safety; that particular point was made in the email Committee members will have received from multiple people overnight. It relates to the requirement that a qualification relied on by an international applicant to the dental care professional register can no longer be a diploma in dentistry. If hon. Members want me to, I can go into further detail on that subject in my summing up.

I also draw the Committee’s attention to an issue raised by the Secondary Legislation Scrutiny Committee, which noted that the House may wish to seek reassurance as to how appropriate safety standards will be maintained. The primary purpose of the professional regulation is to protect patients and the public from harm by ensuring that those providing healthcare are doing so safely. Any new or amended registration pathways will be based on applicants meeting that same standard of training and knowledge as UK-trained professionals. Those standards are set by the independent regulators in consultation with the profession’s public and education providers.

The draft order also makes changes that help to lay the foundation for the regulator to improve processes further in the future. That includes a charging power, so that fees may be charged to international institutions for the cost of recognising their qualifications. That will support the GDC in registering individuals based on an assessment of their qualification, skill and training, or by recognising the qualification that they hold.

I turn to the Nursing and Midwifery Council and the changes to the Nursing and Midwifery Order 2001. The NMC will have flexibility to use two pathways in addition to its test of competence, which will remain the primary registration assessment. The first additional pathway is recognition of an international programme of education, so applicants holding a Nursing and Midwifery Council-approved qualification could meet the council’s requirements without needing to sit the test. The second is qualification comparison, whereby the Nursing and Midwifery Council may ascertain whether an international qualification is of a comparable standard to a UK one. The draft order provides the NMC with greater flexibility to amend such processes by, in effect, stripping out unnecessary detail from the legislation on how it should operate.

The draft order also clarifies the NMC good health and good character declaration requirements, misinterpretation of which can lead to confusion and unnecessary delays to the application process. With that, I commend the order to the Committee.

--- Later in debate ---

[Will Quince]

I take your instruction on the passing of notes, Mr Bone; it will not happen again.

Let me answer a number of the points made by the hon. Member for Enfield North, starting with dentistry more generally. Our aim is to ensure that everyone has timely access to NHS dentistry and that dentistry is an appealing career choice. In too many parts of our country, people do not have access to a dentist in the way that they should. In July this year, we announced a package of improvements designed specifically to increase access to dental services across England. That includes better remuneration, guidance on how patients should expect to attend for check-ups, and measures that enable dentists to make better use of staff in their dental teams. Of course, training has to be part of that. Health Education England undertook a three-year review of education and training as part of its 2021 “Advancing Dental Care” review. It is now implementing its four-year dental education review programme to improve recruitment and retention.

The hon. Member for Enfield North rightly raised internationally trained staff, who have been part of our NHS since its inception and continue to play a vital role. We are doing everything we can to invest in growing our domestic workforce and move towards a more sustainable domestic supply. We are training more, retaining more and encouraging staff who have left to return. Having said that, ethical international recruitment remains a key element of achieving our workforce commitments. As the hon. Lady will know, we have recently recommitted to publishing our NHS long-term plan, which is a commission for NHS England. As the Chancellor of the Exchequer set out in the autumn statement, it will be independently verified.

The hon. Member for Coventry North West asked about the performers list. Although it is not directly relevant, Mr Bone, perhaps you will indulge me for one moment, so that I can explain what we are doing. The Department is currently reviewing the National Health Service (Performers Lists) (England) Regulations 2013—that is, the route by which a dentist can become registered to undertake NHS services—to identify where regulatory requirements could be streamlined and simplified while maintaining the high professional standards that ensure patient safety. Any proposed legislative changes will be subject to consultation.

I think the question raised by the right hon. Member for Hayes and Harlington follows a number of emails that we received overnight. These related to the essence of this statutory instrument, which is about closing a loophole. I understand why people are exercised about that. I do not know the exact figures from the consultation, but it is on that exact point where we expect there will have been a higher percentage that we disagreed with, but I am happy to write to the right hon. Member and the Committee with the exact percentages of people who responded in a particular way. On that one point, I will go into detail because, although we recognise the opposition to that proposal, we intend to take forward this amendment in the interests of patient safety.

[John McDonnell]

Will the Minister write to us, with regard to not that specific proposal, but the generality? If we could receive a breakdown on that, that would be really useful. Can he say at this stage—sometimes, inspiration does come via notes—whether the majority were in favour or opposed?

[Will Quince]

My understanding is that, on this particular point around dental care professional registration with the GDC, the majority were opposed. That is the one major point where we disagreed with the consultation response.

If it is helpful to the right hon. Member for Hayes and Harlington, I will explain why. The change introduces fairness and consistency between UK and international routes because UK dentists cannot qualify or apply to join the DCP register using their dentistry qualification in other countries. I make clear that international dentists already registered as DCPs with the GDC will still be able to maintain their registration following these changes, but the amendment will allow the GDC to process applications from dentists to join the register as DCPs that are received until this order comes into force, which is likely to be in the spring. It guarantees that any live DCP title applications—I suspect those are the driver of some of the emails we received last night—submitted before the legislation has passed will still be processed.

Although we recognise that the majority of respondents to the consultation disagreed with the proposals and many argued that international dentists are already qualified, or have enough clinical experience, to work as a DCP, others also highlighted that in some cases overseas qualified dentists work as dental care professionals outside the UK, and in many countries there is not a separate job title for dental care professionals.

However, in the UK the GDC recognises dentists and DCPs as distinct professions; they undertake similar but different tasks. I understand from the GDC that the majority of such applications from international dentists are, in any event, unsuccessful. This reinforces that one of the GDC’s priorities must be on ensuring that only suitably qualified people join the profession here in the UK, in the interest of patient safety.

I hope that my answers to those questions—notwithstanding the exact point on the numbers and percentages of people that objected on particular points, which I will write to the Committee about—will provide sufficient reassurance. The order promotes flexibility for the General Dental Council and the Nursing and Midwifery Council as independent statutory regulators to fulfil their duties in developing and maintaining robust and proportionate international registration processes. I commend the order to the Committee.

