Physician Associates
Andrew Stephenson Excerpts(3 months ago)
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The Minister for Health and Secondary Care (Andrew Stephenson)
I congratulate my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter) on securing this debate. He spoke knowledgeably, both as a serving NHS medic and as a former Health Minister.
Let me begin by making a very important point. I addressed it in the Delegated Legislation Committee on 17 January, but it is worth repeating. The role of a physician associate is to work with doctors, not to replace them. Improved patient safety and care is at the heart of the NHS long-term workforce plan, which, backed by significant Government investment, shows our determination to support and grow the workforce. As set out in the plan, roles such as physician associates, who remain supervised by doctors, play an important part in NHS provision, and it is therefore right that we include a range of roles and skills in our multi-disciplinary teams that can offer personalised, responsive care to patients.
It is important to note that the NHS long-term workforce plan commits to doubling medical school degree places to 15,000 a year by 2031-32. That compares with 1,500 physician associate places. In turn, this will mean a major expansion of specialty training, on which we are committed to working with the royal colleges. We have accelerated this expansion by allocating 205 additional medical school places for the 2024-25 academic year, with the process for allocating 350 additional places for the 2025-26 academic year already under way. This demonstrates our commitment to the medical profession, and reaffirms that we absolutely do not see physician associates as replacements for doctors. There are currently 139,200 full-time equivalent doctors working in the NHS in England, which is over 42,100, or 43.4%, more than in 2010. Patient safety remains of the utmost importance, and regulation will help bring further clarity to patients and healthcare professionals on the nature of these roles and their remits.
Physician associates are qualified and trained health professionals. They undergo a three-year undergraduate degree in a health, biomedical science or life sciences subject, followed by two years of postgraduate training, gaining significant clinical experience. Alternatively, some universities now offer an undergraduate degree PA course that includes an integrated master’s degree in physician associate studies. Those courses take four years to complete. Training involves supervised practice with real patients, with at least 1,600 hours of clinical training. It also includes 350 hours in general hospital medicine, and a minimum 90 hours in other settings, including mental health, surgery, and paediatrics. The dedicated medical supervisor is responsible for the supervision and management of a student’s educational process throughout the clinical placement of the course.
Dr Poulter
Earlier, in response to the hon. Member for York Central (Rachael Maskell), I made the point about the variability of biomedical science degrees from different institutions. The GMC would not recognise a biomedical science degree as being adequate for a doctor in training as part of their preclinical studies, because of that variability. Will my right hon. Friend raise that issue directly with NHS England, with regard to putting in place a standardised training pathway for physician assistants?
Andrew Stephenson
My hon. Friend makes a valid point, and that is one reason why regulation is so important. The GMC has assured me that although draft regulations are out there, it will be consulting further on them later this year, so my hon. Friend, the BMA and various others can make strong representations about how the training framework should be provided. With that introductory regulation, the GMC will be responsible for setting, owning and maintaining a shared outcomes framework for physician associates, which will set a combination of professional and clinical outcomes. The outcomes framework will help to establish and maintain consistency, embed flexibility, and establish principles and expectations to support career development and lifelong learning. While at the moment there is significant variability in the system, I hope that the regulations we passed in this House on 17 January will help to provide that clarity and give the GMC the powers it needs to ensure that the training provided to physician associates is of the appropriate quality for the roles we are expecting them to undertake in our NHS.
Physician associates can work autonomously with appropriate support, but always under the supervision of a fully trained and experienced doctor. As with any regulated profession, an individual’s scope of practice is determined by their experience and training, and will normally expand as they spend longer in the role. That must be coupled with appropriate local governance arrangements to ensure that healthcare professionals only carry out tasks that they have received the necessary training to perform. Statutory regulation is an important part of ensuring patient safety, but that is also achieved through robust clinical governance processes within healthcare organisations, which are required to have systems of oversight and supervision for their staff.
NHS England is working with the relevant professional colleges and regulators, to ensure that the use of associate roles is expanded safely and effectively. That includes working with the GMC, royal colleges and other stakeholders to develop appropriate curriculums, core capabilities and career frameworks, standards for continual professional development, assessment and appraisal, and supervision guidance for anaesthetist and physician associates. NHS England will also work with colleges, doctors’ representative organisations, AAs and PAs to identify areas of concern. Specifically, the NHS has committed to working with the Academy of Medical Royal Colleges and individual professional bodies to develop and implement recommendations as a result.
Regulation will give the GMC responsibility and oversight of AAs and PAs, in addition to doctors, allowing it to take a holistic approach to education, training and standards. That will enable a more coherent and co-ordinated approach to regulation and, by making it easier for employers, patients and the public to understand the relationship between the roles of associates and doctors, help to embed such roles in the workforce. Indeed, regulation addresses many of the concerns that we have heard in the debate last month and today. The GMC will set standards of practice, education and training and operate the fitness to practice procedures, ensuring that PAs meet the right standards and can be held to account if serious concerns are raised. GMC guidance sets out the principles and standards expected of all its registrants, and that will apply to PAs once regulation commences. Those standards will give assurance that PA students have demonstrated the core knowledge, skills and professional and ethical behaviours necessary to work safely and competently in their areas of practice and in a care context as newly qualified practitioners.
Rachael Maskell
On that point, can the Minister clarify where the liability will sit if error does occur? Will it sit with the clinician or the consultant who is supervising them? I am not clear on that particular issue.
Andrew Stephenson
In many ways, it will be the same as with many medical professionals. Once we have the situation clarified in regulation, it will not be any different from the personal liability of a doctor or others working in an organisation. Those are the kind of things that the GMC will be consulting on and discussing with stakeholders in the coming months, and is important that all these points are clarified. The hon. Lady was in the debate we had in January, where the tragic case of Emily Chesterton was raised. In that case, unfortunately we saw a PA move from one practice to work in another, and we need to ensure that there is a proper, robust fitness-to-practice regime so that any medical professional can be held to account in such cases for what has happened and, if necessary, struck off the register and no longer able to practice.
Dr Poulter
The Minister is being generous in giving, and we are taking advantage of the slightly extended time we have for this Adjournment debate, but it is an important issue, because it is about patient safety. On that point, he is putting a lot of faith in the GMC doing things quickly, when we know there are existing patient safety issues. Would it not be more sensible to wait for the GMC to put in place the proper regulatory framework, the proper scope of practice and the other pieces of work that are being done before we commit to an expansion of a workforce when we know there is variability and patient safety concerns?
Andrew Stephenson
I feel that I am being criticised from both angles on this point. Some people are saying we are going too fast, and other people are saying we are going far too slow. A number of years ago, we consulted on regulating these professions. We are now moving forward. Those regulations have passed through the UK Parliament and the Scottish Parliament. The GMC has had a long time to prepare. In my meetings with the GMC, it has reassured me that it is ready to go. It will want to consult to ensure that any further concerns that people wish to raise are reflected in the regulations. It wants to ensure that it gets the regulations right, but it has known that they have been coming for some time. We consulted on who was best placed to regulate physician associates and anaesthetist associates back in 2019, so the GMC has had some time to lay the groundwork.
Under the long-term workforce plan, there is a much more significant expansion of doctors, as opposed to physician associates or anaesthetist associates. The number of extra doctors we are bringing in to the health service, as compared with physician associates, is of a magnitude of five to one. I hope I can reassure hon. Members that this is not in any way about replacing doctors. Doctors are still absolutely pivotal to patient care and will be heavily involved in overseeing physician associates, who are not doctors and need to be overseen in clinical practice.
The role of physician associates is in no way a replacement for that of any other member of the general practice team. They work in conjunction with and are complementary to an existing team. Physician associates can help to broaden the capacity and skills mix within a practice team by helping to address the needs of patients in response to the growing and ageing population, but let me be clear that the employment of PAs does not mitigate the need for more GPs, nor does it remove the need for other practice staff.
There will be a wide range of clinicians, such as PAs, who are well suited to providing care in general practice as part of a multidisciplinary team, but GPs remain at the heart of general practice and primary care, and that is not going to change. As we develop and progress with changes to the NHS workforce, it is vital that the expansion of physician associates and their role is delivered safely. GMC regulation is a positive step forward in the safe expansion and further integration of AAs’ and PAs’ roles within the NHS.
I thank my hon. Friend the Member for Central Suffolk and North Ipswich for once again bringing the House’s attention to this important issue. I look forward to continuing to work with him and other right hon. and hon. Members to ensure that we get this right.
Question put and agreed to.
Children and Young People Cancer Taskforce
Andrew Stephenson Excerpts(3 months ago)
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The Minister for Health and Secondary Care (Andrew Stephenson)
With World Cancer Day this week, I want to take this opportunity to affirm to the House this Government’s commitment to delivering the best cancer services for everyone across England.
I am pleased to inform the House that I am launching a Children and Young People Cancer Taskforce dedicated to tackling those cancers that affect our children and young people. This is part of our commitment to delivering world-leading cancer services—and our mission to save lives.
