Health Bill (First sitting)
Caroline Johnson Excerpts(1 month, 2 weeks ago)
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Dr Caroline Johnson (Sleaford and North Hykeham) (Con)
I am a member of the Royal College of Paediatrics and Child Health, a member of the British Medical Association and an NHS consultant paediatrician.
Sojan Joseph (Ashford) (Lab)
I used to work in a mental health trust for many years, and I am still its employee—I am on an extended career break from the trust.
The Chair
You are, absolutely. Normally, as a courtesy, I allow a very brief comment if you want to say anything.
Dr Dash: No, thank you.
Dr Johnson
Q
Dr Dash: I do not believe it is affecting our ability to deliver. Much of the work to date has been led by a joint team of people from across NHS England and the Department of Health and Social Care, who are working together, have put together a process and have been going through all the things you would expect of any integration process. That has been a fairly confined team.
As they are starting to look at what needs to happen in each of the different functional areas—the different directorates—that we have set out, they are working with the directors general or the executive directors leading each of those to understand what different functions we need to enact within each of those directorates, and what their teams could look like. They are putting time into that, which is good—that is what we want them to do, not least because they are also looking at ways of working, not just at numbers of people—but I would not say that it is a distraction. In fact, in some ways, I would say it is really helpful, because it is helping to define the core priorities and the key things that we need to focus on, and how we can continue on the journey of seeking to improve health and healthcare services. That is across those executive directors and directors general.
The team who are putting a lot of time into this, not surprisingly, are the people working in the HR functions. That team are spending a lot of time going through the mechanics, and they have been managing things like the voluntary redundancy programme. I would hope, and I believe, that there is no negative impact on our focusing on what we need to focus on.
Dr Johnson
Q
Dr Dash: On the first question, as you say, my first review looked at the CQC, and that there are a number of considerable challenges there. I would have hoped that, by now, many of those challenges had been addressed. Some of them have been, but some of them have struggled. It has already gone from the previous chief exec to a new chief exec, and it is now out looking for another chief exec, and the chair has changed too. That has definitely impeded progress. As I said, it has made considerable progress in some key areas, in particular the use of technology, but it still has a way to go, and we all need to acknowledge that. I note that the ministerial team in the Department of Health and Social care has suggested that the integration of HSSIB into the CQC should happen only when the CQC is in a more stable position, which sounds sensible and pragmatic to me.
On the second review that I did, I was asked to look at the regulatory and quasi-regulatory landscape. I was referred to a report that had been done by Professor Carl Macrae and others that talked about 126 organisations. When I looked, I found more than 150, and I listed all of those in my report. I spoke to many people—well over 200 people who joined various roundtables and so on—and the very consistent theme was that this is so busy and confusing, and keeps leading to all sorts of different recommendations from different organisations, but also to people having continually to respond to all these different bodies asking for people to fill out a form, asking questions and doing reviews. As a result, our clinical staff—not just our nurses, but all our clinical staff—are having to spend considerable time filling out those forms and going through tick-box exercises. You will hear people talk about that a lot.
The concern is that this very busy landscape is distracting from what it is there to do, which is to improve quality of care. I was asked by the Department of Health and Social Care to look at that landscape. I was asked to focus on six organisations, which are listed in my report, of which HSSIB was one. Across the six—of course, six is a small number out of that 150—I was asked to look at where there were opportunities for rationalisation and simplification. The observation was that colleagues in HSSIB have some great skills and capabilities in carrying out investigations into healthcare, highly complementary to the work of the CQC, which is equally there to understand how well different organisations are performing, to give the public confidence, to give ratings and to identify problems, and therefore putting those two organisations together would create significant synergies and opportunities for them both to work well.
Dr Johnson
Q
Dr Dash: I do not see a conflict. I think they are complementary and this is all about improving the regulatory landscape in the healthcare system.
Karin Smyth
Q
Dr Dash: One of the things that I observed when I was doing the review, and that I have observed even more so now that I am in post, is that we do not have effective mechanisms of really learning from patients and patient experience. If I compare how the NHS works with how other large organisations in our country work, we are not systematically collecting patient information, we are not looking at that in detail, we are not segmenting it into different groups of people, and we are not systematically bringing it into board meetings, which is where it should be in order to drive improvement. We are hoping, or expecting, that the new director of patient experience will take a real leadership role in this and will improve the way in which the centre works but, more importantly, will be working with organisations right across the NHS to build those skills and capabilities, and to put patient experience feedback and improvement in patient experience right at the centre of every discussion on improvement.
The Chair
We will now hear evidence from the King’s Fund and National Voices. Again, I fear that we will have to stick to the timings, as we have very limited time. We have until 10.25 am for this session. Could you please identify yourselves for the record?
Sarah Woolnough: I am Sarah Woolnough, chief executive at the King’s Fund.
Jacob Lant: I am Jacob Lant, chief exec of National Voices.
Dr Johnson
Q
“would be minimal in the context of the entire NHS budget”.
Many MPs across the House have struggled to get numbers and costings in questions both oral and written, particularly in relation to staff redundancies. We have not received information on the full arrangements of where NHS England’s functions are going to go yet. How can we be sure that its abolition will save any money at all?
Sarah Woolnough: I think, on the basis of the question, we do not know. Our worry has been about the opportunity cost. The Government, when in opposition, said that they would not launch wholescale reorganisation, because they understood the potential opportunity cost on time and other resources. As this has played out, taking longer than anticipated, we have had multiple examples of teams left in limbo about where they will end up in the target operating model. Our ongoing concern has been, “Is the benefit worth the cost?”
Dr Johnson
Q
Sarah Woolnough: It is inevitable that, in any large-scale change in an organisation, there will be opportunity cost. These arguments were very well rehearsed by the previous Secretary of State. He undertook personally that he would not follow this course of action, exactly because these things take longer and cost more, and because the benefit realisation case is not always clear.
It is also quite hard to tell—we have grappled with this as a think-tank—whether there is good evidence of what you are delivering at the end, and whether the benefits will be realised as you stated they would be up front. It is harder to get the granular evidence and costings to prove the case, but our ongoing concern has been whether you need to wholescale reorganise to drive the sorts of benefits that the Government have said they want to deliver.
We absolutely understand and agree with those who say, “Let’s reduce duplication. Let’s streamline. Let’s make sure that we’re getting value for money and spending taxpayers’ money wisely.” Do you need to launch a large reorganisation—a mass rearranging of the deck chairs of this nature? Our view has been, “You shouldn’t and you don’t.”
Dr Johnson
Q
Jacob, what effect will the abolition of Healthwatch have on people’s confidence in the independence and reliability of views of patient experiences?
Jacob Lant: First, it is important to note that we know that there are people who are reluctant to come forward and share their poor experiences of care with the NHS directly. They fear retribution if they complain or speak up. Research by Healthwatch has shown that about one in five people experience poor care, so a significant proportion of people are unwilling to come forward and speak to statutory agencies. That will be concentrated in communities who are particularly marginalised—those who already lack trust in institutions. There is a clear case already that there will be a group for whom the lack of independence will be a real concern.