Question put and agreed to.

Government PPE Contracts

Will Quince Excerpts

Tuesday 6th December 2022 Commons Chamber

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

I am grateful for this opportunity to come to the House to talk about our vital national efforts on personal protective equipment. Colleagues must cast their minds back to where we were three years ago as we stood on the precipice of a global health emergency, the likes of which had not been seen for over a century. SARS-CoV-2 was not even called covid-19 at that point, and little was known about its impact and transmission. In a matter of a few short weeks, this novel coronavirus pushed global health systems and global PPE supply chains to near breaking point, yet here at home, from a standing start, we initiated work on one of the toughest logistical challenges ever undertaken in peacetime: the provision of PPE for frontline colleagues in health and social care.

[Neale Hanvey]

At the beginning of the pandemic in one of my first Prime Minister’s questions, I asked the then Prime Minister if he would ensure that profiteering would have no place in this Government’s response to the covid pandemic. Now, when we fast-forward to all these years later, that seems to have been at the very heart of it. The British people were told that this Government were helping them. British industry was told that it was going to be supported. I have persisted in my questions about how the domestic diagnostic industry has been promised work by this Government, yet it is being charged for doing the right thing. Will the Minister apologise—

[Madam Deputy Speaker (Dame Rosie Winterton)]

Order.

[Will Quince]

I will come on to many of the points the hon. Gentleman has raised, but I will just say this about UK supply chains. At the beginning of the pandemic, only 1% of PPE used in the UK was produced here. At present, three quarters of the FFP-3 masks provided to the NHS and social care are now manufactured in the United Kingdom and contracts were signed with around 30 UK-based companies to manufacture around 3.9 billion items of PPE.

Colleagues will recall those early days, with planes being turned around on the tarmac, countries imposing export bans, huge inflation in global prices and the price of crucial items such as glass increasing sixfold. These were the conditions under which tough decisions were taken, and these were the decisions under which PPE was procured. These were the conditions under which we stepped up to protect our most vulnerable and to save lives.

[Karl Turner (Kingston upon Hull East) (Lab)]

How can the Minister possibly square the fact that Arco, a leading clinical PPE supplier to the NHS since its inception —the company has existed in Hull for more than 100 years—did not get a sniff of a contract from the Department of Health and Social Care because it was nowhere near a VIP lane? He should be saying sorry from the Dispatch Box, not all this nonsense. Just ‘fess up and say sorry.

[Will Quince]

There were lots of words there, and lots of aggression. [Interruption.] Let us be frank, there was.

I will address many of those points. I fear the hon. Gentleman forgets the pressure under which civil servants were working at the time and the pace at which decisions had to be taken. [Interruption.] If he would like to write to me with those exact conditions—

[Karl Turner]

rose—

[Madam Deputy Speaker (Dame Rosie Winterton)]

Order. The hon. Gentleman must allow the Minister to answer. It is not fair to shout back as soon as he starts answering.

[Will Quince]

The hon. Member for Kingston upon Hull East (Karl Turner) will know that civil servants had to take decisions about speed, pace and quantity. They were looking at contracts that would get the most amount of PPE for the best value for money as quickly as possible.

[Simon Hoare (North Dorset) (Con)]

Was everything that was done, done perfectly? No, and no doubt all the lessons will be learned but, as the Minister says, we would all be well advised to remember, because it was a long time ago now, the absolute panic and fear. The whole world was trying to buy any of this stuff they could get hold of at any price. If we neglect to remember the doctors, nurses and care home operators in our constituencies who were knocking on our doors asking for emergency help, we cannot have a proper debate about this issue.

[Will Quince]

My hon. Friend is absolutely right. Under those circumstances, in those conditions, we had to be quick and decisive to protect colleagues on the frontline so that they could continue providing life-saving care. With lives on the line, of course we had to change our approach to procurement and adjust our appetite for risk. I do not believe the British people would have forgiven us if we had stuck to the same old processes. We had to balance the risk of contracts not performing and supplies being sold at a premium against the real risk of harm to the health of frontline workers, the NHS and the public if we failed.

[Dr Mullan]

Does my hon. Friend agree that the Opposition want to have it both ways? They criticise us for our procurement decisions but, as I said earlier, they recommended a football agent to supply ventilators, and the Labour Welsh Government procured PPE from the same Serco company that they criticise us for procuring PPE from,

[Will Quince]

I am keen not to get into a political slanging match on this point, but my hon. Friend is right that all Members on both sides of the House were receiving multiple emails from people who, as my hon. Friend the Member for North Dorset (Simon Hoare) said, were panicking because they wanted to ensure that we procured PPE as quickly as possible.

Colleagues across Government and beyond worked day and night, taking tough decisions, to keep our country safe. Those efforts secured billions of items.

[Dawn Butler]

On civil servants, will the Minister give way?

[Will Quince]

No. I will come to civil servants in a moment.

[Several hon. Members rose—]

[Madam Deputy Speaker (Dame Rosie Winterton)]

Order. The Minister has indicated that he will give way shortly. Let him make a bit of progress.

[Will Quince]

I have given way equally to both sides so far in this debate. I have some reluctance to give way to Members who tell others to sit down while they are speaking or making interventions.

[Dawn Butler]

But are you giving way?

[Will Quince]

I said I will, and I will.

The efforts of civil servants secured billions of items and, by June 2020, we had obtained 30,000 ventilators and delivered more than 17.5 billion items of PPE to protect frontline workers. What does this mean in practice? It means that we were able to keep our NHS open throughout the pandemic; emergency operations went ahead; and once some of the toughest restrictions were eased, relatives could visit their loved ones in and around care homes.