Although children’s and young people’s cancers make up a small proportion of overall cancer diagnoses, cancers are one of the biggest causes of death in children and young people. While survival is improving, with childhood cancer survival rates in the UK having more than doubled since the 1970s, more invasive cancers have lower survival rates, and the long-term impacts of cancer and of treatment can cause challenges for decades.
In this House we have heard about the devastating impact cancer has on children and young people, and the life-changing impact on their families. I express my gratitude to the families who, despite unimaginable grief, have shared their stories with both Houses, campaigning in the hope that no more families will have to suffer. I commend all the hon. Members who have shone a light on these stories and I welcome their support for this new initiative.
This taskforce represents an opportunity to take dedicated action working across organisations to unify and drive progress. It offers us the chance to meaningfully change how we detect, treat and care for children and young people with cancer.
Through this taskforce, I will be inviting experts to discuss how to improve treatment, detection and research into children’s and young people’s cancers. I am delighted to announce that my hon. Friend the Member for Gosport (Dame Caroline Dinenage) has been appointed as chair of the taskforce, given her campaigning on childhood cancer, her reputation as an exceptional parliamentarian, and her knowledge, experience and dedication.
Areas of focus for the taskforce will include:
Genomic testing and treatment—to ensure all children get timely access to high quality personalised treatments.
Detection and diagnosis—to ensure earlier diagnosis to give children and young people the best chance to beat cancer.
Research and innovation—to explore children’s access to clinical trials, gain greater access to data, target our research funding, and encourage consideration of innovative solutions.
It is important to recognise the excellent work already under way in children’s and young people’s cancers. Rather than seeking to replicate this work, the taskforce is intended to be a unifying force, identifying various projects under way across organisations: including health, science, research, charity and international sectors. It will forge connections, strengthen collaboration, and drive progress in tackling children’s and young people’s cancers.
Following a period of planning and engagement, the taskforce will meet from springtime onwards. Its work will feed into, and align with, the major conditions strategy. I will update the House on its progress in due course.
I will of course keep the House updated on wider progress on cancer. We are improving cancer survival and earlier diagnosis, in part thanks to innovations like lung health checks targeting those at greatest risk of developing lung cancer, with checks mostly carried out in supermarket car parks and other community spaces—reaching those who might not normally come forward. We are also supporting initiatives such as Prostate Cancer UK’s TRANSFORM trial, announced on International Men’s Day, which aims to address some of the inequalities that exist in prostate cancer diagnosis today, and aims to save thousands of men each year.
With this new taskforce, and these ongoing innovations and initiatives, I can assure the House we are taking every step in our mission to improve cancer outcomes.
[HCWS246]
Health and Social Care
Andrew Stephenson Excerpts(3 months, 1 week ago)
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Andrew Stephenson
There are around 1,400 medicines licensed in the UK, most of which are in good supply.
[Official Report, 30 January 2024, Vol. 744, c. 280WH.]
Letter of correction from the Minister for Health and Secondary Care, the right hon. Member for Pendle (Andrew Stephenson):
An error has been identified in the response given to the hon. Member for Edinburgh West (Christine Jardine) in the debate on Type 2 Diabetes: Availability of Drugs.
The correct response should have been:
Andrew Stephenson
There are around 14,000 medicines licensed in the UK, most of which are in good supply.
Type 2 Diabetes: Availability of Drugs
Andrew Stephenson Excerpts(3 months, 1 week ago)
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Westminster Hall is an alternative Chamber for MPs to hold debates, named after the adjoining Westminster Hall.
Each debate is chaired by an MP from the Panel of Chairs, rather than the Speaker or Deputy Speaker. A Government Minister will give the final speech, and no votes may be called on the debate topic.
This information is provided by Parallel Parliament and does not comprise part of the offical record
The Minister for Health and Secondary Care (Andrew Stephenson)
It is a pleasure to see you in the Chair, Mr Pritchard. I thank the hon. Member for Edinburgh West (Christine Jardine) for raising such an important issue. I want to begin by emphasising that I understand that medicine supply issues are a significant cause of frustration for many of our constituents across the United Kingdom. I also recognise that there have been particular challenges recently with certain medicines. Without diminishing those challenges, it is important that we set them in context.
There are around 1,400 medicines licensed in the UK, most of which are in good supply. The Department is regularly notified of supply issues; thankfully, the vast majority of those can be managed with minimal impact on patients. The medicine supply chain is highly regulated, complex and global, meaning that there can sometimes be supply issues that affect the UK, along with other countries around the world.
There are a number of reasons why a limited number of medicines might be subject to a disruption in supply, such as manufacturing difficulties, regulatory non-compliance, access to raw materials or distribution problems. We cannot always prevent supply issues occurring, but where they do the Department has a range of well-established processes to manage them and help mitigate the risk to patients.
Where there are concerns about supply, they largely, although not exclusively, concern medication to treat the most common conditions. That is exactly the case with what we are talking about today—diabetes—a condition experienced by more than 4.9 million people across the UK. Action on diabetes will be included in the major conditions strategy, as it is an important risk factor for cardiovascular disease. If someone has diabetes, they are twice as likely to have heart disease or a stroke than someone who does not have diabetes, which goes to the heart of what the hon. Member for Edinburgh West said about the importance of ensuring diabetics get their medication.
Jim Shannon
I thank the Minister for his comprehensive and helpful response. Some years ago, when I first came to Parliament there was a diabetes strategy for the whole of the United Kingdom of Great Britain and Northern Ireland. If the Minister could look at it, I think a renewal of that particular strategy would help. It was agreed here at Westminster, but took in all the regions of Scotland, Wales and Northern Ireland. It was a marvellous objective to address diabetes and it seemed to work. I would like to see it happen again.
Andrew Stephenson
The hon. Member makes an important and powerful point, as usual. As he knows, I am a proud Unionist and am keen for us to do as much as we can in collaboration. I recognise that health is a largely devolved matter. However, since I joined the Department of Health and Social Care in October, I have visited Northern Ireland, Scotland and Wales, I have talked about how we can collaborate more closely on things such as research and innovation, and I am sure that we can do more together where the devolved Governments agree. Last night we had encouraging news. Hopefully we will have power-sharing arrangements back in place in Northern Ireland so that we can work together collaboratively to deliver those benefits for patients.
I will finish the point I was making about the major conditions strategy. That strategy aims primarily to improve care and health outcomes for those living with multiple conditions, and it will be centred on prevention. We have heard from a wide range of stakeholders, whose views are informing the development of the strategy. I will meet Diabetes UK this week to continue that engagement.
With regards to the availability of drugs to treat type 2 diabetes, as the hon. Member for Edinburgh West set out, there has been a significant global supply issue affecting glucagon-like peptide-1 receptor agonists—GLP-1RAs—with the shortages driven by an increase in demand for such products for licensed and off-label indications, meaning that the medicine is being used for a different use from that stated on its licence.
I will set out the steps we have taken to manage those issues. We have continued to work with suppliers to take action to resolve the issues as quickly as possible, including expediting deliveries and boosting supplies. In July last year, we issued guidance for healthcare professionals, which took the form of a national patient safety alert on how to manage patients during the supply disruption. Clinicians and prescribers were directed not to initiate new patients on these medicines, which were to be used only to treat their licensed indication, protecting supplies for diabetic patients. Guidance was supported and echoed in a statement issued by the professional regulators.
One of the particular shortages affecting the market at the moment is Ozempic, which is the brand name for semaglutide, which is licensed to treat type 2 diabetes. Wegovy is the same medicine—semaglutide—but licensed specifically for weight management and is generally used at a higher dose than Ozempic. Obesity-related conditions can be serious, so it is right that we support people living with obesity to lose weight, and Wegovy is one option for those with severe obesity and comorbidities. However, it became available for prescription in the UK only on 4 September 2023, having received approval for use on the NHS for weight management in March 2023.
We believe that supply issues with Ozempic have in part been contributed to by off-label prescribing of that medicine for weight loss ahead of Wegovy’s launch. However, the strong and clear guidance that we provided on the use of those treatments only for their licensed indications and our ongoing work with the industry has helped to protect supplies for diabetic patients.
As a result of our continued intensive work with the supply chain, I am pleased to inform hon. Members that the supply position of that particular drug has improved. Supplies of Rybelsus have been boosted to support demand from new patients with type 2 diabetes, patients switching from Byetta injections and patients switching from Victoza injections. The national patient safety alert was amended on 3 January to reflect that positive development. The professional regulators have issued a second statement to highlight that update.
I am also delighted to highlight the fact that the Medicines and Healthcare Products Regulatory Agency gave regulatory approval in the last few days to Mounjaro, an injectable medicine for adults with type 2 diabetes. That will bring an additional treatment option and will mean that more diabetic patients will have access to the medicines that they need.
Sadly, supply is not expected to return to normal due to the issues with certain products, but we will continue to work with the manufacturers, the NHS, the MHRA and others working in the supply chain, to help ensure that, overall, supplies of GLP-1 RAs are available for patients.