The second point is about the unsolicited feedback that is gathered by the Healthwatch network. Dr Dash and others have talked about how the system does lots of engagement itself, and how it could therefore surely take over those functions. But the system engages on its terms: it is about service reconfiguration that it wants to do, or about trying to gather experiences on a particular topic in which it is interested. Healthwatch allows an opportunity for continual listening and engagement with communities, where they can speak up about anything that is affecting them, from dentistry to patient transport and administration of care. Those issues are not necessarily on the system’s agenda. As I see it, under the changes that will disappear.
Dr Johnson
Q
Jacob Lant: There are a few points on that. The narrative around the Bill is that Healthwatch is being abolished and its functions lifted and shifted across to local authorities and ICBs. That is not the case. We lose a number of important functions.
For example, the signposting support that Healthwatch provides will disappear so patients and care users will not have that to help them to understand how to navigate local services. I mentioned the unsolicited feedback that is gathered; that function will disappear. The outreach into communities, particularly marginalised communities, will disappear. The voice for patients and communities on health and wellbeing boards disappears, so there is no feed into those local decision-making bodies. There are several places where there is not a direct lift and shift across. That is a concern, and the Committee should probe it further.
On the resourcing point, at least local authorities will get part of the existing funding for Healthwatch to support their functions in that space. Under the Department’s impact assessment, ICBs will not get any funding from the current pot. That represents a 50% cut in the resourcing for listening to patients and communities, which is a concern.
Karin Smyth
Q
Sarah Woolnough: As an organisation, we have taken the view that we would not necessarily relitigate the decision. I think you can argue it both ways. I understand the desire to reduce duplication and to have clearer lines of accountability. Our concern has been the opportunity cost and everything that you are not doing at the time that you are spending so much energy and resource driving the abolition through.
Jacob Lant: I would echo everything Sarah says. From the work that we do, we see that decision making is taking longer, programmes are taking longer and it is taking longer to secure an impact on things. That is very frustrating, and underpinned by the massive change that is ongoing. Let us take as an example a programme exploring the experience of waiting for hospital care—of being stuck on waiting lists. Jim Mackey spoke about that at the NHS ConfedExpo last week. It is a major focus for the NHS and new guidance is expected by the end of the month. We have been waiting for that since 2021. The most recent effort towards it has been about 18 months. I can only think that drags on because we have so much other change going on in the system. I wish we focused more on doing things directly for patient care.
The Chair
We shall now hear evidence from the Academy of Medical Royal Colleges and the Institute of General Practice Management. Once again, I am afraid we have to stick to the timings. This session will end at 10.55 am. Will the witnesses briefly introduce themselves for the record?
Kay Keane: I am Kay Keane, a full-time practice manager at Urban Village medical practice in Manchester, and the chair of the Institute of General Practice Management.
Dr Dickson: I am Jeanette Dickson, the current chair of the Academy of Medical Royal Colleges, a past president of the Royal College of Radiologists and a practising consultant clinical oncologist.
Dr Johnson
Q
Dr Dickson: I would go back to some of the comments that have been made before. It is the opportunity cost at the moment. We know that the workforce plan is being worked on in the background, but when you are unsure what the operating and delivery model will formally look like, there is a difficulty in seeing what the workforce for that will be. We are also talking about massive changes in the way we think about care delivery—movement into the community and a different way of working—so we need a different workforce.
Therefore, we need to put in some work to look at how curricula drive a different type of workforce, how we train people to work in a different way and how we empower them to see the opportunities to work in that way, when they do not have actual role models. We need a culture shift anyway, whatever is happening, but the abolition of NHS England is in many ways increasing the time. Things need to move, and they are moving, but they are not necessarily moving as fast as they should.
Dr Johnson
Q
Dr Dickson: We are delivering services as normal, but that head space and the innovation to see what the future should be and to work towards that future actively are limited by not knowing what that future looks like.
Kay Keane: We do not know what the left shift that we keep hearing about looks like; we do not know what that is for practices. In general practice, we are very practical—we get on with what is in front of us—so the big organisational changes do not have a huge effect on the day-to-day seeing of patients and organising that, but understanding what is around us does.
Dr Johnson
Q
Dr Dickson: The legislation is very much an enabler for a single patient record. The devil in the detail there is not entirely true. In my experience, if you ask most patients if they would like a single patient record, they feel that it is already there. They do not understand that we do not have the ability to share their data in a way that works for them. Therefore, the idea of a single patient record is very much a lodestone for medical practitioners and most patients. When you talk them through the detail of how you achieve that and who owns the data, it is a much trickier issue for many, including the professionals, but also the public.
Kay Keane: I agree. The detail is not there at all. At the moment, we look after the data that is in the GP summary care record. That creates lots of questions for our patients. They will see information in there that they are not sure about or that they want help with. They will perhaps be able to read some of their hospital letters within that record. However, lots of patients have a variety of health inequalities that might mean they cannot access that data. In general practice, our non-clinical staff often help them to navigate their way around all that information. We also have patients who will read something in their record on which they want clarity—maybe something that happened a long time ago that they cannot remember and want explaining to them.
All those things take time. Where will the responsibility for that go? It takes an awful lot of resources in general practice to educate and support patients and to help them navigate their appointments and the letters coming through. Where will that responsibility sit? At the moment, it is of course with the GPs, but practically it is practice managers, up and down the country, who take on the day-to-day responsibility.
Dr Johnson
Q
Dr Dickson: You need to believe that you have found out enough about a patient to deliver their healthcare. I would turn it around and say it is very difficult to deliver appropriate care to somebody on whom you do not have full information.
Karin Smyth
Q
Dr Dickson: Part of it has been touched on by the previous panel, regarding patient experience. Patients come in, they give the same story again and again to different healthcare professionals in different settings, and that frustrates them. Patients are human. I forget what I did last week; patients forget what they did last week, let alone what they did 10 or 20 years ago, although that is still relevant, increasingly. If you go on holiday to Whitby, fall over and break something, have tests done and come back to your house in central London, you cannot see information about that; you cannot share that information.
The opportunity to see everything on a patient across primary care, secondary care and social care is a huge benefit to them in terms of their view of seamless care, but also in terms of safety. I have a chronic health condition; part of my care is delivered by general practice and part by a hospital. At the start of the pandemic I was exceptionally clinically vulnerable; it took the NHS six weeks to tell me that. That is not safe.
The Chair
We will now hear oral evidence from the Health Services Safety Investigations Body. Again, we must stick to the timings, but we are doing rather well at the moment—let us hope we can stick to that. Would you be kind enough to identify yourself for the benefit of the record?
Dr Benneyworth: Good morning, everyone. My name is Rosie Benneyworth and I am the interim chief executive of the Health Services Safety Investigations Body.
Dr Johnson
Q
Dr Benneyworth: We are a safety investigator. We have been modelled on other industries that have very successful safety records, and we have learned from those other industries. We investigate patient safety concerns of national significance, and we make recommendations into national bodies about what needs to be improved. We make very few recommendations—only small numbers—into those national bodies, but they are about what needs to change from a systemic point of view to make patient care better. That is underpinned by learning from other industries—the safety science, the human factors and the real knowledge about how you improve safety—and we are trying to embed that in the NHS.
Regulation is very different. That looks at individual providers. I used to the work for the CQC and regulate primary care. It looks at how individual providers are functioning. It makes recommendations to individual providers about what needs to change, and it judges an individual’s performance against a set of regulations. The two functions are completely different.