[Dawn Butler]

I want to take the Minister back to where he mentioned civil servants. According to the Government’s own records, civil servants were begging Ministers not to give contracts to some of these companies because they had red flags and they were overcharging the Government—we are talking about almost double the price they agreed to be paid. This was an extra cost of £50 million to taxpayers. Civil servants were begging the Government not to act in the corrupt manner that they did.

--- Later in debate ---

[Will Quince]

I am pleased that the hon. Lady made that intervention, because it is the first I have heard of such an accusation being made. If she has evidence of such, I suggest that she presents it.

It might be helpful if I just talk through the process. Thousands of companies made offers; around 430 were prioritised through the high-priority lane; only 12% of those resulted in a contract; and due diligence was carried out on all companies by civil servants. Financial accountability sat with a senior civil servant, and Ministers—this is important—were not involved in the decision-making process. A team of more than 400 civil servants processed referrals and undertook due diligence tests.

On that basis, we will make no apology for procuring PPE at the pace and volume we did. Now that the global market for PPE has stabilised, it is easy for some people to point to the value of goods that are inevitably now sold at a much lower price than we paid, but that is a cheap shot, and one that entirely misses the point. We adjusted down the value of our PPE holding as market prices have changed—that is just standard accounting practice—and even then, we are still putting large quantities of it to use. Our successes should be judged on the conditions we faced at the height of the pandemic, not with the convenient benefit of hindsight.

Let me come to civil servants. If I may, I will give the right hon. Member for Ashton-under-Lyne (Angela Rayner) the benefit of my fast-approaching four years’ experience as a Minister. We rely on hard-working civil servants; they are the backbone of our state and it is my privilege to work with them. She knows that Ministers were not involved in the decision-making process for PPE procurement, and the due diligence, as I have said, was undertaken by a team of more than 400 civil servants. Although I am a Health Minister now, I was not at the time; I was a Minister at the Department for Work and Pensions. I recall how hard civil servants worked, under the most trying conditions, during the pandemic.

[Dame Meg Hillier]

rose—

[Will Quince]

I promise I will come to the hon. Lady.

Those 400 civil servants working on PPE and a senior accounting officer took decisions at pace and under huge pressure, as lives depended on them. Did they get everything right? No, they did not. But they did try their best in a highly competitive global market, with significant challenges in sourcing, procuring and distributing PPE. [Interruption.] Yes, they absolutely did. I gently say to the right hon. Member for Ashton-under-Lyne that her implied criticism of their professionalism, integrity and independence at a time of crisis, with the convenience and luxury now of hindsight, is deeply regrettable.

[Angela Rayner]

The Minister is being disingenuous to say that. I have never suggested for one moment that civil servants do not do an excellent job and work diligently. But why will he not publish the documents and emails about what Ministers, Tory peers and Tory MPs have been up to during the pandemic and these contracts?

[Will Quince]

I will come to that. As I said, due diligence was carried out on all companies. Procurement decisions were taken by civil servants. Financial accountability sat with a senior civil servant. I thank and applaud our hard-working civil servants, and I humbly suggest that someone aspiring to be our Deputy Prime Minister should do the same and not seek to throw them under the metaphorical bus.

[Dame Meg Hillier]

Very early on, the Public Accounts Committee and the National Audit Office were looking into the issue. We know that it was a rush at the beginning, but we were warning about the problems early on, and still they persisted. There was poor record keeping—frankly, it was a lack of record keeping in many cases. This House gave the Government permission to act fast, but not to act fast and loose, and the Minister just needs to acknowledge that.

[Will Quince]

I thank the hon. Lady for her intervention, and I will come on to some of the action that we will take. She rightly mentions accountability. Details of the high-priority lane were published on 17 November 2021 and updated in February 2022. This is an important point, because the right hon. Lady, the deputy Leader of the Opposition, suggests that there is some kind of cover-up. If there is, Madam Deputy Speaker, listen to this, because this is some kind of cover up! As I have said, high-priority lane details were published on 17 November and updated in February this year. The National Audit Office has written three reports specifically about PPE. The Public Accounts Committee has held a number of evidence sessions. The Boardman review of procurement has taken place and we are implementing its findings in full. The independent public inquiry into the Government’s handling of the pandemic is ongoing. Of course there are lessons that we have to learn, and that we can and should learn, but there is clear accountability in this process.

As I have mentioned civil servants, I want to put on the record my thanks to the 400 civil servants who worked tirelessly to source deals from around the globe, buying PPE to the highest standards and quality and, yes, for the best value at the time. It was not only them; it was a true team effort—one that was made possible through some incredible collaborations, including everyone from industry to the NHS, and from social care providers to our armed forces. They all played their part and they played it well.

Turning now to unsuitable PPE or potential fraud, it is a simple truth that 97% of all PPE that we ordered was suitable and fit for use, with only a small proportion of the billions of items procured deemed unsuitable. Where that has been the case, we are actively seeking to recover costs from suppliers and we are working to maximise the value from our stockpiles, including using PPE in other settings outside of our NHS. Equally, in those rare instances where there have been allegations of fraud, my Department’s anti-fraud unit has worked quickly to investigate and move to recover costs.

With respect to some of the specific points raised in today’s motion, of the thousands of companies that made offers, around 430, as I have said, were processed through the high-priority lane, and only 12% of them resulted in a contract award. The right hon. Member for Ashton-under-Lyne knows that all contracts went through the same due diligence process regardless of the source of the offer. She also knows that the NAO has written three reports about PPE, and the Public Accounts Committee has held a number of hearings. I know that she would like me to go into the detail of individual contracts, but she knows—she even alluded to it—that my Department is engaged in commercially sensitive mediation with the relevant companies with a view to resolving the issue without recourse to formal legal action.