Jim Shannon
I think the hon. Members for Edinburgh West (Christine Jardine) and for Wansbeck (Ian Lavery) and I would be interested know about the other option—if I caught you right, Minister—that you mentioned, which is in the form of an injection but is not insulin. Just so we know, is it a different system?
Andrew Stephenson
Sorry, was the hon. Gentleman asking about the approval of the new drug, Mounjaro, which I just mentioned?
Jim Shannon
Yes, I am trying to understand, because I am not aware of it, and neither are the hon. Lady or the hon. Gentleman. It is not insulin for type 2, is it? The Minister mentioned an injection system.
Andrew Stephenson
It is an injectable medicine for adults with type 2 diabetes. It was recently approved by the MHRA. To put a little bit of extra information out there, the National Institute for Health and Care Excellence recommended Mounjaro, the same drug, for the treatment of patients with type 2 diabetes who meet specific criteria. The NHS in England is therefore now legally required, in line with NICE recommendations, to fund its use for eligible patients. The availability of that new medicine in Scotland is, however, a matter for the devolved Administration. The Scottish Medicines Consortium, which makes decisions on the use of medicines in Scotland, has not yet published guidance on Mounjaro. It will be a matter for the SMC as to whether that becomes an option in Scotland.
As I was saying, Mr Pritchard, unfortunately we expect supply chain issues to continue for the rest of the year. Throughout the management of this issue, our guidance has been supported by additional advice issued in Scotland, Wales and Northern Ireland, which has, critically, reinforced the messaging provided by the national patient safety alerts.
Ian Lavery
Does the Minister understand and recognise the benefits of glucose monitoring centres? It is not a supply chain issue, but an access issue. They can and do change people’s lives, but they are not widely accessible. People are very much unaware that they actually exist. If they did and understood that the centres were available from the NHS, it would save the NHS millions if not billions of pounds. It would change the lives of many people, mainly in deprived areas. Can the Minister give a commitment to look at that and see how we can allow more people to access glucose monitoring systems?
Andrew Stephenson
I hear what the hon. Gentleman says and I am more than happy to look at the issue. However, I believe—I may be mistaken—that he is suggesting something that we would routinely advise for type 1 diabetics to be provided to type 2 diabetics. As far as I am aware, the clinical advice does not suggest that we do that, but I am more than happy to look at the issue, because I want to ensure that we support people living with diabetes as much as we can.
Finally, I emphasise that our guidance remains clear that medicines licensed for the treatment of type 2 diabetes should be used only for that purpose. All prescribers, whether employed privately or by the NHS, are expected to take into account the appropriate national guidance. Unfortunately, the supply disruption is a common issue for the UK and other countries around the world, which is both frustrating and distressing for patients. We cannot always prevent supply issues from occurring, but where they do arise, the Department has a range of well-established processes and tools to manage them and to help mitigate the risk to patients. Addressing issues with GLP-1 RAs continues to be a priority for the Department. We will continue to work hard with industry to resolve the issues as quickly as possible. Once again, I am grateful to the hon. Member for Edinburgh West for raising such an important issue.
Question put and agree to.
Milton Keynes Women’s and Children’s Hospital: New Hospital Programme
Andrew Stephenson Excerpts(3 months, 2 weeks ago)
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The Minister for Health and Secondary Care (Andrew Stephenson)
I congratulate my hon. Friend the Member for Milton Keynes North (Ben Everitt) on securing a debate on this important issue. He is a tireless campaigner for better healthcare in Milton Keynes, alongside my hon. Friend the Member for Milton Keynes South (Iain Stewart). Before I talk about the new hospital, I thank my hon. Friend the Member for Milton Keynes North for mentioning the new community diagnostic centres. I am delighted that the Whitehouse health centre is already carrying out tests, checks and scans for his constituents, with another CDC in Lloyds Court shopping centre coming very soon. As he laid out, Milton Keynes University Hospital has already seen improvements to emergency and cancer care facilities. The addition of a dedicated new women and children’s centre through the new hospital programme builds on that record of investment.
Both my hon. Friends, along with the Conservative candidate for Milton Keynes South, Johnny Luk, have spoken to me in detail about the huge difference that the investment will make for local people. My hon. Friend the Member for Milton Keynes North hit the nail on the head in pointing out the smarter hospital design that we have developed as part of the programme, and how it will benefit patients. He is entirely right that it will improve patient care, with features such as more single rooms to give new mums the privacy that they deserve, or for families comforting sick children. The design is a major plus for staff working in our NHS too, providing better lines of sight to monitor patients from nurses’ stations, better IT and equipment so that less time is wasted on non-clinical tasks, and a lighter, brighter environment to work in.
The hospital will also boost the emphasis of my right hon. Friend the Secretary of State on women’s health and maternity care, and I know that she will follow the hospital’s progress with keen interest. As my hon. Friend said, Milton Keynes is rapidly expanding, as the penny drops and people realise what a fantastic place it is to live, work, and raise children, thanks in no small part, I am sure, to his zealous and spirited pursuit of Milton Keynes’ interests in this House. The Government are bearing that important fact in mind, as we work very closely with Milton Keynes University Hospital Foundation Trust on its plans for a new women and children’s hospital, surgical ward block and imaging centre.
In May last year the Government announced a further five hospitals as part of our commitment to build 40 new hospitals by 2030. Structures that were mostly built using reinforced autoclaved aerated concrete—commonly known as RAAC—will be rebuilt by 2030 as part of the new hospital programme, along with two hospitals that were already included on the list. We will not cut any corners when it comes to protecting the safety of patients and staff. We remain committed to every scheme announced as part of the new hospital programme.
I am pleased to inform my hon. Friend that Milton Keynes Community NHS Trust submitted its refreshed strategic outline business case to the programme last week, on 19 January. This will now progress through the appropriate assurance processes, as set out in the Treasury Green Book, to ensure that the trust’s plans are aligned with the national programme approach, are deliverable and provide value for taxpayers’ money. But the intention is very much that these plans will be delivered at pace and with rigour.
I am pleased to inform the House that, up to the end of the 2022-23 financial year, the scheme received more than £11 million for scheme development funding. In the current financial year, we have released more than £600,000 extra, to help the trust develop the business case for the new patient imaging centre. A further £120,000 will be made available for the development of business cases for a multi-storey car park and high voltage supply upgrade. I look forward to receiving further business cases from the trust. I commit to updating my hon. Friend as funding is released for that important scheme. All the money that we have released to date has helped reach key milestones in delivering the plan for the people of Milton Keynes and the surrounding areas, enabling construction teams to crack on early with preparing the site ahead of the main construction commencing in the second half of the decade. The funds also demonstrate our commitment to delivering a new Milton Keynes hospital by 2030 as part of the new hospital programme.
I would like to end by providing a more general update on the ambitious and vital work that we are undertaking as part of the new hospitals programme. I am very pleased that four hospital are now open to patients: the Northern Centre for Cancer Care; the Royal Liverpool Hospital; stage 1 of the Louisa Martindale, also known as the 3Ts hospital—trauma, tertiary and training—in Brighton; and the Northgate and Ferndene hospitals in Northumberland. A further hospital, the Salford Royal major trauma centre, is complete and due to open shortly. Another 17 hospitals are either in construction or in early construction with activity well under way to prepare their sites. This includes surveys and crucial work on non-clinical infrastructure, such as energy centres, demolitions or car parking.
My ministerial colleague with responsibility for the new hospital programme, Lord Markham, has been visiting these sites up and down the country to see at first hand how some of the schemes are progressing. I can assure my hon. Friend that his lordship’s enthusiasm for the programme matches his own.
I thank my hon. Friend for continuing to champion this investment in his constituency and for his continued engagement in the new hospital scheme. He is right to hold our feet to the fire; let the record show that we are committed to every scheme announced as part of the new hospital programme and delivering the new hospital in Milton Keynes by 2030, because I know that he will be holding Ministers to account, as he does so diligently on this and so many other issues.
Question put and agreed to.
Oral Answers to Questions
Andrew Stephenson Excerpts(3 months, 2 weeks ago)
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Mr Rob Roberts (Delyn) (Ind)
The Minister for Health and Secondary Care (Andrew Stephenson)
NHS data shows that we have delivered early on our manifesto commitment to have an extra 50,000 NHS nurses, with the number of nurses working in our NHS increasing from around 301,000 in 2019 to 357,000 today. That has been achieved through boosting training and education routes, ethically recruiting internationally and taking actions to improve retention. Measures such as the health and care visa introduced in 2020 support international recruitment.
Mr Roberts
I thank the Minister for his answer. As he knows, the national health service would completely collapse without the input and expertise of clinical staff from around the world. One barrier to those people coming to help us are the high fees for applying for permanent residency. Some nurses from countries such as India and the Philippines are having to take out expensive loans just to feel like they are welcome and able to stay in our country. I have presented a private Member’s Bill to exempt NHS clinical staff from paying those high fees to become residents. Will the Minister support the Bill and work with his Home Office colleagues to find a way to make that a reality for those people who work so hard in our health service?