The other important thing for us is that we do not attribute any blame or liability in our investigations. That is vital, because we learn from what we see. We learn from those investigations, and we are trying to embed a continuous learning environment and culture within the system.
Dr Johnson
Q
Dr Benneyworth: I think it will be very difficult. At the moment, we have the ability, being an independent organisation, to investigate any part of the system where there is a concern. That includes the national system. In several of our investigations we have looked at how the national system, the regulatory system and NHS England are working, and how other parts of the system are working. We are unique in that, because a lot of those bodies do not get the scrutiny from any other part of the system, and they do not get that oversight and ability to look and understand how the national system works together.
If we were a directorate in the CQC, as outlined in the legislation, it would be very difficult for us to comment on how the CQC was looking at different areas and how it was managing certain aspects of safety. I think there is also concern about our ability to make effective recommendations to the CQC if we are a directorate within it.
Dr Johnson
Q
Dr Benneyworth: That would be unusual. We have undertaken one very detailed set of investigations into mental health in-patients, which was directed by a previous Secretary of State. We would very much want to hear the patient safety concerns of the Secretary of State to understand what we investigate. We work extensively with stakeholders across the system. We want to be a constructive part of the system. We want to investigate the areas that people are concerned about. We work extensively with all stakeholders to hear their patient safety concerns and make sure that our investigations are informed by that knowledge and by what we are hearing from patients and families, as well as staff working in the system.
However, we need to make sure that we have the independence to investigate what we are hearing about. It is very important that we are not stopped investigating something, and it would be concerning if someone told us not to investigate something. We need to maintain that independence.
Dr Johnson
Q
Dr Benneyworth: There is no doubt that it helps to improve safety. That is something we have learned from 100 years of the air accidents investigation branch, which has had an immense impact on aviation safety, the rail accident investigation branch, and many others. Safe space, or protected disclosures, means that people can talk freely to us about things that have gone wrong without fear of sanctions, being told off by their line manager or losing their jobs.
We hear all the time about people who have ended up losing their jobs or getting into trouble because they have raised concerns. We see in our investigations that we are still working in a culture of fear. In an ideal world, that would not be the case and people would feel able to speak up openly about what has gone wrong, but we are working in a culture where people are not in that place.
This enables staff working in the service and patients to talk to us freely about what they see on a daily basis that they think needs to change. Patients sometimes worry that they will be treated differently and not get the same care after they raise things. This enables patients to talk to us in the knowledge that they will not be named. The patients we work with who have been harmed from healthcare tell us, “We don’t want this happening to other families. We’ve been through this awful, terrible time, and we want to change the system.” This enables them to talk to us.
We do not name individuals in our reports and do not name organisations. We are now in a stage where we are growing that trust. We are coming up to being three years old as an organisation, and we are growing that trust with the system. When we launch an investigation, organisations right across the country say, “Please come and see what’s happening here. Please come and talk to us.” I worry that that might be impacted by the changes ahead.
Karin Smyth
Q
Dr Benneyworth: The two key things have been touched on already. The first is the independence to choose what we investigate and make recommendations to any part of the system. The second area is around protected disclosure. The legislation needs to be much clearer around the protection of protected disclosure materials, to give the system confidence in our ability to hold and not share confidential information.
At the moment, the legislation talks about connected individuals having access to the protected materials. The clauses outlining connected individuals mean that anyone working in the CQC could potentially have access to protected materials. That is a very large number of people, and it will create risk. There needs to be a legal duty on the CQC to protect the safe space. There is also something about maintaining an identity that gives people confidence that when they are talking to us, their information will not automatically go into the CQC regulatory functions.
Some of that may be about perception rather than the reality of what is happening, but as we know, perception is very important. People will perceive that we are part of the regulatory system even if we have the same email address, for example.
The Chair
We shall now hear oral evidence from Sir Jeremy Hunt MP. Again, we must stick to the timings and we have to finish at 11.25, so we have got just 15 minutes to put our colleague through the mincer. For the benefit of the record, would you like to identify yourself?
Sir Jeremy Hunt: Jeremy Hunt, former Health Secretary.
Dr Johnson
Q
Sir Jeremy Hunt: As the Committee knows, the principle of HSSIB was modelled on the airline industry, where the air accidents investigation branch has a superb track record of identifying safety breaches. There is a very good rail accident investigation branch that does the same for the railway industry, to make sure lessons are learned. My concern was that the NHS and actually health systems across the world are not very good at learning lessons when there are tragedies.
The heart of what the AAIB has is this concept of safe space, where people can talk to it completely without fear that what they say will get passed on or used against them in a court of law, and so they are very open about what may have gone wrong, allowing a rapid conclusion to be drawn. So that was the principle behind it.
I am against the transfer of HSSIB to the CQC for two reasons. First, I am worried that it will undermine that safe space principle. I think the safe space principle is the bit of HSSIB that is working very well and I am worried this will undermine that. Secondly, the Bill does not do anything to address the bit that is not working well, and that bit is that the NHS is still very poor on acting on recommendations that are made, and by the way not just by HSSIB but by public inquiries, prevention of future death notices, by maternity and newborn safety investigations reports.
We are the world champion at doing inquiries and reports. Unfortunately we are also the world champion at allowing those reports to gather dust without anything actually happening. What I would really like the Bill to do is something, whether through the National Quality Board or whatever, so that the public know that when HSSIB or MNSI or a Select Committee or a public inquiry makes a recommendation, the Government have to make a formal decision within a limited time period—“yes we are going to do this” or “no we are not”; no sitting on the fence about “this is under review and we will consider it, come back to it”, but a positive or a negative decision—and then if it is a positive decision, a timeline by when it will be implemented. That is not a party-political point, because this is a problem that was not fixed when I was Health Secretary and it has remained outstanding for many years. Families just put their heads in their hands in despair that they get these inquiries, get these recommendations, and nothing changes.
Dr Johnson
Q
Sir Jeremy Hunt: What HSSIB has done is positive but it is still trying to solve a bureaucratic problem with more bureaucracy. What there needs to be is a formal system with a legal obligation on the Government. I felt this when I was chair of the Select Committee as well—that Governments would kick recommendations that were awkward, usually things that cost money that they did not want to spend money on, into the long grass without actually saying whether they agreed or disagreed with them. There is a terrible phrase that is often used: “agree in principle”. I may have been the one who invented it, but it is really bad for accountability because it allows the Government to say, “Yes, we really understand where you are coming from, but we are not going to put any timeline or give you any commitment as to whether we are actually going to make the change”. I think we need a proper system—and if it is the National Quality Board, that would probably be a good place—for formally assessing all public inquiry recommendations, all Select Committee recommendations and HSSIB recommendations, and saying, “Yes, we’re going to do this” or “No, we’re not”, but if it is yes, it will happen by this date with this person being responsible.
Secondary Breast Cancer
Caroline Johnson Excerpts(1 month, 2 weeks ago)
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Dr Caroline Johnson (Sleaford and North Hykeham) (Con)
It is a pleasure to serve under your chairmanship, Mr Betts.