Responding specifically to the terms of the motion, the Government are committed to releasing information when all investigations are concluded. Our response will necessarily take into account the wider public interest and the commercially sensitive nature of the material. It is only right that we work with the Public Accounts Committee on the terms on which information might be shared. I understand that the Chancellor of the Duchy of Lancaster will soon begin a dialogue with the Chair of the PAC on how we enact those information-sharing arrangements.

[Dame Meg Hillier]

I thank the Minister for giving way again. I reassure him and the House that the Public Accounts Committee is responsible, not reckless. We have previously received papers from this House and we have a well-established protocol for receiving and dealing with such papers. The Committee is trusted—we never leak. If we decide to publish, that is a choice that we would make, but it is a responsible decision that we would take.

[Will Quince]

I thank the hon. Lady for that response, and I know the Chancellor of the Duchy of Lancaster will soon begin that dialogue with her.

[Dawn Butler]

Will the Minister give way?

[Will Quince]

I have given way once before—

[Madam Deputy Speaker (Dame Eleanor Laing)]

Order. The hon. Lady should not be on her feet when the Minister is answering an intervention from another Member. She is simply getting in the way of the dialogue, and that is not the polite way to do it. If her intervention is to be taken, it will be taken in due course. Standing up for a long time while there is another dialogue going on is really not very polite.

[Will Quince]

Thank you, Madam Deputy Speaker.

[Dawn Butler]

rose—

[Will Quince]

I have given way to the hon. Lady once already, as I promised I would, and I have been generous with my time, so I will not give way again.

[Karl Turner]

rose—

[Will Quince]

I also gave way to the hon. Gentleman, so let us leave it.

We should be proud of the remarkable progress we have made on PPE. We are now confident that we have enough stock to cover all future demands arising from covid-19. The right hon. Member for Ashton-under-Lyne mentioned some figures in relation to storage costs, and I am pleased to say that those are now significantly reduced—I will write to her about the cost of storing that PPE here in the UK.

Moreover, we have strengthened our country’s PPE supply chain for the long term, including manufacturing more PPE here in the UK. Before the pandemic, as I said at the beginning of my speech, just 1% of our PPE was produced here. Now the Government have awarded contracts to around 30 manufacturers for the supply of almost 4 billion items of PPE.

We have learned many lessons from this pandemic, and when it comes to PPE we are on a stronger footing today than ever before, but the successes of our enormous national effort at a time of unprecedented national crisis deserve to be recognised. People from all walks of life came together to protect people in the NHS and social care, and in doing so they saved lives. Even as we continue to learn and to build a system fit for the future, this Government will remain enormously proud of everything that was achieved.

--- Later in debate ---

[Brendan O’Hara]

One would have hoped that people in glass houses, having thrown the first stone, would have realised that it was not the best idea.

Let me put on record that the NHS in Scotland used emergency procurement provisions to award PPE contracts without competition during the first wave of covid-19 but, crucially, the auditors are completely satisfied with the procurement arrangements in place and said that there was

“No evidence of preferential treatment or bias”

in the awarding of contracts in Scotland. I believe that that is the significant reason why our overall costs of pandemic procurement were less than a third of the UK’s, and it perhaps explains why the Government are now paying £770,000 every single day to store PPE in China. The Minister will be aware that I have tabled a series of questions today to ask how much of that PPE is still usable, how much of it meets the standards required for the UK, what quality control methods were used in securing it and the proportion of PPE that did not meet the standard required.

[Will Quince]

rose—

[Brendan O’Hara]

I will give way if the Minister can tell us the exact proportion of PPE produced that did not meet the standard in the UK.

[Will Quince]

I will quickly update the House. As of October, we hold 13.1 billion items of PPE and we have disposed of 145,000 pallets of excess stock so far. The majority is stored in UK sites; about 120 million items are still stored in China. The total cost of storage is now below £400,000 a day, so significantly less than the hon. Gentleman says, and the total cost for storage in China is £35,000 a day.

[Brendan O’Hara]

I genuinely thank the Minister for that information and I look forward to reading it in Hansard so I can digest it. If I heard correctly, we are now on half a million pounds a day for storing PPE.

In conclusion, having to do things differently does not give anyone, whether they are a private individual, an elected politician or an unelected politician, a licence to rip up the rulebook and behave as if we live in an unregulated wild west of public procurement. That is why it is vital that these papers are released. The public have a right to know why, while doctors, nurses and other medical staff battled unvaccinated through the worst of the pandemic, and as the public stood and cheered them in grateful thanks, some people with connections to this Government saw only the opportunity to make themselves a quick buck. I predict that this PPE Medpro scandal is the tip of a very large iceberg—an iceberg that will eventually sink this ship of fools.

Oral Answers to Questions

Will Quince Excerpts

Tuesday 6th December 2022 Commons Chamber

[Andy Carter (Warrington South) (Con)]

2. What steps his Department is taking to increase hospital bed capacity.

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

To support operational resilience, the NHS has set out plans to increase hospital bed capacity by the equivalent of at least 7,000 general and acute beds during the winter. That is alongside £500 million of funding to support quick, safe discharge from hospital and free up capacity, and £1.5 billion of targeted investment funding for new surgical hubs, increasing bed capacity and equipment for elective care recovery.

[Andy Carter]

I am grateful for the Minister’s response. Over the last 20 years, Warrington has had among the highest level of new houses built in the north-west of England, but our healthcare infrastructure has not kept pace. We desperately need a new hospital. Our accident and emergency is at breaking point, we do not have enough beds and there is nowhere for those visiting to park their cars. In 2021, my NHS trust submitted a bid to the Department of Health and Social Care for a new hospital. Will he update us on where we are with that process?

[Will Quince]

I thank my hon. Friend, who has been a long-standing advocate for a new general hospital for Warrington. The expression of interest from the trust has been received. We are currently in the process of reviewing expressions of interest for the eight new hospitals and aim to announce a final decision by the end of the year. I recently met him to hear about the plans, and the people of Warrington could not have a greater champion than him.