Andrew Stephenson
I join my hon. Friend in paying tribute to the enormous contribution made by internationally recruited staff to our NHS. As he will know, immigration policy and fees are a matter for my right hon. Friend the Home Secretary. However, our long-term workforce plan supports international recruitment. In addition to the new visa route, we are exempting health and care staff from the immigration health surcharge.
Florence Eshalomi (Vauxhall) (Lab/Co-op)
The Minister will know that without our fantastic workforce, the NHS would not work. I pay tribute to all those hard-working nurses in all our hospitals and care centres, including at St Thomas’ Hospital in my constituency. Does the Minister recognise that in addition to recruiting staff we have to look at retaining staff, who talk about the workload, their mental wellbeing and the fact that the cost of living is having a big impact on them? Does the Minister agree that the Government need to come forward with a wide-ranging plan on addressing workforce planning, pay, training, staff wellbeing and retention?
Andrew Stephenson
I completely agree with the hon. Lady, which is why this Government became the first Government ever to introduce a long-term workforce plan. Retention is one of the key pillars of the long-term workforce plan, and we are already seeing that deliver the result of keeping more staff in our NHS.
Layla Moran (Oxford West and Abingdon) (LD)
Theresa Villiers (Chipping Barnet) (Con)
The Minister for Health and Secondary Care (Andrew Stephenson)
I know this is an issue close to my right hon. Friend’s heart and pay tribute to her for her work as vice-chairman of the all-party group on radiotherapy. The pandemic has of course presented a real challenge to delivering the Government target to diagnose 75% of stageable cancers at stage 1 or stage 2 by 2028, but I am pleased to be able to tell the House that we are coming through that and last year diagnosed more cancers at stage 1 and stage 2 than ever before.
Theresa Villiers
Cancer Research UK has published an ambitious plan, “Longer, better lives”, which reminds us that for some cancer patients just a few weeks of delay can make the difference between whether they can be offered curative treatment or just palliative care. Will the new diagnostic centres being opened by the Government, including at Finchley Memorial Hospital, bring waiting times down and secure that early diagnosis that is so important to surviving cancer?
Andrew Stephenson
My right hon. Friend makes an important point. Diagnostic checks are a key part of the cancer pathway and the 150 community diagnostic centres opened by this Government, including the one at the Finchley Memorial Hospital, will provide earlier diagnostic tests, support earlier diagnosis and bring down waiting times, benefiting millions of patients. These centres have delivered more than 6 million additional tests for all elective activity since July 2021 and we expect the Finchley Memorial Hospital CDC to provide over 126,000 tests for elective care in the next financial year.
Jim Shannon (Strangford) (DUP)
I thank the Minister for that response. Research and development is very important; it means we can find more cures for cancer. My father, who is dead and gone, survived cancer on three occasions; that happened because of advances in finding cures. What is being done to work alongside those in research and development to ensure that even more cancers can be cured and we can go from a 50% rate to perhaps a 60% or even 70% rate for those who live longer?
Andrew Stephenson
I was delighted that one of my first visits in the new year was to Northern Ireland to see some of the life sciences companies, particularly those based around Queen’s University Belfast. That sector in Northern Ireland is flourishing. We are keen to support companies working in research and bring together world-leading universities such as Queen’s with the private sector and the NHS to deliver improved outcomes for all patients across every part of the United Kingdom.
Janet Daby (Lewisham East) (Lab)
The Minister for Health and Secondary Care (Andrew Stephenson)
I know this is an important issue for the hon. Lady in her role as chair of the sickle cell and thalassaemia all-party parliamentary group. We are working hard to provide the best possible care to those living with sickle cell disease. That includes boosting Ro subtype blood donation numbers, identifying improvements in clinical pathways and delivering world-leading treatments, such as the new blood-matching genetic test announced by NHS England yesterday, which will reduce the risk of side effects and offer more personalised care.
Janet Daby
I congratulate NHS England on the launch of the new blood-matching genetic test for sickle cell patients, but it has been more than two years since the “No One’s Listening” report, which made the key recommendation that sickle cell patients receive pain relief within 30 minutes of attending accident and emergency. Why is that still not happening for sickle cell patients, and would the Minister like to meet me and the Sickle Cell Society to discuss how to achieve that?
Andrew Stephenson
I of course would be happy to meet the hon. Lady and the Sickle Cell Society to look at how we can improve patient experiences and ensure that all patients benefit from timely access to the medications they need. I am delighted that she welcomes yesterday’s announcement. It is an example of how the NHS can bring forward world-firsts and is leading the way to transform patient care and improve patient outcomes.
Ian Byrne (Liverpool, West Derby) (Lab)
The Minister for Health and Secondary Care (Andrew Stephenson)
PAs and AAs are an essential part of the reform piece to the long-term workforce plan. I note that the order was passed by the House last night without a Division, so I am grateful for that cross-party support. We are working with the General Medical Council, the British Medical Association and others to ensure that the regulations are fit for the purpose. We look forward to the GMC launching its consultation on the fine print of the regulations very soon.
Mrs Heather Wheeler (South Derbyshire) (Con)
As my constituents have to travel to Tamworth, Burton or Derby for diagnostic tests, can I encourage the Secretary of State to look favourably on a bid for a new much-needed community diagnostic centre in South Derbyshire?
Derek Twigg (Halton) (Lab)
Andrew Stephenson
The NHS long-term plan commits to a number of key ambitions to improve care and outcomes for individuals suffering from cardiovascular disease, including enhanced diagnostic support in the community, better personalised planning, and increasing access to cardiac rehabilitation. Those ambitions will support the delivery of the aim to prevent 150,000 heart attacks, strokes and dementia cases by 2029.
Chris Green (Bolton West) (Con)
The single biggest concern my constituents raise about healthcare is access to GPs, especially in Blackrod and Westhoughton. What more can my right hon. Friend do to ensure we have better GP access?
Samantha Dixon (City of Chester) (Lab)
Andrew Stephenson
The 62-day backlog has fallen by 27% since its peak in May 2020. We know there is more to be done, and that is why we are bringing forward more measures as early as possible. In April 2023, more than nine in 10 patients—90%—started their first cancer treatment within one month of a decision to treat.
James Morris (Halesowen and Rowley Regis) (Con)
Many of my constituents who use Regis Medical Centre have been left angry and frustrated by the botched implementation of an Anima booking system, leading to them being unable to get an appointment or the treatment they need. Will the Secretary of State meet me to discuss how we can learn the lessons from that botched implementation and make sure trust in that GP surgery is restored?
Draft Anaesthesia Associates and Physician Associates Order 2024
Andrew Stephenson Excerpts(3 months, 3 weeks ago)
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The Minister for Health and Secondary Care (Andrew Stephenson)
I beg to move,
That the Committee has considered the draft Anaesthesia Associates and Physician Associates Order 2024.
It is a pleasure to serve under your chairmanship, Dame Caroline. I will begin by setting out the policy context behind the draft order. Strengthening the future of the NHS workforce remains one of the Government’s top priorities. Anaesthesia associates, AAs, and physician associates, PAs, are already a valued and integral part of the multidisciplinary healthcare team, but they have the potential to make an even greater contribution. Regulating those professions will increase the contribution that AAs and PAs can make to the UK healthcare sector, while improving patient safety and professional accountability.
As well as bringing AAs and PAs into regulation by the General Medical Council, the draft order paves the way for full-scale reform of the regulatory frameworks for all the healthcare professional regulators. This is a rare and significant opportunity to deliver a large-scale programme of reform that will implement improvements to patient and public safety, the system of professional regulation, and the health and care workforce. We are introducing the regulation of AAs and PAs under a new legislative framework without at this stage changing the GMC’s regulatory framework for doctors. That means that the GMC’s overall governance and its regulation of doctors will continue under the Medical Act 1983 after the order comes into effect.
The draft order will give the GMC powers to register AAs and PAs whom it assesses to be appropriately qualified and competent, and to set standards of practice, education and training, and requirements for continual professional development and the conduct of AAs and PAs. It gives the GMC the powers to approve AAs and PAs’ education and training programmes, to operate fitness-to-practice procedures, to investigate concerns and, if necessary, to prevent or restrict an associate from practising.
The legislation provides a high-level framework for the GMC to regulate AAs and PAs, and importantly gives the GMC autonomy to set out the details of its regulatory procedures in rules. The GMC has committed to developing rules and processes for regulating AAs and PAs, which will be subject to public consultation, to enable regulation to begin by the end of this year.
We recognise some concerns about the deployment and planned expansion of the AA and PA roles within the NHS. Let me be clear: the role of associates is to work with doctors and not to replace them. AAs and PAs are distinct, complementary and valued professionals who can enrich the workforce skills mix, freeing up doctors and consultants to spend more time using their specialist skills and training to focus on complex clinical duties and decisions on patient care.
It is important to note that the NHS long-term workforce plan sets out an aim to double the number of medical places in England to 15,000 a year by 2031-32, and to work towards expansion by increasing places by a third to 10,000 a year by 2028-29. We have accelerated that expansion by allocating 205 additional medical school places for the 2024-25 academic year, with the process for allocating 350 additional places for the 2025-26 academic year under way. That demonstrates our commitment to the medical profession and that we do not see PAs or AAs as replacements for doctors.