I congratulate the hon. Members for Wokingham (Clive Jones) and for City of Durham (Mary Kelly Foy) on securing this debate, which I know is extremely personal to both of them. I also congratulate the hon. Member for West Lancashire (Ashley Dalton) on her speech. It is quite common in this place for people to say that an hon. Lady or hon. Gentleman has given an extremely powerful speech, but that was an extremely powerful speech. I was moved by it, and I am in great admiration of her courage and the frankness with which she speaks in this House about her illness. I was fortunate enough to be at a roundtable earlier in the week with the New Statesman about the cancer plan, with the hon. Member for Wokingham and others. I found it very insightful and thought-provoking, like the contributions we have heard in the Chamber today.
As has been said, for many people, primary breast cancer never comes back after treatment, and treatment for primary breast cancer has significantly improved. But sometimes the cancer cells spread to other parts of the body—commonly the bones, lungs, liver, brain or skin—which is called secondary or metastatic breast cancer. As we have heard, the best estimate we have is that there are around 61,000 people living with secondary breast cancer in the United Kingdom, but that statistic is uncertain and the data is unclear. One point in the cancer plan was that the Government would collect the data on secondary breast cancer from 2026. We are almost halfway through 2026, so I would be grateful if the Minister could provide an update on how that is going and when we will see that data. Also, how frequently does she expect it to be published—will it be published monthly, quarterly, every half year or every year? What are her plans for that? There needs to be definition in order to do that, so I wonder if she has settled on that too.
Another point in the cancer plan is the desire to improve screening. Again, I commend the hon. Member for West Lancashire on her work on the cancer plan, but there are women in Lincolnshire waiting five weeks and more for referral to their appointment when they discover a breast lump, and we know that the longer it takes for diagnosis, the more likely metastasis is to occur. Could the Minister give more detail on the promise to expand screening? What does it look like? What workforce will be necessary and when will that be in place? What mammography machines or ultrasound machines might be needed? Are they to be bought and installed, and how quickly does she expect that to happen? For those who need genetic testing, what plans does she have to expand the availability of genetic testing, and what will the timescale be?
The cancer plan, which I am glad is very ambitious—it should be—will work only if it is delivered. It was published just over four months ago, but it is not clear what progress is being made or that the work is continuing at the necessary pace to deliver the ambitions we all want to see achieved. One thing slowing progress is the reorganisation of integrated care boards in response to the cutting of their budgets by 50%, and the Health Bill’s abolition of NHS England. The people who would be organising and planning are organising and planning something else. Some of them are leaving, so we are losing expertise, while others are being made redundant—or leaving before they are made redundant. That is disrupting the planning of our health services. Will the Minister comment on that?
As has been said, there has not been the same progress for treatment of lobular breast cancer as for other forms of breast cancer. The previous Conservative Government committed £20 million to the Moon Shot project, to research ways of advancing treatment of that particular form of cancer, which needs more attention than it has had of late. Will the Minister tell us whether this Government are committed to providing that money for that research?
Hospices provide amazing services for people towards the end of their lives, but, as we have heard in other debates in this Chamber, they are struggling. They have a lot of staff because theirs is a very person-delivered service, and they accrue extra national insurance costs from employing all those members of staff. I appreciate that the Government have put a lot of money into hospices, but that is capital money to enable them to redecorate, build extra bits, provide extra equipment. That is lovely, but it does not help if there are no staff to run the service and provide the care that the patients so desperately need. What discussions has the Minister had about the effects of national insurance contributions on hospices? Has she considered an exemption? What are her plans to help to support the hospice movement?
The hon. Member for West Lancashire referred to what happens when a patient has run out of options. As a doctor, I am always told that a doctor never runs out of treatments. Palliative treatment is treatment, so even when they run out of treatments, they are still providing a treatment. However, what happens when we run out of treatment that is active or likely to be successful in prolonging life or curing disease? It is important that research is supported and able to continue. I look forward to the Minister’s words on what the Government are doing to support research so that new drugs can come online. During the pandemic, we saw how quickly vaccines were brought through the pathway. What is gumming things up now? How do we speed it up so that people can get the necessary drugs more quickly?
What happens in the grey zone, when a drug is going into trial and is sort of but not quite available yet? We have compassionate use schemes, about which I asked an urgent question in the main Chamber this morning. Such schemes are used when individuals have reached the end of the treatment options and perhaps do not qualify for any of the trials that are currently available—in paediatrics, that could mean that they are a few days out of the age bracket—or perhaps the trials are full. Those schemes are also used when a patient received the drug in a trial, but the trial is finished and negotiations about the drug are ongoing. In some cases, the drug companies will provide those drugs to patients for free to help them.
Unfortunately, towards the end of last year, the Government decided to charge VAT on the deemed value of such drugs. That means the companies have to pay sometimes quite significant charges to give those drugs to patients. One large pharmaceutical company has pulled out of the compassionate use scheme, which means that its drugs are not available for the people who need them—that issue was raised by my hon. Friend Member for Hornchurch and Upminster (Julia Lopez). The enforcement of that tax by His Majesty’s Revenue and Customs has been paused for review, but the liabilities remain.
We therefore have a situation in which some drug companies are pulling out and others are considering their position. People with secondary breast cancer, and those with other cancers and serious illnesses, cannot wait for the autumn Budget. They need the Government to make a decision to sort this problem out now. Only last month, the Government decided that they would take VAT off rides at Alton Towers. That is great, but if they can do that, they can sort this issue out as well, and they need to get on with it. Will the Minister raise the matter with her colleagues in the Department of Health and Social Care and in the Treasury to see what she can do to help people who have no option other than these new and special drugs to keep their hope alive?
In summary, the cancer plan is ambitious, which is great—it has some great targets that I hope can be achieved—but we need to see delivery. I am looking to the Minister for the detail on how the plan will be delivered.
Compassionate Use Medicine Schemes: VAT
Caroline Johnson Excerpts(1 month, 2 weeks ago)
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Dr Caroline Johnson (Sleaford and North Hykeham) (Con)
(Urgent Question): To ask the Secretary of State for Health and Social Care if he will make a statement on the effect of VAT on the availability of medicines through compassionate use schemes.
The Minister for Secondary Care (Karin Smyth)
It is very important for patients to have access to innovative medicines as quickly as possible, especially where there is unmet clinical need or no alternative treatment. We are working to streamline the decisions of the National Institute for Health and Care Excellence and the Medicines and Healthcare products Regulatory Agency so that NHS patients benefit from the latest medicines as soon as they are proven to be safe and effective.
Early access and compassionate use programmes can play an important role in enabling patient access to medicines ahead of routine commissioning decisions. However, we should be clear that these programmes are commercial decisions taken by pharmaceutical companies: companies choose whether and how to provide medicines free of charge to patients and the NHS before the medicines go through licensing, post-trial access or a funding decision.
The tax system is, as Members know, a matter for the Chancellor, so I will not get into details about that at the Dispatch Box, but under long-standing VAT rules, supplies of goods free of charge can still be treated as taxable “deemed supplies” where input tax has been recovered. That means that VAT can apply even where no payment is made, reflecting established principles of the tax system. We recognise the concerns raised by industry and others about the potential impact of this treatment on the provision of free-of-charge medicines. We are working closely with the Treasury and His Majesty’s Revenue and Customs to explore options to address these issues, as witnessed by my hon. Friend the Exchequer Secretary to the Treasury, who is here with me on the Front Bench. We will carefully consider the legal, fiscal and operational implications of any potential changes. Until then, we will continue to engage constructively with industry, the NHS and all our partners to make sure that British patients, who we have in our thoughts at all times, have access to innovative medicines.