[Derek Twigg (Halton) (Lab)]

May I associate myself with the remarks of the hon. Member for Warrington South (Andy Carter) about the need for investment in Warrington and Halton Hospitals NHS Trust? It is important that both hospitals have that investment. Part of the capacity problem is the lack of social care capacity in the community, whether in a home or in patients’ own homes. Just recently, I had an email from the chief executive of Whiston Hospital, a large acute hospital, where 115 patients were in beds when they did not need to be—they should have been going out of the hospital—out of a total of 721 adult acute beds. Is that not an example of where the Government are failing to provide enough social care out in the community?

[Will Quince]

We are investing £500 million to create another 200,000 social care placements, but we have significantly increased the number of physical beds available in our hospitals. In July, before we made the commitment to increase bed capacity, we had 96,375 general and acute beds; in October, we had 97,350. We are also delivering that increased capacity outside of hospital through this winter by creating an extra 2,500 virtual ward beds.

[Boris Johnson (Uxbridge and South Ruislip) (Con)]

Does my hon. Friend agree that it is high time the outstanding care and skill of Hillingdon Hospital staff was matched by commensurate outstanding facilities, and that it is therefore great news that Hillingdon is one of the 40 new hospitals that the Government are building by 2030? Can he confirm that the full funding package will be announced soon, so the whole project can proceed as soon as possible?

[Will Quince]

I thank my right hon. Friend for his question. The Secretary of State visited Hillingdon Hospital—a hospital I am also aware of—over the summer. There has been no greater champion of Hillingdon Hospital, or of the new hospitals programme more broadly, than my right hon. Friend. Currently, five hospital schemes are in construction, two are now completed and we aim to announce the next eight by the end of this year.

[Sarah Champion (Rotherham) (Lab)]

Two weeks ago, a 5-year-old constituent of mine, Yusuf Nazir, died because we no longer have intensive paediatric beds in Rotherham. September saw record-breaking ambulance handover delays and the proportion of patients waiting more than 12 hours in accident and emergency rose to 13.8%, nearly double last September’s figure. In the last 12 years, Rotherham’s NHS has been hollowed out. What is the Minister going to do to reverse that?

[Will Quince]

First, let me thank the hon. Lady for her question. I am very sorry to hear about the case she highlights. I understand she has written to the Secretary of State on this issue.

Ambulance waiting times are not where we want them to be. We have increased ambulance staff by 40% since 2010. We have invested, with just under 5,000 more staff in NHS 111; 2,500 more staff in call centres; an extra £450 million last year into A&E departments; the creation of the £500 million discharge fund, which will improve flow through hospitals; and 7,000 extra beds this winter. We understand the system is under considerable pressure. I would be very happy to meet the hon. Lady to discuss the challenges in her own trust.

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

The current state of mental health treatment sees increasing numbers of people languishing on waiting lists becoming more and more unwell, 1.1 million adults denied treatment, and children stuck in emergency departments for days waiting for mental health beds. Are the Government proud that a systemic cutting of a quarter of NHS mental health beds over the last 12 years has led to more patients receiving treatment in private settings? Does the Secretary of State know how much money is given to private mental health providers? Do the Government honestly think they are getting good value for money?

[Will Quince]

This is not my direct area of responsibility, but of course mental health does present challenges for A&Es and for hospitals more generally. We are investing an extra £2.3 billion every year in mental health, we have 16% more staff and we have an additional bursary to attract more nurses into mental health. But we do recognise the challenges, and the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Lewes (Maria Caulfield) is working hard to address them.

[Stephanie Peacock (Barnsley East) (Lab)]

3. What recent steps his Department has taken to reduce waiting times for neurological diagnosis and treatment.

--- Later in debate ---

[Michael Fabricant (Lichfield) (Con)]

14. What recent discussions he has had with the Secretary of State for Education on increasing the number of university places for medical students; and if he will make a statement.

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

The Department has commissioned NHS England to develop a long-term workforce plan. That plan will help to ensure that we have the right numbers of staff, including doctors with the right skills, to deliver high-quality services fit for the future. The plan will be independently verified. We have funded 1,500 more medical school places in England and opened five new medical schools in Sunderland, Lancashire, Chelmsford, Lincoln and Canterbury, and there are record numbers of medical students in training.

[Michael Fabricant]

I thank my hon. Friend for his answer. He will know that it takes five or six gruelling years to get a Bachelor of Medicine or a Bachelor of Surgery degree—or Doctor of Medicine in Scotland—but many students, having graduated, think that they would prefer more structured development by working as hospital doctors. What can we do to encourage young graduates to go into general practice?

[Will Quince]

We have record numbers going into general practice, which is the remit of the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Harborough (Neil O’Brien), but part of the plan is to make it more attractive through practice improvement through cloud-based telephony, the additional roles reimbursement scheme, the 24,000 extra staff in primary care, developing multi-function staff so that people can develop their skills and have specialism but still practise as a GP, increasing the use of pharmacy, moving towards more continuity of care and the new GP contract for 2024-25.

[Chris Bryant (Rhondda) (Lab)]

But when are we going to see the workforce plan? The other day I spoke to a radiologist who runs a radiology department. There are meant to be 15, but there are only five and they have not had a single person apply. It needs more radiologists and radiographers. We have a national shortage of dermatologists, which is one reason why skin cancers are not being picked up, and a national shortage of pathologists and histopathologists. We need a dramatic increase in the number of people working in the NHS. When are we going to see that workforce plan?

[Will Quince]

As I said, we have committed to publishing a comprehensive workforce strategy, which, as the Chancellor set out, will be independently verified. That will come soon. We have also set out new pension flexibilities. However, it is important to point out that we have 29,000 more nurses and we are on track to meet our 50,000 target. We have 3,700 more doctors compared with last year, 9,100 extra nurses and 2,300 more GPs.