Currently, more than 139,200 full-time equivalent doctors work in the NHS in England. That is more than 42,100—or 43%—more than in 2010. There are fewer than 3,500 PAs and AAs. Patient safety remains of the utmost importance, and regulation will help to bring further clarity to patients and healthcare professionals on the nature of the roles and their respective remits. Regulation will give the GMC responsibility and oversight of AAs and PAs, in addition to doctors, allowing the council to take a holistic approach to education, training and standards. That will enable a more coherent and co-ordinated approach to regulation, and make it easier for employers, patients and the public to understand the relationship between the roles of associates and doctors. Each nation is considering the operational deployment of those roles within their respective workforces.
In England, the long-term workforce plan reaffirms the commitment to PAs and AAs, and commits to increase the PA workforce to 10,000, and the AA workforce to 2,000, by 2036-37. Over the same period of the long-term workforce plan, we will deliver an additional 60,000 doctors. That is a factor of 5:1 in favour of doctors, which I hope addresses the mistaken belief that PAs and AAs will replace doctors within our NHS. It is vital that this expansion is delivered safely. NHS England is working through partners, including the GMC, the Royal Colleges and other stakeholders, to ensure that associates can be effectively trained and integrated into teams across a range of specialities.
To summarise, the draft order will provide a standardised framework of governance and assurance for clinical practice and professional conduct to enhance patient safety and enable AAs and PAs to make a greater contribution to patient care. I commend the order to the Committee.
Andrew Stephenson
I thank my right hon. Friend the Member for Suffolk Coastal and the hon. Members for Bristol South, for Leicester East, for Worsley and Eccles South, for York Central, and for Wirral West for their contributions to today’s debate.
I would like to turn first to the contribution by the hon. Member for Worsley and Eccles South, who spoke movingly on behalf of her constituents Marion and Brendan Chesterton about the death of their daughter, Emily. I know that the hon. Lady also did so in a very moving fashion during an Adjournment debate, which was responded to by my predecessor, my hon. Friend the Member for Colchester (Will Quince). Ahead of today’s debate, I was very keen to listen to that debate, so I watched it back and I am keen to see what more we can do to learn lessons.
No family should ever have to endure the loss of a child, and no words from me will assuage the family’s grief. However, I hope that by passing this order we are helping to ensure that some lessons have been learned and that we can deliver improved patient safety through better regulation of these roles. I recognise that there have been delays to the previously published timescale for the regulation of AAs and PAs. Although that is in part due to the pandemic, it is important to reiterate that this work is being taken forward as part of a broader package of reforms of regulators, governing a whole range of medical professions. That work is significant and complex. On that basis, a huge amount of work and input from all the regulators and a range of stakeholders has contributed to the draft legislation for AAs and PAs, which will be used as a template for reforms to other regulatory bodies.
Throughout this process, officials from my Department have met the BMA and other stakeholders to develop the policy behind this legislation. On the basis of feedback received through public consultation and additional targeted engagement, officials have made a number of amendments to the draft order to ensure that the legislation is fit for purpose and delivers the flexibility and autonomy required to empower regulators to be able to introduce new regulatory processes that would better serve patients and their registrants. That engagement has been crucial in shaping both our policy intention and the resultant legislation to ensure that it remains a practical piece of legislation that can be used by regulators.
The forthcoming GMC rules consultation, which will follow the passage of this order, represents a further opportunity for the BMA and others to have input into the regulation of these roles. When I met the GMC, I was assured that they were confident that they could bring forward this consultation quickly so that there are no further delays to the timetable of implementing these regulations.
Turning to the AA and PA titles, which quite a few Members have raised today, the physician associate title has been well established in the UK since 2014, and the Government have no plans to change the titles of PAs or AAs. As set out in the National Institute for Health and Care Excellence guidelines, all healthcare professionals directly involved in patient care should introduce themselves and explain their role to the patient. AAs and PAs are not and should never be referred to as medical practitioners, doctors or consultants.
The GMC has published interim standards for AAs and PAs in advance of regulation that make it clear that professionals should always introduce their role to patients and set out their responsibilities in the team. Ahead of regulation by the GMC, the Faculty of Physician Associates has issued guidance for PAs, supervisors, employers and organisations that helps to provide a structured and standardised way of using the title. In addition, NHS England has produced patient-facing materials that have been shared widely with GP practices to support patient awareness and understanding of the PA role.
Barbara Keeley
I thank the Minister for his words of sympathy; I will pass them on to Mr and Mrs Chesterton. On patient-facing advertising, I think a couple of months ago, I raised with the previous Secretary of State for Health, the right hon. Member for North East Cambridgeshire (Steve Barclay), a post from Norfolk and Waveney integrated care system that read, “Got abdominal pain that isn’t going away? A Physician Associate based in your GP practice can help…They are highly skilled at diagnosing conditions”. That was marketing material related to the role, which does not help. We have had tragic cases like Emily’s, and it does not help to have over-egged advertising like that. Can the Minister can say anything about that?
Andrew Stephenson
I completely agree. Things like that do not help, and that is why bringing forward these regulations will help. The GMC is obviously very keen to start its consultation and have the regulations introduced. As soon as this is set out in statute, it will be very helpful, not just for PAs but everybody, particularly employers and others, in ensuring that they never oversell the abilities of a PA and are clear about the role of a PA or AA in an integrated health team.
Turning to the shadow Minister, the hon. Member for Bristol South, I thank her for her contribution and join her in paying tribute to the PAs and AAs already working in our NHS. She asked about the impact on training opportunities for junior doctors, which leads me on to addressing quite a few of the points about why we have decided to go with the GMC as the regulator. The assessment of the most appropriate regulatory body for AAs and PAs was completed in 2019 following a public consultation. The majority of respondents were in favour of the GMC taking on regulation, including the professional bodies representing the two roles and the medical royal colleges. For the record, from a total of over 3,000 responses, 59% of respondents felt that the GMC was the most appropriate, while 20% thought it should be the HCPC.
Regulation of the associate roles by the GMC will allow it to take a holistic approach to the education, training and standards of associate and doctor roles. That will enable a more coherent and co-ordinated approach to regulation, hopefully ensuring that concerns around training places for junior doctors, for example, are addressed appropriately. I am happy to reassure the shadow Minister that I will continue to work with all stakeholders to ensure that we get the regulations right.
I thank the hon. Member for York Central, who spoke knowledgeably about these roles. We would all agree that it has been long recognised that we need to reform the legislative framework for the regulation of healthcare professionals to make things faster and more flexible. The current UK model needs to change to better protect patients, support our health service and help the workforce to meet future challenges.
Successive Governments have considered such reforms, but they have never come to fruition until now. While it is our intention to work as swiftly as possible to deliver reform for each regulator and profession, we will prioritise delivery based on criteria including the size of the registrant base, the need for reform, and our assessment of regulators’ readiness to implement the changes. Based on those criteria, we intend to start working with the regulators to develop reform legislation for their professions over the next couple of years.
The hon. Lady asked about fee levels. I believe the GMC’s current plan is to charge AAs and PAs a fee of £221 per annum, adjusted for inflation. That is what PAs are currently paying the FPA—of course, AAs do not currently pay a fee. The GMC, like the NMC and other regulators, works on the basis of their activities being funded by the fees from registrants, which is an important way of keeping them independent from Government.
This draft order represents a vital step forward to improve patient safety by ensuring that PAs and AAs meet the standards that we expect of all regulated professionals and that they can be held to account if serious concerns are raised. I hope that I have addressed as many of the points raised by the Committee as I can, but I am more than happy to continue dialogue with the Opposition Front-Bench team and others to ensure we get the changes right. I commend the draft order to the Committee.
The Chair
Order. Before I put the question, I have a reminder. We have heard from Members from both sides of the House who are not formal members of this Committee, but only members of the Committee are allowed to vote.
Question put and agreed to.
Resolved,
That the Committee has considered the draft Anaesthesia Associates and Physician Associates Order 2024.
Draft Medical Devices (In Vitro Diagnostic Devices etc.) (Amendment) Regulations 2023
Andrew Stephenson Excerpts(3 months, 3 weeks ago)
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The Chair
Before I call the Minister to move the motion, let me I make it clear to the Committee that this is not exclusively a Northern Ireland instrument, as items to which it refers can be sold in the rest of the UK. I will therefore allow this Committee to run for 90 minutes.
The Minister for Health and Secondary Care (Andrew Stephenson)
I beg to move,
That the Committee has considered the draft Medical Devices (In Vitro Diagnostic Devices etc.) (Amendment) Regulations 2023.
It is a pleasure to serve under your chairmanship, Dame Maria.
I will begin by setting out the policy context of the draft regulations. The Medicines and Healthcare products Regulatory Agency is the UK regulator for medical devices, including in vitro diagnostic devices. The agency is responsible for enforcing the regulations and protecting patient safety. The provisions in the instrument will enable the MHRA to carry out its duties effectively in Northern Ireland.