Dr Johnson
I declare an interest as a consultant paediatrician. One of the worst moments as a paediatrician is when all treatments have failed and there is no suitable clinical trial. At that point, in those dark moments, compassionate use schemes can be a glimmer of hope, and new unlicensed medicines with clinical potential have been provided free to the patient, and free to the NHS. Last year, however, the Government started charging VAT on the deemed value of those drugs, meaning that companies had to pay tax to give the drugs away. When hearing that “every meeting” with Labour MPs was about
“who can we tax in order to pay benefits to others?”
few would have imagined that that would include potentially lifesaving, charitably given drugs for sick adults and dying children.
Following lobbying by my hon. Friend the Member for Hornchurch and Upminster (Julia Lopez), the Government have paused enforcement while they review the situation, but they have said that liabilities remain, and they are taking too long. Bayer has now withdrawn from the scheme, and others could follow. Patients are at risk. Does the Minister recognise that that makes trials in the UK less attractive, and that HMRC’s pause is not enough? How much money do the Government expect to raise with this VAT? How did the Government find time to reduce VAT on fairground rides at Alton Towers, but not to sort out this problem? How many patients have missed out so far? Does the Minister recognise that this delay could cost lives, and who was the Minister who signed this off? Was it the Health Secretary when he was a Minister in the Treasury?
I understand that the Government say this situation is not new, and that it may apply to a law dating back over 30 years. I gently point out, however, that the application is new, and that the levers to change it—and change it quickly—lie in this Government’s hands. Patients need them to act swiftly.
Karin Smyth
I pay tribute to the hon. Lady’s service as a clinician, and she is right to say that, at times, for patients facing such situations, compassionate use schemes are a glimmer of hope, but I think the rest of her comments were ill deserved. I understand the desire of the Opposition to attack a new Secretary of State because he was in the Treasury, but I will move on to the actual issues, because patients care about this. The rules had been in place for a long time when this Government took office, and we have not changed them. We have inherited this system, and we are looking at how we can improve it.
The previous Government could have abolished VAT on such medicines, but they chose not to do so. What is more, since we have been in office, we have struck a deal with the USA that not only guarantees 0% on pharmaceutical tariffs, but changes the old formula that we use for medicines. For the first time in 20 years, the Government are spending more to ensure that our patients are first in the queue for innovative medicines. The previous Government could also have raised the threshold, but they chose not to do so. Now, for example, patients facing Duchenne muscular dystrophy, children as young as 12 who need a brain cancer drug, or those who have a type of rare and aggressive stomach cancer, are being treated.
We recognise the importance of the UK remaining a leading location for life sciences, investment and innovation. That is precisely why we are engaging with industry and partners across the Government to understand and address concerns, including the issue of VAT payable on donated medicines. In considering a way forward, it is important to safeguard the robust and fair system by which routine access to medicines commissioned by the NHS is determined. A range of options are being considered. No decisions have been made at this stage, and I will not pre-empt any.
Draft Food Supplements Purity Criteria (Magnesium L-threonate monohydrate) (England) Regulations 2026
Caroline Johnson Excerpts(1 month, 2 weeks ago)
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Dr Caroline Johnson (Sleaford and North Hykeham) (Con)
I just have a couple of questions. I have read about magnesium L-threonate: it is supposed to promote relaxation, unlock true cognitive potential, improve sleep, mood and overall wellbeing, and enhance mental clarity, memory and focus, so I was thinking I might get some of that. However, if I were to recommend it as a supplement, there are a couple of things I would need to know. What would the dosing be? Can the Minister confirm whether the plan is to set the dosing of magnesium in line with other types of magnesium supplements and in line with the EU, or has that not been decided? Will that be decided on a different day?
My other question is how, when we look at supplements, we can be sure they contain what it says on the tin. The Food Standards Agency regulates that, but how many reports has it had of concerns about the content of supplements, and how many products does it test? I looked at its retail survey for 2025, which found that 83% of caffeine supplements failed because they had the wrong amount of caffeine, there were allergens not described on the labels, or they contained substances that should not have been there. How often should we expect the supplements to be tested? What sort of programmes are in place to ensure that the huge variety of supplements that people can choose from in shops these days are safe and that they contain what they say they do? Other than that, I am happy with the regulations.
Oral Answers to Questions
Caroline Johnson Excerpts(1 month, 3 weeks ago)
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Dr Caroline Johnson (Sleaford and North Hykeham) (Con)
Does the Secretary of State agree that state-funded healthcare should be provided to all children based on clinical need, not economic or educational status?
James Murray
It is an essential part of our NHS and its founding principles that the NHS is available to all on the basis of need, not their ability to pay. That is a fundamental principle that we in the Labour party support. I know that some Opposition parties have been moving away from that recently and seeking to privatise the provision of our health service and move to an insurance-based model, but Labour Members believe that all people, including children, must get healthcare based on their need rather than their ability to pay.
Dr Caroline Johnson
I thank the Secretary of State for his answer. Does he therefore share my concern at reports that some children are being turned away from state-funded healthcare because they are not attending a state school? Will he look into those reports and ensure that he makes provision for children who are not attending state schools to receive the healthcare they need?
James Murray
I am surprised by the hon. Lady’s remarks, because where a child goes to school should have no bearing on their ability to access NHS services. If she would like to write to me with further details, I would be happy to look into that matter.
Health Bill
Caroline Johnson ExcerptsMonday 1st June 2026
(1 month, 4 weeks ago)
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Dr Caroline Johnson (Sleaford and North Hykeham) (Con)
Before I start, I must declare an interest as an NHS consultant paediatrician, a member of the British Medical Association and a member of the Royal College of Paediatrics and Child Health, as well as someone who has been moved to the back of a waiting list, after asking for a consultant review for the third time, and finding that I still do need it but it will have to wait a bit longer.
Churchill once said:
“Healthy citizens are the greatest asset any country can have”.
Good health is perhaps the most important asset that any individual can have, and I am sure that across the House, we all want the very best healthcare and the most efficient NHS for our constituents. As such, I am confident that this Bill has been brought before the House with the very best of intentions, but does it achieve its goals?
In general, organisational restructure involves some sort of assessment of where we are now, followed by a vision of what the future should look like, and then a focus on how to get smoothly from A to B. The Government started with a review of the current system. They called it the “Independent investigation of the NHS in England”, although the House should note that it was independently conducted by a former Labour Minister. In his report, Lord Darzi said that
“a top-down reorganisation of NHS England and Integrated Care Boards is neither necessary nor desirable”.
The then Secretary of State, the right hon. Member for Ilford North (Wes Streeting), seemed to agree. In September 2024, he was reported as saying that a top-down reorganisation was the “last thing” he wanted to do. Within six months, he seemingly changed his mind, which he is allowed to do, but it is regrettable that, having begun the last thing he wanted to do, such little progress has been made on his promised first acts, such as the roll-out of fracture liaison services. So many other promises are delayed, undelivered or, in the case of the promise to double the number of medical school places, somewhat bizarrely denied.
