Hereditary Tyrosinemia Type 1
Andrew Stephenson Excerpts(2 months ago)
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The Minister for Health and Secondary Care (Andrew Stephenson)
I would like to inform the House that I have accepted the UK National Screening Committee’s recommendation to introduce a new condition, tyrosinemia type 1, to the newborn blood spot screening programme in England.
Hereditary tyrosinemia type 1 is a rare genetic condition that affects approximately seven babies in the UK per year. Left untreated, this condition can lead to severe complications such as liver, kidneys and nervous system damage, and in some cases requires liver transplant. Without treatment, children with tyrosinemia type 1 often do not survive past the age of 10. There is no cure for this condition but treatment can help prolong life.
There is currently an inequitable situation whereby families with a known history of this condition can seek early screening and access treatment before their child shows symptoms, when treatment is most effective, while parents without a known history will only discover their child’s condition when symptoms become evident and when treatment is less effective. Introducing tyrosinemia type 1 to the newborn blood spot screening programme will create a fairer, faster, and simpler route to diagnosis and treatment. NHS England have started the work needed to ensure this programme can be implemented next year.
I would like to take this opportunity to thank the UK National Screening Committee for continuing to provide invaluable expert advice on screening programmes. I would also like to pay tribute to all those who work in delivering high-quality screening across the country. The addition of this new condition will maintain the Government’s commitment to improving equity of access to effective treatments for rare diseases.
[HCWS328]
Equity in Medical Devices
Andrew Stephenson Excerpts(2 months ago)
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The Minister for Health and Secondary Care (Andrew Stephenson)
The NHS is committed to upholding high standards in medical device safety. In response to emerging evidence of potential ethnic and other unfair biases in the design and use of some medical devices commonly used in the NHS, an independent review was commissioned by former Secretary of State for Health and Social Care, my right hon. Friend the Member for Bromsgrove (Sajid Javid).
Today, I am pleased to publish the final report of the independent review into equity in medical devices, alongside the Government’s response.
I would like to place on record my gratitude to the review chair, Dame Margaret Whitehead, and the panel who conducted this review. They embraced a comprehensive approach, involving stakeholders, fostering collaboration with clinical experts, NHS planners and policy advisors, engaging with health professionals on the frontline, educators and crucially, patients and the public. This deliberate approach underscores the importance and impact of the panel’s findings, and their recommendations are integral to our commitment to fostering a fair and healthy future for all.
The panel made 18 recommendations, taking these recommendations in turn:
Recommendations 1 to 3 focus specifically on pulse oximeters and cover immediate mitigation measures to ensure existing devices can perform to a high standard and improvements in international standards for approval of new device models.
Recommendations 4 to 7 focus on prevention of potential for harm through improved detection of bias in optical devices, including better research and testing, more robust monitoring and auditing and refreshed education for health professionals.
Recommendations 8 to 14 focus on enabling the development of safe and equitable artificial intelligence (AI) medical devices.
Recommendation 15 underscores the urgency of preparing for the transformative impact of large language and foundation models on healthcare and regulatory systems.
Recommendations 16 to 18 address equity concerns and societal challenges related to polygenic risk scores (PRS) in genomics. They emphasise the need for regulation in response to the influx of commercial PRS tests in the UK.
The Government’s response has been published alongside the final report. The Government welcome and acknowledge the importance of the outlined recommendations, endorsing its main argument that, unless appropriate actions are taken, biases can occur throughout the entire medical device life cycle.
We are dedicated to ensuring equitable medical device practices, spanning from design through to use. The Government have already initiated substantial efforts addressing many of the essential elements of the report’s recommendations, as detailed in the Government response. As we continue to drive progress, we welcome ongoing collaboration with industry partners, which is paramount to embedding best practices and supporting the NHS in delivering optimal and equitable care for all.
Both the final report from the independent review into equity in medical devices and the Government’s response will be deposited in the Libraries of both Houses, and published on www.gov.uk.
[HCWS329]
Breast Cancer Screening
Andrew Stephenson Excerpts(2 months ago)
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The Minister for Health and Secondary Care (Andrew Stephenson)
I would like to inform the House that on Monday 4 March, NHS England wrote to a group of women who are at very high risk of breast cancer who have been eligible for annual MRI checks, but who may not have been routinely referred to the annual tests recommended in NHS guidance.
This is an historic cohort of women who from 1962 to 2003 received radiotherapy treatment above the waist to treat Hodgkin lymphoma. Because of their treatment, this group were at an increased risk of breast cancer, so in 2003 clinicians were asked to contact both previous and current patients to refer them for annual checks. Women do not start annual MRI testing immediately following treatment—but between eight and 15 years after treatment depending on their age at the time they were treated.
A number of women who were eligible for more regular annual testing did not receive it. This was due to variable referral processes. To rectify this, specialists set up a database to identify how people were referred on to the very high-risk pathway for breast screening. Details of the missed group were shared with NHS England in late September 2023, and they have since analysed data to triangulate information about clinical history, current status and residency in order to identify the individuals in the affected cohorts. Ministers were notified in February 2024.
We have overseen a system that has resulted in the identification of these very high-risk women, and we are now taking the appropriate action. This week, NHS England has written to 1,487 women whom they have identified as not currently on the correct very high-risk pathway to receive annual MRI testing. This cohort will now be urgently offered an MRI follow up and inclusion in the very high-risk pathway. We expect all women to be offered a scan within the next three months.
The specialist team have also identified a much smaller historical group whose details are currently being verified, and they will be written to in the coming weeks.
NHS England has set up a helpline for affected women, the details of which will be included in letters sent to them. More widely, NHS England will undertake a review of the process that refers these women into the most appropriate service for their risk to mitigate any future impact of this issue.
Further details of this issue can be found in a letter from NHSE to the Secretary of State for Health and Social Care, the right hon. Member for Louth and Horncastle (Victoria Atkins), which will be deposited in the Library.