IVD devices are used to test samples taken from the human body, to monitor a person’s overall health or to treat and prevent diseases. These can include complex tests, such as blood tests to detect HIV or hepatitis and tests for cancer biomarkers, or more commonly used tests, such as pregnancy tests. In May 2022, the EU replaced its regulatory framework for IVD devices with a new regulation, the EU in vitro diagnostic regulation. The EU IVDR has automatically applied in Northern Ireland since 2022 under the terms of the Windsor framework.
This statutory instrument brings important benefits to patients and businesses across Northern Ireland. First, it enables the MHRA and the Department of Health and Social Care to protect patients in Northern Ireland more effectively. Without it, the MHRA will lack important powers equivalent to those in place across Great Britain, leaving NI patients lacking important safety protections available elsewhere.
Secondly, the SI is particularly important because life sciences and medical technology are major growth sectors for the Northern Irish economy. It provides for a stable regulatory environment in Northern Ireland, enabling the whole of the UK to remain an attractive market for research and the development of medical technologies. Thirdly, the SI will unblock UK-wide clinical studies of medical devices and IVD devices that include Northern Irish locations. Last, the SI facilitates consistency between the operation of devices regulation in Northern Ireland and GB where beneficial to Northern Ireland, including through provisions to charge comparable fees and to reflect the unfettered access of NI IVD devices into the GB market.
I will summarise the key provisions in the instrument. It lays down proportionate penalties and gives the MHRA powers to serve enforcement notices for breaches of the EU IVDR in Northern Ireland. Although the MHRA previously had the necessary tools to respond to safety concerns, the draft regulations further strengthen that toolkit. The SI also gives the MHRA powers to designate and monitor notified bodies in relation to the EU IVDR and charge fees relevant to those services. Notified bodies in the UK can carry out the technical conformity assessment of IVD devices for EU regulatory compliance, allowing manufacturers to affix the CE and UK(NI) marks for placing their devices on the market across the UK.
Sponsors of performance studies for new IVD devices in Northern Ireland will need to apply to an ethics committee in the UK for an ethics review, and hold sufficient insurance to meet any potential financial liability in the event of injury or death as a result of participation in the study. The instrument also creates an arbitration procedure for refused performance study applications. It allows performance studies of IVD devices and clinical investigations of medical devices taking place in both Northern Ireland and Great Britain to require only a contact person to be established in Northern Ireland, rather than a legal representative, supported by a sponsor or legal representative established in Great Britain. That reduces the burden on business and makes it straightforward for investigations to include sites across the whole of the UK. This will enable more studies and investigations to go ahead in Northern Ireland.
The instrument includes specific provisions to ensure unfettered access of qualifying NI IVD devices to be placed on the GB market with no additional barriers or burden. This product-specific legislation sits alongside general protections for Northern Ireland’s unfettered access to the rest of the UK market under the United Kingdom Internal Market Act 2020.
IVD devices play a critical role in maintaining patient and public health, and this statutory instrument will strengthen the regulation of these devices in Northern Ireland. It protects patient safety and facilitates consistency in IVD regulation between Northern and Great Britain, which will enable the whole of the UK to remain an attractive market for research and development of medical technologies, bolstering the UK Government’s commitment to the life sciences sector.
Andrew Stephenson
I thank the shadow Minister for her remarks and her support in principle for the instrument. She asked about the MHRA’s capacity to deal with these new regulations. We have received assurances that the agency sees this as a tidying-up exercise. It welcomes the regulations, which it wanted to be introduced, and sees no capacity constraints.
To update GB regulations on medical devices with a specific focus on patient safety, the Government will bring forward secondary legislation in the near future. I cannot be more granular about the timescale, but we do intend to introduce that at the earliest opportunity.
We consulted widely on the draft regulations. I was in Northern Ireland on 4 January, when I spent the day meeting life sciences companies in Belfast and Lisburn. The Government are committed to promoting access to safe and effective IVD devices for all patients across the whole of the United Kingdom, and this SI supports that commitment by strengthening the MHRA’s enforcement powers in Northern Ireland. The MHRA has worked collaboratively with the Northern Ireland Department of Health throughout the development of the regulations, and will continue to do so to ensure their effective implementation and to monitor impacts on the market.
By supporting the regulations, we will ensure that the MHRA can effectively carry out its role as a regulatory authority in Northern Ireland, ensuring that patients in Northern Ireland and in Great Britain have access to safe and effective IVD devices. The provisions will reduce the burden on NI businesses when placing a device on the market. We believe the measure will generate innovation and attract investment into the UK and UK businesses, build on the life sciences strategy, and realise the opportunities in the life sciences sector. I am grateful to the Opposition for their support and to the Committee for considering the draft regulations today. I commend the regulations to the Committee.
Question put and agreed to.
International Health Regulations 2005
Andrew Stephenson Excerpts(4 months, 3 weeks 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 George, and I am grateful to the British public and the hon. Member for Lancaster and Fleetwood (Cat Smith) for raising the important issues covered in the e-petition we are considering today. I start by thanking for their contributions the hon. Member for North West Leicestershire (Andrew Bridgen) and my hon. Friends the Members for Shipley (Philip Davies), for Devizes (Danny Kruger) and for Christchurch (Sir Christopher Chope), as well as my right hon. Friends the Members for Wokingham (John Redwood) and for Rayleigh and Wickford (Mr Francois). I also thank the hon. Member for Birmingham, Edgbaston (Preet Kaur Gill) for her remarks. I am only surprised not to see our friend the hon. Member for Strangford (Jim Shannon) here, although I am sure that he would be if he were able.
We have held a similar debate on this matter already. However, this debate is slightly different from the one we had in April; the matter before us is whether the House should vote on amendments to the international health regulations. That has stirred discussions both in this place and outside because it relates to two vital aspects of our governance: our sovereignty and our national interest. On both, I am pleased to offer assurances to colleagues and the public that I am satisfied that our approach to the negotiations safeguards our national interest without compromising our sovereignty. I will set out why I believe that before turning to the specific questions put by my right hon. and hon. Friends during the debate.
Why are the negotiations in our national interest? Because the international health regulations do not just exist to protect others from health threats: they directly benefit the UK and help to keep our people safe. The last decade has shown that diseases such as covid, mpox and Ebola do not respect borders. In the case of other health threats, such as the recent case of botulism in France, the IHR allowed us to swiftly engage with French officials to identify and follow up with exposed UK citizens. When Vladimir Putin committed an act of terror on our own soil, the IHR helped to slow and stop the spread in Salisbury. The IHR provide international standards for what it means in practice for each WHO member state to prepare for, detect, prevent and respond to public health events.
Andrew Bridgen
I thank the Minister for the speech he is making. The point he is actually making is that the IHR are currently working perfectly adequately—in which case, why do we need to amend them?
Andrew Stephenson
The IHR are working well. However, as a number of my hon. and right hon. Friends said in the debate, there has been lots of criticism of how they worked. As the hon. Gentleman will remember, our right hon. Friend who is no longer in this place—Boris Johnson, the former Prime Minister—was one of the leading voices in saying that we should update the IHR, because we surely need to learn lessons and move forwards.
I believe that there is mutual interest—interest for us and for other countries—in working together. One example is delivering a sensitive surveillance system providing an early warning of potential threats to inform decisions that national Governments will make during public health events and emergencies.
Mr Francois
The House has already heard that we may have to vote on the amendments, along with others, by the end of May 2024. It is possible that by then we will already have had a general election. The House has heard very plainly from the hon. Member for Birmingham, Edgbaston (Preet Kaur Gill) that the Labour party would be minded to support all the amendments; when we challenged her, she stopped taking interventions. Labour would back these amendments if it was in government. What would the Conservative party do?
Andrew Stephenson
I thank my right hon. Friend for that point. I genuinely believe that a lot here is in all our interests, and I do not want to turn this into a party political ding-dong. I genuinely believe that having us in Government leading the negotiations and getting them settled before any general election is firmly in the UK’s national interest, because I believe that we will deliver a treaty that is in the interests of all our citizens and respects national sovereignty. However, I very much hope that an incoming Labour Government would do the same. That is one of the reasons why I believe that we need to make rapid international progress to agree any revisions to the IHR—because I believe that we are in a good place to do that now and should move swiftly, rather than kicking it into the long grass. The last pandemic taught us that trying to make things up as we go along was not the best course of action. Laying some good foundations and providing some better certainty on how things will be dealt with is the best way forwards.
Sir Christopher Chope
Surely the regulations and the changes are not just one block that we either accept or reject. The Government can deal with each proposed amended change seriatim—one by one. That is why I hope that my right hon. Friend will spell out, in response to the points that have been made, exactly which of the amendments he supports and which ones he does not.