--- Later in debate ---

[Antony Higginbotham (Burnley) (Con)]

The East Lancashire community diagnosis centre already includes Burnley hospital, and as part of that we are opening two new endoscopy rooms in the spring. Residents, the trust and I know that the local hospital can do even more to reduce the covid backlog with the right Government investment. Will the Minister agree to meet me to discuss phase 9 of the hospital’s development, which would bring a brand-new radiology suite?

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

My hon. Friend is a strong champion for Burnley, and I congratulate Burnley General Teaching Hospital on the incredible innovative work it is doing. He is right that rolling out 91 out of 160 CDCs is a tremendous effort, but we want to go further, and I would be delighted to meet my hon. Friend to discuss these plans further.

[Beth Winter (Cynon Valley) (Lab)]

T8.   Last week, the First Minister of Wales, Mark Drakeford, said that pay awards are not being funded at the level they should be. The Wales TUC general secretary said that unless we have a fairer funding settlement for Wales, we are going to struggle going forward. When will this Government listen to the Welsh Government and the Welsh trade unions and provide the proper funded pay award that NHS staff deserve?

Accountability in the NHS

Will Quince Excerpts

Wednesday 30th November 2022 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Sir George. I congratulate my right hon. Friend the Member for Hemel Hempstead (Sir Mike Penning) on bringing this important debate to the House today. I know from our numerous conversations over the years that he is a tireless champion of healthcare provision, not just within his own constituency, and an advocate for instilling accountability and a learning culture throughout the NHS as a whole. Today, he has raised some difficult cases, albeit anonymised. I know the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Lewes (Maria Caulfield), who is responsible for patient safety, looks forward to receiving more information and will be happy to meet our right hon. Friend to discuss the cases further.

I assure my right hon. Friend that this Government share his commitment to ensuring that the NHS delivers excellent care to all of its patients. We will never tire in striving to ensure that patient safety and high-quality care are at the heart of all patient care in our country. I am of the firm view that accountability for excellence applies at all levels of patient care, from the individual clinician caring for an individual patient through to Parliament’s role, as my right hon. Friend set out, in ensuring accountability for healthcare delivery by the NHS. It is essential that the commitment to excellence is central.

My right hon. Friend rightly says that we love our NHS. Of course we do. However, we recognise that on rare occasions—not as rare as I would like—patient care falls short of the very high standards that we expect. He talked about getting answers for his constituents as a Member of Parliament. That is hugely important. I apologise that ministerial responses have not been as full as he hoped they would be. I will certainly look into that, because those responses are important. As a constituency MP, I too have cases from constituents who have raised concerns, either about their GP or their acute trust, and the level of service provided.

My right hon. Friend rightly raises questions about why the NHS as an organisation does not more often simply say “sorry” when things go wrong. It is, as he sayd, a human business and things do go wrong.

I hear what he said about ministerial responses. He is also right to say that Ministers are unable at present to respond to individual cases. There are reasons for that. As the hon. Member for St Albans (Daisy Cooper) and the hon. Member for Westmorland and Lonsdale (Tim Farron) said, the NHS is a complex organisation. We have NHS England, integrated care boards, integrated care systems, primary care networks, acute trusts, mental health trusts and ambulance trusts, and there is a question about whether Ministers or bodies such as NHS England and individual trusts should hold a level of operational accountability or delivery responsibility. That is a fair question, raised by the hon. Member for Westmorland and Lonsdale, but it is a tricky balance to reach.

Ultimately, who is responsible for any failings within the NHS? Well, that is me. Who is responsible for delivery of services through the NHS? Not me. That position presents some challenges. Ministers have the ability to set the strategy at national level, but there is a big difference between the strategy, the approach, the culture and the leadership set in Whitehall and what actually happens at grassroots level at individual trusts. However, although I do not have direct operational responsibility, trust me when I say that every single day I am thinking about every single case where an ambulance is delayed and people have to wait too long; about all the 7.1 million people in our elective backlog, and about all those who do not get the excellent care that they rightly deserve and expect through our NHS. That is because I am the one who is responsible for that. I get the letters, and sometimes the responses are not as full as we would want, because I do not have at my fingertips all the information I need to be able to respond in the way I would like. We need to look at that.

My right hon. Friend rightly says that most people do not want to sue or take legal action against our NHS. They are desperately sad about what has happened, and they may be disappointed or even angry, but that does not mean that they want to seek financial redress or sue a hospital trust. They know the implications of that—the money comes out of operational budgets.

Having been the responsible Minister, I am acutely aware that we have an annual clinical negligence bill of £2.6 billion, which is huge. Understandably, I would rather spend that £2.6 billion on NHS frontline services. I have huge sympathy with my right hon. Friend’s view that we should collectively put our hands up, explain what went wrong and why, demonstrate how we are learning from that as an organisation, and clearly explain the steps that we are taking to put it right. We collectively as Ministers have a role to play in that. I will reflect on his comments and explore what more we can do.

The Government have made significant strides to advance patient safety over the last decade. As I said, it remains a top priority not just for the Government but for me personally. We are creating a transparent learning culture across health systems. That is key to avoiding tragedies in the first place, and essential to driving the improvements that we want to see. As my right hon. Friend pointed out, patient feedback has to be at the heart of that. Patients have to have the opportunity to share their experiences.

It is vital that clinicians reflect upon the lessons learned and translate them into opportunities to improve their practice. That is vital for not just the individual consultant, doctor, nurse or allied health professional, but the NHS as a whole. We have to listen and learn from individual patient stories. Accountability is a thread that has to run through every single level of the NHS—from individual patient complaints and the learning they generate to organisational responsibility for the standard of patient care, through to integrated care boards and the delivery of high-quality outcomes and access to care for their populations.

The accountability owed to partner organisations and local patients is just as important as accountability to national bodies. As my right hon. Friend pointed out, that is why we passed the Health and Care Act 2022, which embeds the principle of accountability throughout the NHS and our health and care system.