Attachments can be view online at:
http://www.parliament.uk/business/publications/written-questions-answers-statements/written-statement/Commons/2024-03-05/HCWS312
[HCWS312]
Oral Answers to Questions
Andrew Stephenson Excerpts(2 months ago)
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The Minister for Health and Secondary Care (Andrew Stephenson)
At Buckinghamshire Healthcare NHS Trust, the number of gynaecology patients waiting more than 52 weeks reduced by over 30% between August and December, but I sympathise with the many women who are still waiting too long. NHS England has been doing targeted work to help trusts with the most long waiters to support gynaecology patients in the community where appropriate, and to find specialist services that can treat them as quickly as possible.
Sarah Green
My local NHS trust recently stated that the average wait for a gynaecology appointment is 18 weeks, with patients starting treatment within 24 weeks, but that does not include those on cancer pathways. One of my constituents who had been identified as having abnormal cells in her cervix waited more than 60 weeks for a diagnostic assessment. She is one of many contacting me with tales of long delays for gynaecology appointments and paying to go private out of desperation. What steps is the Department taking to reduce waiting times for gynaecology assessments and treatment for those on cancer pathways?
Andrew Stephenson
Significant investment is going in to reduce both general wait times and cancer wait times. More patients on the cancer pathway have been seen than ever before; nearly 220,000 patients were seen last December following an urgent GP referral for suspected cancer, representing 117% of December 2019 levels. We continue to keep this under review and continue to strive to make the system go faster and reduce the elective backlog.
Abena Oppong-Asare (Erith and Thamesmead) (Lab)
NHS figures from December show that the number of women waiting for gynaecological treatment reached another record high of nearly 600,000. That number has tripled since 2012. A Labour Government will cut NHS waiting lists in England by funding 2 million more appointments a year. What can the Minister say to the women waiting urgently for treatment?
Andrew Stephenson
I would say that we are sticking to our plan to back the NHS to cut waiting lists and make our NHS fairer, simpler and faster. When there is no strike action, that plan is working. We already eliminated the longest waits, and, in November, we saw the biggest fall in waiting lists outside of the pandemic in more than a decade, alongside record investment in things like women’s health hubs. We are prioritising women’s health.
Julie Marson (Hertford and Stortford) (Con)
Neale Hanvey (Kirkcaldy and Cowdenbeath) (Alba)
The Minister for Health and Secondary Care (Andrew Stephenson)
We have delivered our manifesto commitment of 50,000 more nurses six months early. There are now almost 361,000 nurses working across the NHS. As part of that, community nursing has grown by over 9% since 2019.
Neale Hanvey
There has been a crisis brewing in community-facing nursing over the past decade, with the number of district nurses down by 40% and health visitor numbers in England and Wales falling by almost a third. What guarantees will the Minister provide that this vital workforce will be supported, when health budgets in all the nations of the UK are under increasing strain and NHS funding faces a £2 billion black hole, and cuts to spending in England have a consequential impact on budgets in Scotland?
Andrew Stephenson
Record funding is going into our NHS. In addition to the 9% increase in community nursing since 2019, we are investing over £2.4 billion in education and training through the NHS long term workforce plan, which commits to increasing training places for district nurses by 41% by the end of the decade. Since 2010, we have delivered over 63,300 more nurses and midwives into our NHS.
Vicky Ford (Chelmsford) (Con)
The Minister for Health and Secondary Care (Andrew Stephenson)
I thank my right hon. Friend for her question and her kind invite to visit her constituency. I pay tribute to all the work she has done to secure investment in Anglia Ruskin University. She is right to highlight the importance of delivering clinical placements as part of the long-term workforce plan. I assure her that we are working closely with NHS England and partners in health and education to ensure that happens.
Alan Brown (Kilmarnock and Loudoun) (SNP)
Medicine shortages have doubled in the UK in the last two years. There might be some global pressures, but two issues have particularly affected the UK: first, the post-Brexit regulatory framework; and secondly, the fact that the pound has tanked, making it more expensive to buy medicines. What are the Government doing to undo that Brexit dividend?
Andrew Stephenson
The hon. Gentleman sounds like a broken record, as usual. The Department has no evidence to suggest that EU exit is leading to sustained medicine shortages. Shortages occur for a wide range of reasons and are affecting countries all over the world.
George Freeman (Mid Norfolk) (Con)
Rural Norfolk is experiencing a dental crisis and a generation of children are in danger of going without dental care. I welcome the dental recovery plan, but I notice that it will be four or five years before we get more dentists. Last week, NHS Norfolk and Waveney integrated care board announced a £17 million underspend on dentistry. Will the Minister agree to meet with me and the ICB to work out how we get more money out now to help dentistry in Norfolk today?
Sir Jacob Rees-Mogg (North East Somerset) (Con)
Will my right hon. Friend explain an anomaly in the “Agenda for Change” pay deal as it affects non-NHS providers? People working in the NHS for non-NHS providers may be eligible for extra money if the organisation they work for is in financial difficulties, but not if it is not. So badly run organisations are being rewarded and well-run organisations are being penalised, which seems to me to be perverse.
Andrew Stephenson
I am happy to meet my right hon. Friend to discuss the matter. We have reached pay settlements with the “Agenda for Change” unions, and we continue to reach pay deals with other unions. We are also supporting non-NHS providers whose contracts are dynamically aligned. It is a complex area, so I am more than happy to meet my right hon. Friend to discuss his concerns.
Florence Eshalomi (Vauxhall) (Lab/Co-op)
The Secretary of State will know that NHS England is expected to announce the decision about the primary children’s centre for cancer treatment in south London and south-east London. Evelina London Children’s Hospital in my constituency is one of the only specialist centres in south London. Does she agree that the final decision should be made as soon as possible in order to benefit staff, patients and families? Will she join me in visiting Evelina London?
Paul Bristow (Peterborough) (Con)
I remind Members of my entry in the Register of Members’ Financial Interests. The Medicines and Healthcare products Regulatory Agency’s international recognition procedure will ensure faster access to innovative treatments, but it will realise its full potential only if it is matched by the National Institute for Health and Care Excellence’s evaluation process. What is my right hon. Friend the Minister doing to ensure that the two processes are aligned?