Andrew Stephenson
My hon. Friend tempts me, but he will remember that we did not provide a running commentary on the Brexit negotiations. We do not provide a running commentary on our trade negotiations. We do not believe that is in the national interest. Indeed, it is very clear that no text in the latest draft of the accord, published in October and available on the WHO website, has been agreed yet. The whole text is still under negotiation. The draft is just a basis for negotiations, and it will evolve. There are areas of the new draft that we clearly reject and there are areas that we would like to make even stronger. This is an active negotiation between 193 member states to come up with revisions to the IHR that we all believe, by mutual consensus, will be in our global interest.
Mr Philip Hollobone (Kettering) (Con)
Would the Minister be kind enough to answer the question posed by my hon. Friend the Member for Devizes (Danny Kruger)? Who is actually negotiating on this country’s behalf, and which Minister has ultimate responsibility?
Andrew Stephenson
The negotiations are being led by civil servants across Whitehall. [Interruption.]
Andrew Stephenson
I do not believe it is right to name those civil servants. I am the overall lead on this in the Department of Health and Social Care. I am working closely and have already met with the Minister of State, Foreign, Commonwealth and Development Office, my right hon. Friend the Member for Sutton Coldfield (Mr Mitchell). Many other Government Departments will also have a very clear interest in this, including the life sciences Minister, my hon. Friend the Member for Arundel and South Downs (Andrew Griffith). Any treaty agreed will of course be subject to cross-Government write-rounds in the usual fashion, to agree a UK-wide position. It is fair to say that there will not just be one pair of eyes from the ministerial ranks looking at this. There will be multiple pairs of eyes looking at this from across Government to ensure that when we get to a deal, it is a deal that can be agreed across Government and that we believe is in the UK national interest.
John Redwood
The possibility that the language may shift from saying “may” to “shall” is fundamental. I welcome all that the Minister has said about the current collaboration. I am glad it is working so well, but that is based on advice and urging, rather than requirement. It seems to me that this is just like the British people voting for the Common Market with the assurance that we had a veto on any law we did not like, but then somebody came along and took the vetoes away without seeking the British people’s permission, and the relationship went wrong from thereon. This could do exactly the same to the WHO, if we take away the veto.
Andrew Stephenson
I hear where my right hon. Friend comes from and I share his concern. As I hope he will recognise, the WHO is led by its 193 member states, which are currently negotiating this. All international health regulations to date have been agreed by consensus, and we would hope that any changes to the regulations are also agreed by consensus. As I say, there are many amendments and parts of the draft that we would not agree to in their current form. I believe these negotiations will hopefully get us into a position—because I believe it is in all our interests and in the national interest—to agree revisions to the IHR. That has to be done through negotiation and consensus. I think that having an approaching deadline focuses minds, and I think it is the right thing to do.
I will give another concrete example of why I believe this is important. During the pandemic, the genomic data shared by our friends in India and elsewhere helped us to tailor vaccines as new variants emerged around the globe. We all saw over the pandemic that, as the shadow Minister, the hon. Member for Birmingham, Edgbaston said, no one is safe until everyone is safe and that global problems require global solutions.
The best way to protect the UK from the next pandemic is by ensuring all WHO members can contain and respond effectively to public health events through compliance with strengthened IHR. Targeted amendments to the IHR will further strengthen our global health security, by helping Governments plan together, detect pathogens swiftly, and share data where helpful and necessary. The pandemic highlighted weaknesses in the implementation of the IHR for global health emergency response. For example, covid demonstrated that the IHR could be strengthened through a more effective early-warning system with a rapid risk assessment trigger for appropriate responses to public health threats.
Philip Davies
Does my right hon. Friend the Minister not fear that what happens in the World Health Organisation negotiations will be very similar to what happens at things such as COP26, COP27 and COP28, at which all these countries sign up to something—most of them knowing full well they have absolutely no intention of following what they have signed up to—and we are left following the agreements when other countries do not even bother?
Andrew Stephenson
I hope that no Government would sign up to any treaty that it will not follow. I agree that, in a whole range of areas, countries around the world have sometimes not fulfilled their part of international obligations, but the UK Government will certainly not sign up to something that we do not believe is fair and proportionate, that is not our national interests and that we would not seek to follow ourselves. I share my hon. Friend’s concern that other countries have not followed regulations in the past, and there is no point in our passing strengthened regulations if we do not believe that other countries will follow them. We believe that the regulations are designed to prevent and control the international spread of disease. They are limited to public health risks and designed to avoid unnecessary interference with international traffic and trade. That is why we support the process of agreeing targeted amendments to the IHR as an important way to better prepare for future global health emergencies.
Sir Christopher Chope
Can the Minister explain the process in relation to the amendments? He talks about consensus, but what happens if this country does not get its way in relation to some of the amendments that it opposes? Would that mean that, if those amendments are incorporated in the final text, we can and will opt out of them?
Andrew Stephenson
Yes, that is exactly what consensus means. To be clear, the WHO secretariat is supporting both processes by hosting the international negotiating body and the working group on amendments to the regulations, and by supporting the chairs to prepare texts and answer questions from member states. Both negotiations, however, are member state-led processes. It is member states that are negotiating; it is not the World Health Organisation. I completely appreciate that some see this as a WHO power grab, but it is important to remember that it is a member state-led process.
We came together with other nations through the World Health Organisation to agree a process to negotiate targeted amendments to the IHR at the 75th World Health Assembly back in May 2022. By consensus, we adopted process-related amendments under article 59 of the regulations. The UK supported those amendments because they increased the timeliness of member states’ compliance with future amendments to the IHR. That will better protect us from future global health emergencies. As part of the agreed process, member states could submit proposed amendments for consideration, and to that end a working group, made up of all WHO member states, through which the amendments would be negotiated and agreed was created.
Andrew Bridgen
The Minister is being generous with his time. The crucial question on which the Chamber and the public would like an answer from the Minister, who is speaking on behalf of the Government who are negotiating the instruments, is whether the Minister believes that the WHO guidance—recommendations, as they were—becoming mandatory under amendments to article 1 and new article 13A of the treaty are compatible with retaining UK sovereignty.
Andrew Stephenson
I think that that was covered in the previous debate and has been covered by various Ministers. We have been clear from the outset of the process that we will not agree to any amendments that cede UK sovereignty. If the UK Government accept an IHR amendment that we have negotiated with our international partners, then, depending on the context of that amendment, changes to international law may be required. In those instances, the Government would prepare any draft legislation, and Parliament would vote on it in the usual way.
It is important to remember that, in and of themselves, IHR amendments and the new pandemic accord do not change the power of UK law. If required, we would ourselves change UK law through our sovereign Parliament, to reflect our international obligations under the IHR amendments. Let me be clear: in all circumstances, the sovereignty of the UK Parliament would remain unchanged and we would remain in control of any future domestic decisions on national public health measures.
Mr Francois
I thank the Minister for giving way so often. To be clear and to follow on from my earlier question, he has put on the record that we have a right to opt out of any amendments with which the UK does not agree. That is reassuring. On that basis, if an amendment were to be voted on by the WHO to say that it could impose a lockdown on the United Kingdom without our approval, will the Minister give a commitment that we would opt out of it?
Andrew Stephenson
I can give a categorical reassurance to my right hon. Friend that that is a red line for the UK Government. We would never allow the World Health Organisation to impose a lockdown in the UK. That is a clear red line for us. I cannot think of any Minister who would agree to such a request.
I can confidently say to my colleagues—as someone who campaigned for Brexit and who has helped to deliver Brexit in this place—that I am passionate about this country’s sovereignty. I believe that the Government’s position needs to be crystal clear and it is one that I endorse. We support the member state-led process of agreeing targeted amendments to the IHR and the new pandemic accord for the sake of global health preparedness, but we will not agree in any circumstances to provisions that would cede sovereignty to the WHO. That includes the ability to make decisions on national public health measures, whether lockdowns, which we just mentioned, or vaccine programmes.
Philip Davies
The Minister will understand people’s nervousness about this. As my right hon. Friend the Member for Wokingham (John Redwood) referred to, in the 1971 White Paper Ted Heath said that there was no question of Britain losing essential sovereignty by joining the Common Market. We saw how that went. My point, and what I am worried about, is whether the Government will have to bring forward proposals that the WHO insists on even if they do not like it, and so bring the power of Government voting to that decision. That is what I worry about, that Parliament will still decide, but that the Government will be forced to bring forward measures in Parliament, even though they may not necessarily agree with them.
Andrew Stephenson
I reiterate: this is a member state-led process, with 193 member states negotiating. It will be a difficult negotiation, but all previous regulations have been agreed by consensus. If the text ends up in a position where the UK Government do not feel that we can sign up to it, the other member states may decide to proceed, but they will not be regulations that we are bound by, because we will not agree to them. This is an evolving situation and we have agreed a pathway for negotiations. As right hon. and hon. Members know, the text and the amendments are available online.
May I turn to some of the contributions? I will start with those paying tribute to my right hon. Friend the Member for Rayleigh and Wickford in paying tribute to his wife and other NHS staff, who did an incredible job during the pandemic. Sometimes, when debating technical issues such as this, we can overlook their incredible contribution, but it is right what my right hon. Friend said today. He also talked about the importance of data sharing globally, which I think we would all agree is vital.