[Sir Mike Penning]

The Minister is being generous in his comments to myself and to colleagues. The issue for colleagues and patients is that the over £2 billion bill, the delayed operations and the waiting lists would be remarkably smaller problems if we had addressed them right at the start. The biggest point, going back to my constituent, is that the wrong operation was done in 1986. That gentleman has been back and forth with the NHS, with help from myself and others, which must have cost the NHS a small fortune in legal fees. Instead of addressing the individual issue to stop it getting bigger, the NHS fobbed and fobbed it off and passed it back around.

I know we are short on time and the Minister wants to conclude. My final point is that when Ministers send out letters, it is often the trust that we are complaining about that has drafted the letter to their officials, which actually ends up coming to us. In a classic example the other day, I was thanked for being so supportive of the refurbishment of Watford General Hospital, when actually I have opposed it for the last 20 years. The trust wanted to send that message to the Minister, rather than address what we needed to address, which is patient safety. The stress on patients in this particular case is huge.

[Will Quince]

My right hon. Friend is right that there is a lot more that we can do. Reflecting what he has just said, I will touch on some of the measures that have been put in place over recent years.

In 2019 there was the NHS patient safety strategy. We introduced, for the first time ever, a patient safety commissioner. There is the Health Service Safety Investigations Body, which will be an arm’s length body from April 2023 and which was the brainchild of the Chancellor when he was Secretary of State for Health and Social Care. As my right hon. Friend pointed out, there has also been huge investment in maternity services following those awful cases, not just to boost staff numbers, but to improve leadership and culture. There have also been changes to the Care Quality Commission, with the single framework coming in from January next year.

My right hon. Friend is absolutely right that some cases take far too long, especially some of the neonatal cases. Those are often the cases that result in the largest payments made, but it can take many years before patients and families get the redress they needed. The Health Services Safety Investigations body is designed to be far more upfront about where something goes wrong. It is much better to learn the lessons in the period immediately after something has gone wrong than several years after the event, looking back retrospectively on what could have been done differently. We need to learn the lessons now and ensure that as few patients as possible go through the same experience. Clinicians, not just within that trust but across the integrated care board, or, where appropriate, across our NHS, should learn those lessons.

My right hon. Friend the Member for Hemel Hempstead has hammered home the point again about ministerial responses. I hear him, and I will speak with my hon. Friend the Member for Lewes to see what more we can do in that space. Those points are well made. However, it is difficult because of the number of NHS acute trusts and the fact that we rely on information about what happened on the ground. It is a huge and complex organisation, but I understand, recognise and take his point that ministerial responsibility and oversight is important.

We need to know the facts, and not just the facts as they are presented by a trust, in whose interest it might be to paint a rosier picture than it actually is on the ground—or to not paint the full picture. That is why it is so important that Ministers engage with local Members of Parliament to get the facts. They are the ones who are meeting with the trust executives and the board, as well as their constituents and the clinicians and health professionals on the ground delivering care, who will often—for want of a better word—whistleblow about what is actually happening in a trust, and not give the rose-tinted view that the executives of a trust may want.

This has been a hugely important debate. It speaks to issues that are at the heart of our NHS. It is about getting it right first time and the excellent and consistent patient care that we rightly expect from our NHS. I hope, to some extent, that I have assured my right hon. Friend the Member for Hemel Hempstead of the importance that the Government place on quality, excellent patient care and accountability. His points have been well made. I will reflect on them, as will my hon. Friend the Member for Lewes. I look forward to working with him to improve the situation across our NHS.

Question put and agreed to.

NHS Staffing Levels

Will Quince Excerpts

Tuesday 22nd November 2022 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Hollobone. I am grateful to the hon. Member for Wirral West (Margaret Greenwood) for raising this important issue. I join her in thanking all NHS staff for everything they do for us. The workforce are the beating heart of everything our NHS does and stands for. I hugely value the work of everyone who works in health and care, from consultants to care workers, nurses to neurosurgeons, and porters to physios. I thank all hon. Members from across the House who have taken part in this important debate. In the time available to me, I will try to respond to as many of the themes raised as possible—I have been franticly scribbling throughout the contributions.

I have only been in post for a handful of weeks, and in that time I have seen the very best and the future of our NHS with cutting-edge technologies and innovation. For example, it was only earlier this week when I saw genuinely world-leading world genome sequencing. Innovation and technological advancement is only as good as the highly trained and qualified clinicians who operate it or, importantly, who interpret the data. Health is a human business. I know this from my own family’s experience of the NHS, and I am sure hon. Members know that too. Only caring NHS staff can provide the patient-centred and compassionate care that we all hope and expect when we interact with our NHS. That is why I am personally passionate about supporting our health and care staff, particularly when we are in challenging times. Last week, the Chancellor announced an additional £3.3 billion a year in the autumn statement to assist in this endeavour.

I turn first to workforce pressures, which were raised by the hon. Members for Batley and Spen (Kim Leadbeater), for Westmorland and Lonsdale (Tim Farron), for Bradford West (Naz Shah) and for Birmingham, Erdington (Mrs Hamilton)—I am particularly grateful to her for sharing her 25 years of nursing experience. I am acutely aware that the workforce remain under sustained pressure. Staff worked tirelessly through the pandemic and they have my huge thanks and gratitude for doing so.

I know that every day hundreds of thousands of NHS staff provide high-quality care under considerable challenges. As well as the pressures we see every winter, in the summer, which is usually—I am told in the NHS you cannot use the Q-word, which stands for quiet—less busy, we had covid waves where we would not ordinarily. There is also the recovery of elective care and the 7 million people on waiting lists, including the 400,000 who have been waiting over a year, as the hon. Member for Wirral West rightly pointed out. There is the rising number of covid and flu cases—I take this opportunity to make a public health announcement encouraging people to check their eligibility and get their covid and flu jabs if they have not already done so.