Andrew Stephenson
My hon. Friend will be aware that there have been delays with approvals by the MHRA and NICE. We are keen to ensure that those delays are reduced, and I am delighted to tell the House that significant progress has been made in both organisations. I am happy to work with my hon. Friend and both organisations to ensure that progress continues to be made.
Sarah Dyke (Somerton and Frome) (LD)
Figures obtained by the British Dental Association project that £8 million of the NHS budget in Somerset is going unspent. Will the Minister explain to my constituent, who is suffering in dental agony, why that is happening?
Sir Chris Bryant (Rhondda) (Lab)
How many people were treated for acquired brain injury last year?
Andrew Stephenson
The hon. Gentleman has caught me off guard—I will write to him. I am keen to continue working with him on that issue. As he knows, we have already shared draft details of the acquired brain injury strategy with him and members of the all-party parliamentary group, and I am very keen to continue working collaboratively on that issue with him.
Eating Disorders Awareness Week
Andrew Stephenson Excerpts(2 months, 1 week ago)
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The Minister for Health and Secondary Care (Andrew Stephenson)
It is a pleasure to see you in the Chair, Mr Hollobone. I start by paying tribute to the hon. Member for Bath (Wera Hobhouse) for securing an important debate on an important topic. I know that both as an MP and as the chair of the all-party parliamentary group she has long been a champion for those living with eating disorders. She has worked with the hon. Member for Sheffield, Hallam (Olivia Blake) and others on the APPG to ensure that eating disorders are kept high on the political agenda.
I share the passion for this issue expressed by all the hon. and right hon. Members who have spoken in this debate. As the right hon. Member for Hayes and Harlington (John McDonnell) said, one thing that unites everybody in the Chamber today is that we have all tried to help a constituent, or the family of a constituent, who is suffering from an eating disorder. I have certainly done so in my 13 years as the MP for Pendle, and those cases that I have dealt with are some of the most difficult and emotional to have come across my desk in my surgery.
Improving eating disorder services is a key priority for the Government and a vital part of our work to improve mental health services. As we have heard, this week is national Eating Disorders Awareness Week, and raising awareness is essential to making progress on this important issue. I am grateful for the work of Beat and other charities across the whole sector; they have shone a light on eating disorders and they support people who are struggling.
We know that having an eating disorder can so often be utterly devastating for those with the condition, as well as for those around them. As I think has been said by pretty much every hon. Member who spoke today, we know that eating disorders can affect people of any age, gender, ethnicity or background. However, we do know that recovery is possible, and that access to the right treatment and support can be life changing. Early intervention is vital, and we want to ensure that children and young people with eating disorders get swift access to support.
Since 2016, investment in children and young people’s eating disorder community services has risen every year; £53 million was invested per year in 2021-22, and that figure rose to £54 million in 2023-24. As part of the £500 million covid-19 mental health recovery action plan, we invested an extra £79 million to significantly expand young people’s mental health services—enabling 2,000 more children and young people to access eating disorder services. We have also introduced a waiting time standard for children and young people with eating disorders. Our aim is for 95% of children to receive treatment within one week for urgent cases, and within four weeks for routine cases.
Abena Oppong-Asare
On the Minister’s point about getting waiting time targets down to one week, those targets were implemented in 2015, and they are yet to be met. Could the Minister explain what work is being done to address that, because he just mentioned those same targets again?
Andrew Stephenson
I completely recognise the shadow Minister’s challenge on that point and the concern that she has—I will set out what we are doing to address it. She also mentioned the Royal College of Psychiatrists, which published a report on this today. It is worth putting on record that we very much welcome that and that we look forward to working with it and other stakeholders. Waits are not as short as we would like, and the Government are determined to meet our waiting-time standards for children and young people with eating disorders. Extra investment is going into the services to meet increased demands and reduce waits, so hopefully we will start to see progress made towards meeting those targets. However, we acknowledge that, while there has been record investment and progress in improving access to eating disorder services and improving quality, there has also been a significant increase in demand for those services over the past few years. That was especially true during the pandemic, with increased demand outstripping the planned growth in capacity.
Children and young people’s eating disorder services are treating 47% more children and young people than before the pandemic, with almost 12,000 children and young people starting routine or urgent treatment in 2022-23, compared with just over 8,000 in 2019-20. That surge in demand has made meeting our waiting-time targets more challenging, and waits are not as short as we would like them to be. However, I am proud that our services and clinicians, backed by new funding, are supporting more children and young people than ever before. Those services are changing and saving lives.
We also know that even earlier intervention is critical to prevent eating disorders from developing. Community-based early mental health and wellbeing support hubs for children and young people aged 11 to 25 can play a key role in providing that support. In October 2023, we announced that £4.92 million from the Treasury’s shared outcomes fund would be available to support hubs, and an evaluation to build the evidence base underpinning those services.
Wera Hobhouse
Can the Minister perhaps comment on what I said about intensive out-patient units, in that we really do not have any information on how widely spread they are and where they are being provided? They are a very good alternative way of treatment, and we really need more information about where they are available.
Andrew Stephenson
We do need more information on that, and I will come to that point. The next point that I wanted to make was on an announcement that I know the hon. Lady will already be aware of, but other hon. Members may not be. Following the evaluation of some excellent commercial tenders from hubs across the country, the Government announced just this week that we are now providing an additional £3 million, which means that total of 24 hubs will receive a share of almost £8 million in 2024-25. That is more than double our original target of funding 10 hubs, and organisations across England—from Gateshead to Truro—will now benefit.
I appreciate that there is still a bit of a postcode lottery around the country, but we are looking to strengthen services, working with different partners across England, to ensure that we are improving services—enhancing existing services—or developing new services where they have not been provided in the past.
Abena Oppong-Asare
I just want to add to the point made by the hon. Member for Bath (Wera Hobhouse) about hubs. What work will be done to ensure that the data is captured to see how the growing problem of eating disorders can be addressed and what effective treatments could slow the increase?
Andrew Stephenson
We are working very closely with NHS England and partners to ensure that that data is captured. We are also working with the charities involved in this sector and with others.