Another of the Government’s stated objectives is improving the patient experience. At the moment, we have Healthwatch—an independent organisation that listens to patients and provides feedback. More than 300,000 people a year share their experiences with their local Healthwatch to improve services, and that feedback has led to positive change. The Government cited Healthwatch data in their King’s Speech publication. Against the backdrop of rising clinical negligence claims, concerns about maternity care and even reports of abuse in hospitals, it is clear that more must be done to listen to patients and address the problems, but this Bill abolishes Healthwatch England and effectively ends local Healthwatch organisations. The Government plan to replace it with a patient experience directorate within the Department of Health and Social Care. As Councillor Dr Wendy Taylor of the Local Government Association has warned that this
“risks organisations being seen to mark their own homework.”
There is another concern. Facts are stubborn, but statistics can be pliable. How can the public ensure that they are getting reality and not spin from the Government? Ministers keep celebrating falling waiting lists, when in fact patients are being removed from the list without treatment because their appointments have been cancelled, because they missed an appointment they were not told about, because they have not filled in a form, or because they were called several times asking if they still needed an elective operation and agreed to see a consultant to check.
My hon. Friend the Member for Harwich and North Essex (Sir Bernard Jenkin) made a passionate speech about the importance of HSSIB. This Bill seeks to abolish the Health Services Safety Investigations Body. It provides a safe space, modelled on air accident investigations. Through the avoidance of blame and liability, it can get to the truth and prevent future tragedies. The Bill abolishes HSSIB apparently to simplify the patient safety landscape and reduce the number of organisations. In response to criticism, the Government have attempted to provide reassurance by saying that HSSIB will retain autonomy within the CQC, but the Government cannot have it both ways. Is HSSIB being abolished, or is it being hidden within the CQC?
Either way, the new unit within the CQC will face a number of challenges, such as the undermining of confidence in safe spaces, because it will be within a regulatory body. Its independence will be undermined, because Ministers have now signalled their intent to direct the vast majority of investigations and because the national quality board will prioritise any recommendations that they make. We will also have a CQC board without full oversight of what it is accountable for and, somewhat bizarrely, a risk that if the regulatory part of the CQC wants information from the safe space, and the other part of the CQC does not want to publish it, we could see the CQC suing itself. We have all this upheaval to have one less—or at least the illusion of one less—organisation. How on earth does that improve patient safety?
As many have said, including my hon. Friends the Members for Runnymede and Weybridge (Dr Spencer) and for South Northamptonshire (Sarah Bool), the single patient record is a good idea in principle. Patient information is currently fragmented across different parts of the healthcare system, and bringing it together could save lives, save time and improve prevention. However, the introduction of such a system must be well executed.
First, there are practicality concerns. Do patients want their full medical records, including sensitive conditions and perhaps including sexual health records, visible to every health professional? The hon. Member for Bury St Edmunds and Stowmarket (Peter Prinsley) talked about the difference between a single patient record that is all of the same type and one that is part of a federated platform. The Secretary of State talked about linking up people’s ability to see the current system, but there is huge variety in systems. Even within one hospital, there might be a different system for maternity, A&E, blood results, historical notes and current clinic appointments. Will NHS staff be required to learn all those systems for all over the country, or will data be transferred to a new system? Either move has its downsides, but I am not clear which the Government intend to do.
Secondly, there are security concerns. As has been said, the NHS has the most valuable health dataset in the world. The Government must provide clarity in relation to who controls the data, who is responsible for maintaining its accuracy, and how it will be kept securely. Hackers are already trying to gain access to it, knowing that even if it is encrypted, quantum computing will be able to unpick encryption in the years to come. The Government must ensure that they are quantum-ready. What role is the National Cyber Security Centre playing in this regard?
Life, in all things, is a balance. If arm’s length bodies are in control of things for which Ministers are nominally responsible, we have a democratic deficit, and it is understandable that the Government want to recoup that, but, as we heard from my hon. Friend the Member for Meriden and Solihull East (Saqib Bhatti), the powers in the Bill for them to take control of everything risk the creation of a politicised service in which those who shout the loudest get preferential treatment. Those with very rare conditions such as corticobasal degeneration, Wiskott-Aldrich syndrome, Lafora body disease, Friedrich’s ataxia and many more such conditions may not have as well-funded or celebrity lobby groups acting on their behalf as those with other conditions. How will the Secretary of State ensure that clinical need drives the provision of services, rather than the resources of lobby groups or access to Ministers or, indeed, the Secretary of State?
As the NHS is undergoing a massive reorganisation, I am mindful of what the Minister once said:
“The reorganisation of health services always distracts from people’s jobs, destroys morale and wastes money”.—[Official Report, 22 September 2022; Vol. 680, c. 809.]
It also stalls progress and takes a lot of staff time, which may be why we have a 10-year health plan that took a year to write, why the workforce plan has still not been produced, why the so-called “rapid” national maternity investigation has not been completed, why waiting lists are up for patients referred for admission in several specialities, why we have a glacially slow roll-out of fracture liaison services, why the mechanical thrombectomy service promised for stroke victims by April is not available, why there is no response to the Hughes report, why there is a denial of the promise of an increase in the number of medical school places, and why doctors have announced their 16th strike, costing millions of pounds in appointments. The Government promised results, but all they have delivered is disruption, delay and disappointment.
I feel for the current Health Secretary. His predecessor was more focused on unseating the Prime Minister, and he is left to pick up the pieces. However, despite our political differences, I do have hope. Previously, he insisted that trans women were women, but I understand that he has now changed his mind. He has listened, and he has accepted that biological women are distinct and require single-sex spaces, in line with the law, biology, and common sense. I am therefore hopeful that the new Health Secretary will also listen to concerns about the Bill, and that we can work together in Committee to improve it. As I said at the beginning, we all want the best possible health service for our constituents.
Health and Social Care
Caroline Johnson Excerpts(3 months ago)
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Dr Caroline Johnson
The Minister talked about less-than-full-time training, which has obviously had an impact on the number of doctors we need. The Secretary of State said before the general election that if Labour was elected, it would double the number of medical school places. Is that still the Government’s intention?
Stephen Kinnock
Yes, that is the Government’s intention. Obviously, we have had some challenges in April around our hope that we could create 1,000 additional places. We have not been able to do that, unfortunately, because of the reckless decision of the BMA to go back out on strike. The absorption of huge capacity, as well as operational issues, has meant that we have not been able to do that.
[Official Report, 22 April 2026; Vol. 784, c. 133WH.]
Written correction submitted by the Minister for Care, the hon. Member for Aberafan Maesteg (Stephen Kinnock):
Stephen Kinnock
This Government have never committed to doubling medical school places. Obviously, we have had some challenges in April around our hope that we could create 1,000 additional places. We have not been able to do that, unfortunately, because of the reckless decision of the BMA to go back out on strike. The absorption of huge capacity, as well as operational issues, has meant that we have not been able to do that.
Dr Johnson
I thank the Minister for that answer, but I believe that it relates to postgraduate training places. I was asking whether it is still the intention to double the number of medical school places?
Stephen Kinnock
Sorry; I misunderstood the question. Yes, it is still our intention to double the number of medical school places.
[Official Report, 22 April 2026; Vol. 784, c. 134WH.]