Of course, it is vital that we support the workforce, not just now but for the future. The NHS workforce have grown since last year, with an extra 3,700 doctors and 9,100 nurses, but I understand that—this point was made eloquently and articulately by hon. Members—demand is growing significantly, too.

[Paul Girvan (South Antrim) (DUP)]

In the light of workforce planning, somebody seems to have taken their eye off the ball. We have doctors who decide they want to be locums and get three times the shift rate. We have nurses who leave the NHS and sign up with the agency, costing three times more. When will we grasp the nettle of workforce planning and deal with it?

[Will Quince]

The hon. Gentleman is right that that is happening and I will come on to that matter in more detail. I would be happy to meet him, because it is an issue that I know needs gripping not just at the national level but by local integrated care boards too.

As hon. Members have pointed out, training the doctors, nurses and allied health professionals of the future takes time. We have to plan for the next decade now, as the hon. Member for York Central (Rachael Maskell) said. Despite the challenges, we have a growing NHS workforce. We have record numbers of staff working in our NHS. There are record numbers of doctors and nurses. The NHS now has over 1.2 million full-time equivalent staff. In the last year alone, there were over 15,800 more professionally qualified clinical staff in trusts, and 129,800 more hospital and community health service staff than in 2019. Nursing numbers are 29,000 higher than in 2019, which means that we are on track to meet the 50,000 extra nurses manifesto commitment.

However, as the hon. Member for Wirral West pointed out, we face challenges. There are over 132,000 vacancies, including, as she rightly said, 40,000 nursing and midwifery vacancies, and vacancies for around 10,000 doctors. As the hon. Member for South Antrim (Paul Girvan) rightly pointed out, that means an over-reliance on bank and agency staff. They have their place, but they come at a significant cost, of which we have to be mindful.

We have a long-term workforce plan, which is an NHS England-commissioned project that will set out what workforce we need across the next five, 10 and 15 years. As the Chancellor said in the autumn statement, it will be independently verified. It will look at recruitment, retention and productivity. It will look at where the challenges and the gaps are. As the hon. Member for York Central, who is no longer in her place, rightly asked, what do we need the NHS to look like? Do we need specialists? Do we need more generalists? Do we need a mixture of skills, where people are specialists but also retain generalist skills so that they can do other work? The plan is for the project to report back by the end of this year—very soon—and that independent verification process will then take place. Integrated care boards will need to do the same, or a similar, piece of work at local level.

I am also aware that there are specific challenges. The hon. Members for Strangford (Jim Shannon) and for Westmorland and Lonsdale rightly raised mental health services. An extra £2.3 billion is going in, and our plan is to recruit an extra 27,000 staff, but it is a challenge, which is why we have the advanced bursary in that area. We have increased staff in the area by an extra 5.4%. I know that is not enough, and I know the challenges on local mental health services, so we have to do more.

There is a similar challenge in rural and coastal communities, which the hon. Member for Westmorland and Lonsdale has raised with me many a time. We have to look to expand the apprenticeship route and blended learning programmes so that people do not have to travel to big towns and cities to undertake their training. That work is being done, and there is an extra £55 million for additional placement capacity.

Investment in training is also important. We funded an extra 1,500 medical school places—a 25% increase—last year and this year. That was an investment in five new medical schools. The £5,000 non-repayable grant for nursing, midwifery and allied health professionals has been in place since 2020. There is also additional funding for certain courses, and for things such as support for childcare, dual accommodation, and costs and travel.

[Jim Shannon]

Will the Minister comment on what the Royal College of Psychiatrists has said about staffing shortages?

--- Later in debate ---

[Will Quince]

Mental health does not fall specifically within my brief—it falls within that of the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Lewes (Maria Caulfield)—but I am happy to write to the hon. Gentleman on that point.

Let me turn to staff wellbeing, which is an important point that the hon. Member for Wirral West rightly laboured. It is not just about pay; it is about many other issues. Recruitment is important, as the hon. Member for Coventry North West (Taiwo Owatemi) pointed out, but retention is equally important. We have to ensure that we keep the highly qualified, highly experienced people we have in our NHS. I am determined to ensure that staff are supported and that the NHS works to ensure that staff feel valued, not just by us at the national level, but locally.

The NHS people plan and the people promise set out a comprehensive range of actions that we are taking, such as expanding flexible working. That is important. For example, if somebody does not feel that they can do a full shift but they can work two or three hours, we should be saying, “Yes, of course we want you to work in our NHS and give us what you can.” Flexible working is important, as are improving leadership and ensuring that there is high-quality line management. People often say, “We leave the line manager; we do not leave the organisation.” We must support staff wellbeing and mental health. We also have the NHS retention programme, and we are growing occupational health and wellbeing.

I am conscious that time is short, but I want to turn to the issue of pay, which was mentioned by many hon. Members. I cannot touch on pharmacies today, but that is a hugely important issue and I would be happy to meet the hon. Member for Coventry North West to discuss it. I completely understand that pay is a hugely important factor in looking after staff, and we hugely value the hard work and dedication of NHS staff. I deeply regret that some union members have voted for industrial action, but I understand that these are challenging times for many, largely as a result of global economic pressures, and we are working hard to support NHS workers.

As hon. Members have rightly pointed out, we accepted the recommendations of the independent NHS pay review body in full. That means a pay rise of at least £1,400, or the equivalent of 4% to 5%, for most nurses, which is broadly in line with the private sector. It is important to point out that that is on top of a 3% award last year, when wider public sector pay was frozen, and the Government’s cost of living support with energy.

Through the programme of current work and long-term planning, we are building the robust and resilient workforce that our NHS needs for the future. We are working to ensure that we have the right people with the right skills in the right places, and to ensure that they are well supported and well looked after, so that they can look after those who need our great NHS services and keep delivering the world-class standard of care that people need now and in the future.