I know that the Minister with responsibility for mental health, my hon. Friend the Member for Lewes (Maria Caulfield), has been doing a lot of work on this and has met with various stakeholders. I perhaps should have said at the start of the debate that the reason my hon. Friend is not here and hon. Members have me instead is, of course, that the International Women’s Day debate in the Chamber was still going when this debate started —so, unfortunately, there was an unavoidable clash.
However, I know that this is a topic very close to my hon. Friend’s heart, and getting the data right is really important for us to ensure that the gaps that currently exist in services are being addressed. I will certainly ensure that the shadow Minister’s issue is raised with my hon. Friend; if I may, I will ask her to write to the hon. Lady on that.
We know that eating disorders can have devastating effects on adults too. Under the NHS long term plan, by 2023-24 we are investing almost £1 billion extra in community mental health care for adults with severe mental illness, including eating disorders. That extra funding will help to enhance the capacity of new or improved community eating disorder teams covering the whole of the country. As part of funding provided in 2021-22 in response to pressures created by the pandemic, we also provided £58 million to support the expansion of community mental health services for adults, including those relating to eating disorders.
Many hon. Members in their contributions raised avoidant/restrictive food intake disorder, or ARFID. I share their ambition to improve support for people living with this under-recognised condition. In 2019-20, NHS England funded seven community eating disorder teams for children and young people, one in each region of England, in a pilot programme to improve access, assessment and treatment for children presenting with ARFID. The pilots ran from September 2019 to March 2020 and included training to support the adaption of each service’s existing care pathways, assessments and treatment interventions for children and young people with ARFID. The training from those pilots is now available for local areas to commission for their community children and young people’s eating disorders services. In 2021, NHS England also commissioned ARFID training for staff delivering treatment in inpatient children and young people’s mental health services.
We recognise that more needs to be done. We know that the earlier treatment is provided, the greater the chance of recovery. NHS England continues to work with eating disorders services and local commissioners to improve access to treatment for all children and young people with a suspected eating disorder, including those presenting with ARFID.
Several hon. and right hon. Members raised the issue of BMI and the Dump the Scales campaign. NHS England continues to emphasise to systems and services that BMI should not be used as a single measure to determine access to treatment within either adult or children and young people’s eating disorders services. That is in line with NICE recommendations and is included in the national published guidance, as well as in the recent community mental health framework. NHS England is also in the process of updating the children and young person’s guidance, which will also state that BMI should not be used as a single measure.
The hon. Member for Bath asked whether we would consider appointing an eating disorder champion who could help to galvanise action and support for people living with those conditions. As she may know, the Government do not currently have plans to appoint a specific champion role, but I can assure her that the Department of Health and Social Care and NHS England already work closely with stakeholders advocating for better care, such as Beat. We are also very grateful for the work of Dr Alex George in his role as the Government’s ambassador for children and young people’s mental health, which includes championing the needs of those with eating disorders.
The right hon. Member for Hayes and Harlington raised the issue of palliative care pathways. I want to assure him and other hon. Members that people with eating disorders should not be routinely placed on palliative care pathways, including those with severe, complex or enduring eating disorders. The NHS is clear that all those with severe, complex or enduring eating disorders should have access to evidence-based treatments focused on helping people recover, including hospital-based care if appropriate. Staff involved in the care of people with complex and severe eating disorders must adhere to the legal frameworks that safeguard their best interests, and NHS England will work with patient groups and stakeholders to develop further guidance on that.
The hon. Members for Bath and for North Ayrshire and Arran (Patricia Gibson) raised the issue of suicide. It is critical that we all do all we can for those affected by eating disorders before they reach that point. That is why the Government published a suicide prevention strategy in September of last year, which aims to reduce suicide over the next five years. I want to reassure right hon. and hon. Members that people in contact with mental health services, including those with eating disorders, are a priority group for the strategy.
In closing, I extend my thanks once again to the hon. Member for Bath for securing the debate, and to all the hon. and right hon. Members here today for their thoughtful contributions and questions.
England Rare Diseases Action Plan 2024
Andrew Stephenson Excerpts(2 months, 1 week ago)
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The Minister for Health and Secondary Care (Andrew Stephenson)
The Government have published England’s third rare diseases action plan on www.gov.uk today, on international Rare Disease Day.
Rare diseases are those affecting less than 1 in 2,000 in the population. Although rare diseases are individually rare, they are collectively common with one in 17 people being affected by a rare disease at some point in their lifetime. Approximately 3.5 million people in the UK are living with one of over 7,000 rare diseases, such as muscular dystrophies or Huntington’s disease. People living with rare diseases often face challenges with the health and care system. The National Conversation on Rare Diseases received nearly 6,300 responses and helped us to identify the four priorities of the 2021 UK rare diseases framework: faster diagnosis; increased awareness of rare diseases among healthcare professionals; better quality of care; and improved access to specialist care, treatment and drugs.
This 2024 England rare diseases action plan is part of the Government’s continued commitment to improve the lives of those living with rare conditions. This year’s action plan provides an update of the progress made against actions outlined in the 2023 and 2022 action plans, and sets out seven new actions to continue to address the priorities highlighted in the UK rare diseases framework.
The Government have shown strong leadership in addressing the concerns faced by the rare diseases community over the past year. Key achievements include:
Designing and securing funding for a pilot of two syndromes without a name clinics in England to deliver care and diagnosis for people with rare undiagnosed conditions.
Updating the National Institute for Health and Care Excellence quality standard on transition from children to adults’ services to ensure that it is relevant to the rare diseases community.
Publishing the UK rare diseases research landscape report, illustrating the strengths of UK research, with over £1.1 billion of rare disease research funded by the Government and charities, and over 250 research projects supported by industry over a five-year period.
A £14 million investment to fund the UK rare disease research platform, which is made up of 11 UK-wide research nodes and a co-ordinating hub facilitating greater collaboration between academic, clinical and industry research, and people living with rare diseases, research charities and other stakeholders, to accelerate the understanding, diagnosis and therapy of rare diseases.
Announcement of over 200 rare genetic conditions that will be screened in the Generation Study. This is the biggest study of its kind in the world, screening over 100,000 newborns with the aim to understand whether sequencing babies’ genomes can help to discover rare genetic conditions earlier.