Written correction submitted by the Minister for Care, the hon. Member for Aberafan Maesteg (Stephen Kinnock):
Junior Doctors’ Foundation Programme
Caroline Johnson Excerpts(3 months, 1 week ago)
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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.
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Dr Caroline Johnson (Sleaford and North Hykeham) (Con)
It is a pleasure to serve under your chairship, Mrs Barker. I congratulate the hon. Member for Bury St Edmunds and Stowmarket (Peter Prinsley) on securing this debate and giving a great speech. I need to declare an interest as a consultant paediatrician in the national health service, a member of the Royal College of Paediatrics and Child Health, and a member of the British Medical Association.
Going back a little while to when I was young—in fact, we are going back 25 years—I graduated as a doctor in 2001. I had done a five-year degree and I had provisional registration with the General Medical Council. In order to get full registration, I had to complete a year as a pre-registration house officer, most commonly referred to as a house officer. That was six months of medicine and six months of surgery in adult care in either order. It was, to some extent, an extension of medical school. Indeed, it was supervised by the medical school in terms of placements, and almost everyone—I say “almost”; I will come back to that in a moment—stayed local.
In the process that I followed in Newcastle, where I was a student—I am recollecting this from 25 years ago—we had to apply for two medical and two surgical jobs. I applied for the Royal Victoria Infirmary and the Freeman hospital, but there were other options across the north-east where people were involved in training and medical school placements, such as Carlisle, Sunderland, North Tyneside—which was particularly popular at that time—South Cleveland and others. As with any other job, one was shortlisted, interviewed and potentially offered a job. The system worked so that, if a person was offered both jobs, they had to pick one. When the first round went out, people said which job they wanted and that was theirs. All the other jobs that were not allocated were put back into round two, people applied again, and by the time it got to round three essentially everyone had a job.
The benefit of the system was that everyone knew that they had a job in the region where they trained to complete their full registration with the GMC, and the Government knew that all the people they had invested in for that training would become fully qualified doctors, provided they put in the requisite effort and attainment.
However, changing over deaneries was extremely difficult. I applied for the RVI and the Freeman, and I got offered both. That was straightforward, but then I fell in love. I was proposed to, I accepted and I planned a wedding for no more than a week before I graduated. I did not fall in love with another member of hospital staff; I fell in love with a farmer, and farms are quite difficult to shift.
I then decided that I wanted to move to Nottingham deanery. It is fair to say that Newcastle deanery was not keen on that idea, although it was supportive, and Nottinghamshire deanery was really not keen on the idea because it had to fit an extra person into the system. It made that clear, saying, “Well, you’re not having a job in a big teaching hospital.” That was fine: I just wanted a job near to where my husband’s farm was. I was allowed to move deaneries under those special circumstances.
I first spent time at Lincoln under Dr Patterson, a wonderful consultant, as a young doctor. He was a respiratory physician, and I very much felt part of his team. I then went to Mansfield, where I worked for Mr Moulton, an orthopaedic surgeon. He was a lovely man; we used to do French verbs together during knee operations. After that, I worked for Miss Patterson, a vascular surgeon.
As the hon. Member for Bury St Edmunds and Stowmarket put it, I very much felt part of a firm or part of a team. There was continuity of care, as I was looking after my consultant’s patients. I was not part of a massive group of people performing a list of tasks for a whole range of consultants on a group of patients who I did not know, which is how it can be for many junior doctors now.
The other thing provided at that time was accommodation. Part of the system with a PRHO job was that accommodation was provided for free, on the hospital site or very close to it, for the first year. That meant that when junior doctors were doing those two six-month jobs straight out of medical school, they had accommodation.
In their wisdom, the people negotiating the pay and conditions decided to give that accommodation up for a little bit of extra money. At the time I thought that was mad, but since I had passed that stage, at the time I considered that it was really none of my business. However, I think that it caused a problem, particularly because the European working time directive has meant that instead of working really long shifts, people work much shorter shifts but have much longer travelling times. I was working long shifts but not having to do a lot of travelling. Junior doctors now have to do shorter shifts—more of them, on a much less flexible rota, to get all the required shifts in—and they are also travelling for miles at the beginning and end of each shift. I think that change has been counterproductive; I wonder whether the Minister has any thoughts about it.
The other thing is that the system was based on merit—whether or not I got the job at the RVI or the Freeman was based on merit. I had to apply. I had to say that I had done things such as presenting at an international conference as a final-year student. That sort of thing was considered important, as was getting good grades in my exams or in my project work at medical school; now it is not.
I just wanted to examine what happened between that time and now. In 2005, the then Labour Government introduced a modernising medical careers programme, which changed the one-year foundation programme to a two-year foundation programme—I am not clear why that was thought necessary—and the placements were changed from six months to three or four months in duration. I agree with the hon. Member for Bury St Edmunds and Stowmarket that that is too short for someone to really get into a job, and to understand the team they are in and what they are doing, before they have to move on again. People have virtually just arrived and then they are going.
There was then the medical training application scheme, or MTA scheme, in 2007, which was a national scheme. There were lots of errors and data breaches. The Secretary of State apologised, and we went back to the deanery approach. There was then a lot of concern that that system was not fair, and that it was stressful; it required people to perform well in exams, and people did not like that very much.
So we have gone to the Oriel system—this preference-informed allocation system that matches people with places. In the engagement process before it was brought in, there were 14,500 responses, mostly from students, and 66% of respondents said they wanted the system, while about 30% said they did not, so it was brought in. The education performance measure and the situational judgment tests, which have been referred to, were removed, and a lottery system was brought in. Essentially, it means that junior doctors are given a completely randomly allocated number, based on nothing but chance. Junior doctors are then allowed to express a preference for particular foundation programmes.
However, when I refer to foundation programmes, I mean areas of the country. As I said, in the case of Newcastle that can mean an area that goes all the way from one coast to another—for example, right down to Middlesbrough and up to Hexham and Berwick. Those are not small areas; they are quite chunky bits of the country to travel around, requiring many hours of travel, from north to south to east to west, in some of them.
Nevertheless, applicants get to express a preference. The computer system will allocate places on the basis that if someone’s first preference is available, they get it, but if it is not they effectively get put back in the box for later. The computer will go down the list until it has allocated all the first preferences and, as the hon. Member for Bury St Edmunds and Stowmarket said, quite a lot of people do get their first preference although, as he also said, whether or not it was their first preference in truth is another matter.
Then an applicant gets to look in the foundation area that they have been allocated to, and to express a preference regarding the jobs within that region. The computer, using the same number—if the student was lucky the first time, they are lucky the second time—goes down the list and allocates them. If they are not allocated, it has to go round again and allocate them a later preference. That means that people either get their first preference or go very much further down the list: a Newcastle medical student, as I was, could get sent to Penzance, which is a lovely place but a long way from Newcastle. There is nothing the student can do about that. They have no control over their life. Even if they are the best-performing medical student in every capacity in the whole country, they still get sent where they get sent—and that is tough.
Peter Prinsley
Some time ago, when I came here, I had working with me an intern, Dr Harry Dunn, who was a medical student at Cambridge University. He graduated last year. He came top, not only of the University of Cambridge medical student cohort, but of the whole of the University of Cambridge, so he was the top student of his year. He was offered a foundation post in Northern Ireland. He chose not to take it, and has now gone into consulting, having given up medicine. That is an extremely sad example of an unintended consequence of this crazy lottery.