My hon. Friend the Member for Devizes asked when the next iteration of the text will be available. No new texts or amendments have been agreed yet, so there is nothing further to be shared. However, we expect negotiations to continue until May 2024, when member states will agree completion at the World Health Assembly. I am actively exploring ways in which I can keep the House informed of further developments, although as I say, the standing position of the Government on such issues is that we do not do a running commentary on negotiations. I am actively looking at what more we can do to keep Members informed.
That leads me on to another question that my hon. Friend asked about the costs of these measures. Obviously, as we have not agreed the provisions of the treaty, we cannot yet estimate how much it might cost and whether we would publish our red lines. Unfortunately, as I say, I will decline to say more on red lines now; I have set out one clear red line today and we have a very clear red line on sovereignty. However, I do not believe that we should run through these negotiations in public; I believe that we should give our negotiators time to reach as much international consensus as possible.
Mr Hollobone
The Minister is being extremely generous in giving way. One of the lessons from the Brexit negotiations was that civil servants in the room negotiating were not always following the ministerial line, so may I encourage my right hon. Friend to go himself to the negotiations, repeat what he has told the House today, and make sure that the civil servants who are in the room when he leaves get the message that he has just delivered?
Andrew Stephenson
I will certainly bear in mind what my hon. Friend has said. Some of the civil servants involved in the negotiation have already heard clearly from me, the Minister of State, Foreign, Commonwealth and Development Office, my right hon. Friend the Member for Sutton Coldfield, and my hon. Friend the life sciences Minister about various red lines and other things that we are very clear about, so there is clear ministerial input. There will be a part in this process where Ministers can get involved, but I will certainly look into what my hon. Friend the Member for Kettering (Mr Hollobone) suggests and what more I can do to ensure that UK sovereignty is in no way compromised, so that I can continue to provide further reassurance to all those right hon. and hon. Members who have spoken today.
We all want—well, maybe not all of us, but I believe the Government want a strong World Health Organisation that is fit for purpose and able to respond rapidly to global health challenges and future threats. The UK is working with our international partners to shape the WHO in that way.
Our priorities for the amendments and for the accord are global in scope but they are also in pursuit of our national interest. It is in our national interest to prevent another pandemic. Should—God forbid—another pandemic should occur, it is in the national interest to co-operate with others to slow and stop its spread. In these negotiations, I can assure right hon. and hon. Members that I would never countenance acting contrary to our national interest. We will protect our country from future public health emergencies without ceding an inch of sovereignty.
Question put and agreed to.
Resolved,
That this House has considered e-petition 635904, relating to the International Health Regulations 2005.
Sexual Harassment of Surgeons and Other Medical Professionals
Andrew Stephenson Excerpts(4 months, 4 weeks 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 Mundell. I am grateful to the hon. Member for Canterbury (Rosie Duffield) for raising this incredibly important issue. She has been a tireless voice for women in this place, on this and many other matters. Our health service holds a special place in all our hearts. It is appalling that NHS staff face sexual assault. The reports the hon. Lady talked about, “Breaking the Silence” and that from Surviving in Scrubs, make for incredibly difficult reading. I salute the authors for their courage and professionalism.
The first report highlights that up to two thirds of women and nearly a quarter of men had been the target of sexual harassment from colleagues in the past five years. It also states that a third of women in surgery have experienced sexual misconduct in their training, including sexual harassment, sexual assault and even rape. Sadly, there is other such published research about the alarming levels of unwanted sexual behaviour happening to NHS staff and patients, including an investigative report by the Women’s Rights Network, which again the hon. Lady mentioned.
Let me be clear: that behaviour is disgusting and deplorable, and has absolutely no place in our hospitals. Staff who dedicate their lives to helping others need to be able to do their jobs without fear of any kind of abuse, let alone sexually motivated remarks, insults or attacks. NHS leaders have a duty of care towards their staff and patients. Ensuring staff are safe and treated with respect is a crucial part of creating safe and compassionate workplaces.
NHS organisations also have clear policies to deal with reports of harassment or bullying. We know that raising and reporting sexual harassment and misconduct is never easy, particularly when the perpetrators are in positions of authority or are patients. However, victims need to feel confident to raise such issues and be reassured that appropriate action will be taken by their employers.
Caroline Nokes
I thank the Minister for giving way, and welcome him to his new role, appreciating that he has only been in it a few weeks. I gently say to him that there is a real challenge in our NHS when 10% of women in one study reported unwanted sexual conduct in return for career opportunities. That is absolutely about power, and it is going to take a step change to break down those structures that enable such harassment to continue, behind a veil of silence, so that women are still afraid to speak out.
Andrew Stephenson
I pay tribute to my right hon. Friend the Member for Romsey and Southampton North (Caroline Nokes), who is the Chair of the Women and Equalities Committee, for her work in this area. I completely agree with her point; there needs to be a serious culture change. We would all recognise that over many years the NHS has been fantastic in treating patients. However, quite often the same clinicians, in many regards, have not been as compassionate when looking after each other.
The workplace culture that has developed in parts of the NHS need addressing. Even though I am new to my role, with only three weeks in post, as part of the NHS long-term workforce plan, I am looking at that culture and the staff leaver rates across a whole range of different parts of the profession. That is important because we must ensure that people have a safe and enjoyable working environment. At the moment, reports such as those detailed by the hon. Member for Canterbury show that in far too many trusts, employers are falling well short of providing that supportive environment, which is the least people should expect.
Turning to what has been happening, most NHS organisations now have trained staff to help colleagues raise concerns in this area. That includes a network of more than 1,000 local freedom to speak up guardians across all trusts, supported by an independent national guardian to help drive positive cultural change. We have also established a confidential helpline for staff who want to speak up but need guidance about what to do and where to turn. That, again, goes to the point made earlier by my right hon. Friend the Member for Romsey and Southampton North about the experience of people complaining but being passed from pillar to post between the GMC and trust. I hope that the confidential helpline will help make a difference.
NHS organisations must do everything they can to stamp out the unacceptable behaviours at all levels across the health and care system. In April, the former Secretary of State, my right hon. Friend the Member for North East Cambridgeshire (Steve Barclay), convened an urgent meeting with NHS England to ensure that NHS organisations are doing more to tackle such behaviours. We have made some progress, although I acknowledge that there is much more to do.
This year, NHS England broadened and strengthened the remit of its domestic abuse and sexual violence programme, which was established in 2022, to address sexual harassment and misconduct on NHS premises. All trusts and integrated care boards were asked by NHS England to appoint an executive and operational lead for domestic abuse and sexual violence. Those leads are reviewing their policies, training and support systems to enhance support for staff and patients.
In September, NHS England launched the first ever NHS sexual safety charter across the healthcare system. There are now 200 signatories, including NHS employers and the Royal College of Surgeons. Signatories commit to taking a zero-tolerance approach to any inappropriate or harmful sexual behaviours in the workplace by implementing all 10 charter commitments by July 2024. The commitments include establishing clear reporting mechanisms, implementing training programmes and providing essential support for those involved in investigations. NHS England will use the new network of domestic abuse and sexual violence leads to share and promote good practice and develop practical solutions in implementing the new charter.
Data capture is also a key commitment in the charter and to gauge the charter’s impact, the NHS staff survey now includes a question related specifically to sexual safety. That systematic approach reflects a commitment to transparency and accountability in creating a safer working environment. The Equality Act 2010 has also been amended this year to include a new duty on employers to take steps to prevent the sexual harassment of their employees. Implementation of the charter will assist NHS employers with meeting the duty when it comes into force next October.
The GMC is unable to consider complaints about registrants that relate to matters more than five years old unless it considers it to be in the public interest to do so, which has been raised during the debate. We are modernising the legislation that governs professional regulators, which includes removing the five-year rule as part of the reforms to regulatory legislation for doctors. It will allow the GMC greater discretion to consider whether a concern should be investigated. Introducing those changes remains a top priority for the Government.
I hope that these measures show that we are committed to addressing the problem with targeted action. However, I acknowledge that there is more to do, and I would be happy to work with the hon. Member for Canterbury and Members across the House to ensure that we get it right. We will not be satisfied until the number of staff facing sexual harassment is down to zero. There must be a collective effort across our health service to enact change. Strong and effective leadership is crucial, and it starts from the top. The Government, with NHS England driving this work, are calling upon all NHS boards to sign the sexual safety charter and ensure that their healthcare settings are safe places for our current and future workforce.
I will close by acknowledging the bravery of all those women and men who have come forward with their experiences of sexual harassment and misconduct in the healthcare workforce. That includes the testimonies in the report from Surviving in Scrubs, some of which the hon. Member for Canterbury read out. It takes incredible bravery and selflessness to come forward. Thanks to those brave women, and some men, we are getting ever closer to ending the scourge of sexual assault in our health service. I thank the hon. Member for putting a spotlight on the issue today. We must not tolerate it.
Question put and agreed to.