The 2024 action plan also includes significant new commitments against the framework priorities, developed collaboratively with our delivery partners across the health landscape, and in close consultation with members of the rare disease community. These include:
Developing a genomics communication skills resource to ensure healthcare providers are equipped to have sensitive conversations relating to the gathering of genomic information, consent for diagnostic genomic testing and feedback of results.
Developing the specialist genomics workforce through the Genomics Training Academy.
Developing networked models of care for rare diseases, ensuring that specialist expertise is always available while allowing patients to be treated and cared for as close to home as possible, starting with networked models for inherited metabolic disorders and amyloidosis.
Improving access to whole body scans to increase survival rates and outcomes for people who have rare conditions that result in an inherited predisposition to cancer.
Addressing health inequalities for people with rare conditions through publishing a toolkit for highly specialised services and by mapping and measuring the geographic spread of patients accessing these services.
Under the action plan, the millions of people with rare diseases in England will see more efficient and equitable access to care and new treatments introduced. Over the coming year, we will closely monitor the progress of these actions, seeking input from those living with rare diseases to ensure we are measuring the outcomes that matter most. Progress will be reported in 2025, as part of England’s commitments to report annually over the five-year lifetime of the UK rare diseases framework.
Through this third action plan, we will continue to take steps towards achieving our overarching vision—delivering improvements in diagnosis, awareness, treatment and care, and creating lasting positive change for those living with rare diseases.
[HCWS298]
Leighton Hospital Rebuild
Andrew Stephenson Excerpts(2 months, 1 week ago)
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The Minister for Health and Secondary Care (Andrew Stephenson)
It is a pleasure to serve under your chairmanship, Mrs Harris. I congratulate my hon. Friend the Member for Crewe and Nantwich (Dr Mullan) on securing this important debate on the rebuild of Leighton Hospital. He is a tireless campaigner for improving healthcare in his constituency and across our country. I commend him for the frontline service that he gave in our NHS as an A&E doctor before entering the House, and for returning to work on the NHS frontline during the pandemic.
Securing the rebuild of the hospital was a long-term team effort. My hon. Friend worked hard alongside the local hospital leadership, my hon. and learned Friend the Member for Eddisbury (Edward Timpson), my hon. Friend the Member for Congleton (Fiona Bruce) and thousands of their constituents who signed a petition to show their support. I myself have spoken to Aphra Brandreth, the Conservative parliamentary candidate for Chester South and Eddisbury, who has told me of the huge benefits that the rebuild will have for local residents.
The Government announced the rebuild of Leighton Hospital in May 2023 as part of the new hospital programme. Like Leighton, six other hospitals that we are rebuilding were initially constructed using reinforced autoclave aerated concrete, more commonly known as RAAC. We took the decision to rebuild those hospitals by 2030 not only to protect the safety of patients and staff but to give them access to the best facilities and the newest technology, which is progress that will allow our NHS to improve patient outcomes, cut waiting lists and deliver for another 75 years.
I was particularly delighted by that announcement because, as the MP for Pendle, I was campaigning, like my hon. Friend the Member for Crewe and Nantwich, for the full rebuild of my own local hospital—Airedale General Hospital, which is just “over the border” in the Keighley constituency—so I was incredibly pleased that its rebuild was also approved by the Government on the same day. For the sake of clarity, I was not a Health Minister at the time when I was campaigning for that rebuild, so all propriety and ethical rules were followed.
I know that my hon. Friend and his constituents are eager to hear about how the rebuild of Leighton Hospital is progressing and I hope to provide a comprehensive update today. I am pleased to say that the local trust is working in lockstep with the new hospital programme to develop designs for its new hospital, following the standardised designs that we have developed to accelerate construction and get patients better care faster. The trust is also working with the programme to prepare its strategic outline case, which will be submitted to my Department this year.
By providing more than £2 million of funding, we have already supported the trust to develop the business case for critical early works, which will prepare the site for main construction, including more than £350,000 to support upgrades to the new hospital’s electricity capacity and over £250,000 to support geothermal and solar enablers. The support that we are giving to Mid Cheshire Hospitals NHS Foundation Trust signals this Government’s commitment to rebuilding Leighton Hospital as quickly as possible; I will keep my hon. Friend updated as further funding is released and the strategic outline case progresses.
The rebuild of Leighton Hospital is just one part of this Government’s commitment to improve healthcare in Crewe and Nantwich, and across Cheshire. We have provided Mid Cheshire Hospitals NHS Foundation Trust with over £50 million to address RAAC at the existing hospital, £15 million to upgrade its accident and emergency department, and £19 million to build a new surgical hub at the Victoria Infirmary in Northwich.
I know that my hon. Friend is championing cross-Government work to utilise geothermal energy, which he referred to in his speech, and I also know that he has already engaged with the Mid Cheshire Hospitals NHS Foundation Trust’s chief executive officer and with my ministerial colleague, Lord Markham, on how geothermal energy could be used at Leighton Hospital and across our NHS. This is incredibly exciting technology and the Government are exploring how it could be used throughout our economy. The Department for Energy Security and Net Zero is working on proposals to do that and my ministerial colleagues will keep the House updated on progress.
If I may, I will provide the House with a broader update on the new hospital programme. We are engaging with the market to build awareness of the programme among businesses, particularly main works contractors and those operating in the mechanical, electrical and plumbing markets. In all, we have held over 100 engagement events and spoken directly to over 1,500 businesses. What is more, later this year we will launch the full version of Hospital 2.0, which is our national approach to standardisation. That will be a major milestone for the programme and we will continue to develop our designs over time, in order to deliver better care for patients and better value for taxpayers.
I am also very pleased that four of our new hospitals are already open to patients: the Northern Centre for Cancer Care in Newcastle; the Royal Liverpool University Hospital; and Northgate Hospital and Ferndene Hospital, which are both in Northumberland. In addition, there is stage one of the Louisa Martindale building, which is also known as the “3Ts hospital”, in Brighton.
By the end of the next financial year, we expect to open another four hospitals: Salford Royal Hospital’s major trauma centre; the Dyson Cancer Centre in Bath; the National Rehabilitation Centre near Loughborough; and the Midland Metropolitan University Hospital. I am delighted that at another 18 hospitals, either construction is already taking place or early work has started—or been completed—to get the sites ready for construction.
I again thank my hon. Friend the Member for Crewe and Nantwich for securing this debate on the rebuild of Leighton Hospital. He is right to hold our feet to the fire on this issue and he is also right to demand that patients and staff, both in his constituency and throughout the country, have access to world-class facilities and world-class care. This is what the new hospital programme will deliver. The Government remain absolutely committed to delivering every scheme that has been announced as part of this programme and we are also absolutely committed to delivering the rebuild of Leighton Hospital by 2030.
Question put and agreed to.
North Tees and Hartlepool NHS Foundation Trust
Andrew Stephenson Excerpts(2 months, 1 week ago)
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The Minister for Health and Secondary Care (Andrew Stephenson)
It is a pleasure to see you in the Chair, Sir Charles. I congratulate the hon. Member for Stockton North (Alex Cunningham) on securing this important debate. He has used it to raise important questions that are vital to NHS governance—localism, transparency and accountability. He is right that patients in his constituency and the wider region should be at the forefront of decision making about their healthcare. NHS England has found that shared leadership and group working arrangements between trusts can stabilise governance and align approaches to help improvement.
Matt Vickers (Stockton South) (Con)
I thought that those were very legitimate questions and concerns about the way forward with mergers—joint working—but one of the issues in our part of the world is that South Tees Hospitals NHS Foundation Trust was burdened by the last Labour Government with a huge PFI deal at James Cook Hospital that cost £1 million a week. That is what makes this contentious. That is what makes it so difficult to see joint working in our part of the world.
Andrew Stephenson
I thank my hon. Friend for making that point. I recognise that they are two trusts with very different characteristics. He is right about the eye-watering legacy in one trust—I think it is £57 million a year of PFI debt—which can make joint working controversial. However, as I will come on to say, I have been assured that the two trusts want to work together with joint arrangements, but not merge. I hope we can set the record clearly: in doing the research behind this speech, I have heard that this is not the prelude to a merger through the back door; rather, it is about trusts wanting to work together to address the healthcare needs in the area.
It is right that any decisions about shared leadership arrangements are made in Stockton, not Westminster. However, where an NHS trust is facing performance challenges, the Government back targeted interventions by NHS England, bringing the trusts together to properly diagnose the problem and develop an improvement plan, which could include shared leadership. Any leadership changes should be kept under constant review to ensure that they are effectively delivering for patients and the local area. The point is to help challenged trusts to improve and take ownership of local issues. External evaluations of NHS England’s leadership interventions have found them to be effective.
I will address the current leadership arrangements of the North and South Tees trusts. Up and down the country, trust governance fits a variety of different frameworks. As the hon. Member for Stockton North knows, putting a round peg in a square hole is pointless. However, although we support a diversity of models, I am crystal clear that every arrangement should be geared towards building a faster, simpler and fairer NHS that works for both patients and staff. I am happy to assure him that, in this instance, I have been assured that the shared leadership and joint working arrangements are not in any way a precursor to trust mergers or acquisitions. In other words, both trusts intend to remain statutory organisations in their own right.
NHS England promotes those models of working to maintain consistency within trusts and to ensure that everyone is on the same page when lessons are being learned. However, for over 10 years now, North and South Tees trusts have been discussing how to work together to provide a better offer for the people of Stockton.
Alex Cunningham
The Minister may like to acknowledge that the North Tees and Hartlepool trust and the South Tees trust have worked together for many years. It is not a case of how they can do it in the future; they have been doing it for many years.
Andrew Stephenson
They have been doing it for many years. There are shared challenges in the area that they need to work on together, and this model of operation has worked in many parts of the country. I hope that what the hon. Gentleman describes is very much a bump in the road rather than something that characterises the past 10 years of joint work, most of which seems to have been constructive and conducted through local consensus.
In September 2021, the trusts appointed a joint chair. Just over a year later, they announced plans to form a group model to strengthen health services in the local area. That model was intended to improve recruitment and retention of specialist doctors and nurses, ensure join-up with local communities and partners, and secure capital investment to rebuild and upgrade hospital facilities. To deliver that new way of working, I understand that North Tees and South Tees foundation trusts engaged extensively with partners in the local area.
There is now strong collaborative work taking place across the Tees Valley, in the long-term interest of patients. The North Tees foundation trust is one of the best performing providers across the country for urgent and emergency care. The area’s NHS urgent care services will now be run by an alliance of four health organisations, including the North Tees and South Tees foundation trusts. Together, the partnership will oversee minor injuries and illnesses across the Tees Valley, including urgent care centres at the University Hospital of Hartlepool, the University Hospital of North Tees, and Redcar Primary Care Hospital.
I am delighted that the new urgent treatment centre at the James Cook University Hospital opened in March. We are backing the centre with a £9 million investment in urgent care services on Teesside, which will integrate services, provide patients with care close to home, and ease pressures on A&E. We should also celebrate the new Government-funded Tees Valley community diagnostic centre, which will open in Stockton town centre later this year. The centre will offer rapid scans, tests and checks for a number of major conditions. It will help thousands of people to access simpler services, with easily accessible life-saving tests and faster treatment.
I turn now to the investigation that the hon. Member for Stockton North raised. I understand that NHS England looked into the proposed appointment of a joint chief exec, as well as the actions and behaviours of the board. It aimed to find out whether these concerns amounted to breach of the trust licence. The investigation determined that the trust board had not acted consistently in relation to moving to a single chief executive appointment for South Tees. This constituted evidence suggesting a breach of a provider licence by the North Tees and Hartlepool Trust, which would normally lead to formal regulatory action being taken. After careful consideration, however, NHS England decided that the trust should implement the recommendations on a voluntary basis.
Alex Cunningham
Does the Minister recognise that the non-executive directors had moved on by then? They had actually resigned from their posts in protest at the lack of due process. Does the Minister, or maybe even the region, accept that this matter could have been handled a lot better?
Andrew Stephenson
I hope the hon. Gentleman recognises that there are local government arrangements, and also that these are very much operational matters for NHS England and for the region. Certainly, given the concerns that he has outlined, it is quite clear that things could have been done better to take people with them, rather than alienating people. I also echo the tributes he paid to people who serve as non-exec directors on trust boards across the length and breadth of the country. They play a vital role in local NHS governance, and it is therefore regrettable to see a large number of non-execs resign for any reason.
I think that looking at the reasons behind this and investigating the best way forward is something best delivered by the NHS, and not dictated centrally by Ministers. The recommendations arising from the report were that a summary of it should be presented at the next board meeting and that an action plan for the next steps should be agreed, which has now been completed. It was also recommended that proper consultation between board members of both organisations should take place in future, so that they can reach the best collective decision for better services for Stockton. I hope that the trusts are now able to move forward with these new arrangements, especially with a new joint partnership board, establishing a clear chain of accountability going forward to address their challenges during this troubled period.
In wrapping up, I would like to thank the hon. Gentleman for bringing this debate forward.
Alex Cunningham
The Minister has just indicated that he is wrapping up, but the central question here is whether or not that report will be published. I have a heavily redacted report, which has more black ink than white paper. Does he accept that those people have the right to understand what judgments were made on the accusations against them? They should see the full report, not a version from the person who ordered it and then refused to publish it.
Andrew Stephenson
I hope the hon. Gentleman will appreciate that the NHS commissions a large number of reports on a whole range of services. When those reports are published internally, we expect all participants to be frank and open with investigations. They do so on the basis that they are internal reports to improve the governance of the organisation. It is not expected, and it is not the normal course, for such a report to be published. My understanding is that, following the hon. Gentleman’s freedom of information request, the report will be published in a heavily redacted fashion, as he said. The redactions were made by NHS England, in accordance with its policies. It is not a report that I am privy to and, to the best of my knowledge, it has not even been shared with the Department. It is an NHS England report that, as I say, has been published in accordance with its usual practices.
Alex Cunningham
Frankly, I find it amazing that a Minister cannot even get access to a report that questioned the integrity of five long-standing non-executive directors, who then resigned because of the lack of due process in the appointment system. I remind the Minister that, as I said in my speech, Mr Barker sat in my office and told me, face to face, that he would publish the report and that I would get to see it. He has reneged on that promise. Does the Minister think he should fulfil that promise?
Andrew Stephenson
Unfortunately, I will just reiterate the point that a summary of the recommendations emerging from this investigation were published; they were shared with the board. They are accessible by anyone who wishes to see them. Through his own endeavours, the hon. Gentleman has been able to secure a copy of the redacted full version of the report. As far as I can see from the investigations that I have made, the report has been published fully in accordance with NHS England’s normal practices.
Clearly, this is something that has led to a rocky period for the trust, but I believe that the recommendations that have been shared with the board are now being implemented and that the group model of working, as I have said today, is not a merger by the back door. I know that, in securing this debate, the hon. Gentleman wanted to give greater impetus to the trust to get its act together and resolve these issues. I am absolutely sure that the issues he has mentioned today will have been heard by members of the trust’s board—I am absolutely sure they have been listening. I urge them to work with him and other local MPs to ensure that any other concerns that he has raised, and any other concerns that other hon. Members may have, are addressed in due course.
NHS Property Services
Andrew Stephenson Excerpts(2 months, 2 weeks ago)
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The Minister for Health and Secondary Care (Andrew Stephenson)
I congratulate the hon. Member for Tiverton and Honiton (Richard Foord) on securing the debate. I am grateful for the opportunity to set out the role of NHS Property Services. This subject is understandably of great interest to right hon. and hon. Members across the House.
The hon. Gentleman raised the issue of the future of Seaton community hospital. I will come to that in the latter part of my speech, but let me say for the record that I completely understand his desire to protect a much-loved community health facility. As the Member of Parliament for Pendle, I successfully fought to keep open Pendle Community Hospital in Nelson, and in the neighbouring constituency of Ribble Valley, the new £7.8 million Clitheroe Community Hospital opened in May 2014, so I recognise the importance of community hospitals, not just in offering in-patient care, but in acting as a hub for other healthcare services. It will be most useful for me to first set out to the House why and how NHS Property Services came into being.
Under the Health and Social Care Act 2012, the coalition Government abolished primary care trusts and transferred their commissioning responsibilities to clinical commissioning groups. Their property interests transferred to either NHS trusts or NHS Property Services, which was established in 2013 for this purpose. That decision was made because it allowed commissioners to focus on providing care for patients, rather than managing property. NHS Property Services took ownership of nearly 3,500 local facilities, such as community hospitals, health centres, GP surgeries and care homes. In the past 10 years, NHS Property Services has reduced the size of that estate by a fifth, saving over half a billion pounds of taxpayers’ money, every penny of which has been reinvested into the NHS.
Richard Foord
I understand the Minister’s point about reinvesting the proceeds from selling what might have been regarded as excess NHS property, but my concern relates to where that money goes. My understanding is that, following a sale, half the money might go back to the integrated care board, which would be Devon in this case. The problem with that situation is that it does not take account of the fact that local communities donated the money to build the infrastructure in the first place. That is certainly the case in the Axe valley with Seaton Community Hospital.
Andrew Stephenson
I appreciate the hon. Gentleman’s concern. I hope to provide reassurance in the latter part of my speech that the sale of Seaton Community Hospital is certainly not on the cards and is exceptionally unlikely. However, I appreciate that when property is sold, there is always tension between how much of that money will be reinvested in local communities—many of which have a stake in having created the facilities in the first place—and how much goes into the general NHS pot. The important point for me to land today is that all the money remains within the health services and none returns to the Treasury, so any sales of property from this portfolio are not a way for the Government to generate income, but simply a way of ensuring that the property estate is managed in the most effective fashion.
NHS Property Services was established as a limited company and is led by a board of executive and non-executive directors who are appointed for their property and healthcare expertise, including a departmental shareholder representative. The board’s directors all have the usual responsibilities relating to the proper governance of a limited company, with certain shareholder matters reserved, such as share issue or senior appointments. The board must work within the wider frameworks across Government, such as the Treasury’s guidance on managing public money, which rightly sets out the strict rules for delivering value for taxpayers’ money. The company therefore works with the Department to agree fiscal targets to work within, and is rightly held accountable for its use of public money. However, it is important to emphasise that my Department is not responsible for operational decisions, which are taken by the board and its executive management team.
One reason for the creation of NHS Property Services was to ensure that decisions could be taken without political interference. Although I appreciate that the hon. Member and others across the House may be of the view that my noble Friend Lord Markham, who has ministerial responsibility for NHS Property Services, can intervene to reduce the rents for unoccupied space at Seaton Community Hospital or similar facilities across the country, it would simply not be appropriate for him or any other Minister to intervene in any individual case.
The coalition Government established NHS Property Services through the cost recovery principle, which is the broad framework that the organisation works under. This means that it is funded through charging its costs to the occupiers of its buildings and the recipients of its services. As such, every pound it spends and does not recover is a pound that cannot be spent on delivering frontline care.
The Devon properties were transferred to NHS Property Services on the basis that their ongoing running costs would be funded through rents at market rate and service charges. This approach was taken to give real incentives to local commissioners to take the tough decisions on which properties were most suitable for delivering their clinical strategy, looking at areas as a whole and moving away from a situation whereby subsided property costs could lead to a less effective approach. I accept that that can sometimes lead to tensions about how reasonable charges are set, but the aim is that NHS bodies, and other voluntary and charitable organisations that wish to occupy NHS premises, must factor in the full cost of occupying and maintaining specialist facilities in their decision making.
I will now turn to the future of community hospitals in Devon, including Seaton Community Hospital. As the hon. Gentleman set out in his Adjournment debate in November, Seaton Hospital was part of a group of community hospitals that transferred to NHS Property Services in 2017, when large parts of Seaton Hospital and others in Devon were already vacant. The clinical commissioning group carried out a consultation on the model of community care and a new model of care was introduced, making it more integrated and more community based, with more people receiving care at home. That resulted in a significant reduction in the number of community hospital beds required across Devon. Since then, progress has been made to identify sustainable alternative healthcare uses for vacant spaces in community hospitals in Devon, such as Ottery St Mary and Axminster. In addition, NHS Property Services and Devon ICB have worked with the voluntary sector to support local initiatives in some properties, such as, as the hon. Gentleman will know, the Waffle café at Seaton Hospital.
I understand that Seaton Hospital and some other hospitals still have significant amounts of vacant space. Despite their best efforts, NHS Property Services’ commissioners have been unable to identify relevant services that could fill this gap. NHS Property Services has continued to manage the property, with the costs of the vacant space being charged to the ICB to ensure the costs attributed to the property are fully recovered, but recently the financial challenges facing Devon ICB have called the sustainability of that position into question and it has explored options for alleviating those costs. However, as I explained, simply seeking to pass those costs back to NHS Property Services would not result in the Department having any more money to spend on local healthcare services in Devon.
As I am sure the hon. Gentleman will appreciate, the responsibility for decisions about where to locate clinical services in Devon is a matter for the ICB. It is not a matter for Ministers. However, NHS Property Services is working closely with local leaders to identify options that would help to mitigate the cost pressures arising due to Seaton Community Hospital not operating at full capacity. If, and only if, the ICB determines the property is wholly surplus to its requirements, NHS Property Services would have the responsibility for selling the asset, following Treasury guidelines, but it is important to stress that the site remains an operational site and NHS Property Services therefore has no plans to sell it.
As has been mentioned in the local media, the idea of partial demolition of the hospital has been floated. Again, there are no plans for that course of action, which would very much be a last resort in any event. I believe the site has now been listed as an asset of community value, which means that such a drastic step is exceedingly unlikely to be supported by the local planning authority or other local stakeholders.
Richard Foord
It is true that the property has been registered as an asset of community value. To my mind that gives it a stay of execution, rather than that it is inevitable that it will be preserved intact. NHS Property Services talked through the very many options—I think 28 options—on the table for the vacant space at Seaton Hospital. One of that long list of options is indeed selling off the redundant ward, which could be demolished and used for houses. Did the Minister not know that?
Andrew Stephenson
I know the idea of demolition has been floated in a meeting, but I have been assured that there are certainly no plans for demolition. As the hon. Gentleman will know, an asset of community value nomination was accepted by the local authority, and as an ACV nomination remains live for five years, it will expire in January 2029, although I am pretty sure that local community groups and others would campaign for that to be extended. It is certainly much more than a stay of execution. I hope that has provided suitable reassurance to the local community that the threat of demolition is exceedingly remote, because the local planning authority and other local stakeholders simply would not agree to the demolition of this much-valued community asset.
I fully recognise that the local community has invested in the building of the hospital in the first place, and therefore is a key stakeholder in its future. The ICB and NHS Property Services continue in ongoing dialogue with a range of community groups about potential future uses, and the community has been invited by the ICB to develop a business case for the future use of the property by the end of June 2024. Any future decisions on the future of Seaton Hospital will be taken following evaluation of that business case. I sincerely hope that a financially sustainable solution can be found locally and in the best interests of the people of Devon.
Question put and agreed to.
Correction to Written Parliamentary Questions
Andrew Stephenson Excerpts(2 months, 2 weeks ago)
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The Minister for Health and Secondary Care (Andrew Stephenson)
I wish to draw the attention of the House to data errors in the Government response to two parliamentary questions—numbers 332 and 12694—tabled by the hon. Member for Ilford North (Wes Streeting). The questions enquired as to the costs paid by the national health service for the outsourcing of teleradiology in the last five years. The data provided by NHS England to the Department for Health and Social Care was incorrect. Therefore, the PQ response underreported the number of scans provided in the requested timeframe. NHS England has been asked by my right hon. Friend the Member for Louth and Horncastle (Victoria Atkins) to urgently conduct a full audit of the quality of the data. Once NHSE has completed the audit, and I am satisfied that the data is sufficiently robust, the House will be updated.
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