Dr Johnson
I congratulate that person on his prowess in university. He is clearly an incredible person, and it is a shame that he has been lost to medicine. I am sure Northern Ireland is a great place to work, and it is disappointing that he did not want to go there, but he should have been able to apply for the jobs that he wanted in places where he wanted to work, and to compete fairly for them. That is a bit stressful and competitive—but getting into medical school is competitive.
You may not know this, Mrs Barker, but the hon. Member for Bury St Edmunds and Stowmarket and I grew up on the same street, in the same town, and went into similar-ish careers. We competed for medical school places and for our jobs. We are all here today having competed against others for election—that is the reality of life. To remove the competition, which is based on meritocracy, and replace it with a random allocation is more unfair and stressful than the alternative.
One of the issues raised about the old scheme was that it was difficult to recruit in some areas. The competition for the best jobs, or at least those perceived to be the best or most wanted jobs, means that some areas of the country and some specialties could find themselves with the people who did not succeed in getting the jobs they wanted. How do we manage that? It used to be managed with rotations. When people went to the interview for specialist jobs, they would be called in one at a time and told, “These are the rotations available. Which one do you want?” The best jobs—the most popular ones—would be mixed with the least popular, so that would mitigate the problem.
There is one issue that I want to raise briefly. Some medical schools in the UK, including Newcastle, have overseas campuses in Malta, Cyprus and Malaysia. Some British people have gone to those branches of UK medical schools and have found themselves completely excluded from places in the United Kingdom under the medical training changes that the Government have made in the past couple of months, which seems wrong. We talked about that when the Bill went through, and the Minister was keen to reassure us that all would be well, but we have found that British students have not been able to get jobs in the British training programme. Will the Minister look at prioritising at least those who went to medical school before the changes for British jobs?
The current system gives junior doctors—resident doctors, as they are called now—no agency, no control, no appeal and no alternative. It is clearly unfair. Could the Minister update the House on how he intends to fix the system?
The Minister for Care (Stephen Kinnock)
It is a real pleasure to serve under your chairship, Mrs Barker. I congratulate and thank my hon. Friend the Member for Bury St Edmunds and Stowmarket (Peter Prinsley) for securing this vital debate, and all the hon. Members who have contributed. I pay tribute to my hon. Friend’s significant and distinguished career and experience in our NHS. I take the opportunity to thank resident doctors up and down the country for the vital contribution they make to our NHS and to treating the patients it serves.
As my hon. Friend said in his opening speech, the UK foundation programme is a central part of the pathway to becoming a doctor, bridging the gap between medical school and specialty or general practice training in the NHS. It supports newly qualified doctors to develop the clinical and professional skills needed to deliver safe and effective care, preparing them for progression into core, specialty or general practice training. Resident doctors who currently work in the NHS have made it clear that they have concerns and frustrations with their training experience. We are committed to listening to and addressing that and to improving the training pathway for the medical workforce, for the benefit of NHS services and patients.
Through phase 1 of the medical training review we conducted extensive engagement to ensure that doctors, patients and NHS leaders had the opportunity to describe what works well in medical education and training and what needs to improve to meet the needs of both resident doctors and patients. The phase 1 diagnostic report was published last year and made 11 recommendations centred on four key priorities: more flexible training; removing the divide between service and training; ending the damaging recruitment bottlenecks and rewarding teams where doctors feel valued.
The implementation team, led by Dame Jane Dacre, who has been appointed as the independent chair for this work, will now work with doctors, the General Medical Council, the Medical Schools Council, royal colleges and other bodies to drive this much-needed change.
Dr Johnson
Could the Minister highlight the timing of that in relation to the workforce plan, and when that will be published?
Stephen Kinnock
The workforce plan will be published this spring, so there is not too long to wait. It has taken a little longer than we initially hoped, but we think it is really important to ensure that it is anchored in very solid engagement with our partners and stakeholders.
Earlier this year, the Government delivered fast-track legislation to put UK medical graduates at the front of the queue for foundation and specialty training places, reducing uncertainty and ensuring that they can progress to full registration as doctors. We have confirmed that all eligible UK medical graduates will be offered a place on the foundation programme this year. Of course, our fast-track legislation seeks to rectify the unforgivably reckless and damaging decision made by the previous Government to remove the resident labour market test after Brexit, which in many ways is the root cause of the mess created by the neglect and incompetence of the previous Government over 14 years.
I turn now to the process for allocating places to applicants for the UK foundation programme and the steps the Government are taking to improve it. We recognise that the location a foundation doctor is assigned for training has both professional and personal impacts. The four UK Health Departments determine the number of places available each year based on workforce planning across the continuum of postgraduate medical education and training. Applicants are allocated across the UK using a nationally applied preference informed allocation system, which has been extensively commented on in the debate.
The PIA system was introduced in 2024, following extensive engagement with the four UK statutory education bodies, medical students and key stakeholders. The move to the new system aimed to address concerns that the previous system was unfair and stressful for applicants and that there was a lack of standardisation within and across schools. It is worth mentioning that the consultation on the PIA system received over 14,500 responses, 66% of which favoured a move to the PIA option against the status quo. There were 106 organisations among those 14,500 responses. It was an extensive consultation with fairly conclusive feedback on the change that was required.
Stephen Kinnock
It is worth highlighting that around 82% of applicants get their first preference. That is a significant improvement—it was 71% in 2023. We are taking steps in the right direction, but we would love to get to 100%. It is difficult to get to 100% of anything in a large and complex system, but that is our aspiration. Of course, those who do not get their first place are welcome to re-engage with the system, and efforts are made to ensure they get their preference, although we do not always succeed in that process. I will take the hon. Member’s question away and discuss it with my colleague the Minister of State for Health—she leads on this portfolio, although she was not available for this debate—and we will write to him with further clarifications on the important point he makes.
The introduction of the PIA was broadly supported by stakeholders, and I am pleased that we have seen an improvement under this system in the number of students allocated their first preference programme. As I said, 82% of applicants to this year’s foundation programme were allocated their first preference, up from 71% in 2023. However, we are committed to ensuring that the system remains fit for purpose. NHS England will conduct a review to ensure that it is still working for applicants. The timelines of that review will be confirmed in due course.
Furthermore, although some individuals may want to move away from their university area for foundation training, some need greater certainty, for a range of reasons, about their foundation placements. In the last two years, we have supported a portion of students in three UK medical schools by allocating them to foundation programmes in their local area. Last Friday we went further, announcing that we will work with medical schools and foundation schools to extend that support to trainees across the country from disadvantaged backgrounds. Providing a post close to where they live will mean more stability for trainees and will support employers in developing a local workforce.
I would like to say a final word on the PIA. I think we all accept that it is not perfect—it is very difficult to have a perfect system—but I take issue with the characterisation by some Members in the debate that it is a random system. We do not agree with that characterisation. We are clear that the system in place is enabling people to clearly articulate their first preference, and in the overwhelming majority of cases they are getting their first preference. That does not feel like a random system to us, but we absolutely accept that it is not perfect, and there is always room for improvement.
Let me turn to rotations. We recognise the importance of stability for doctors in training and the impact that frequent relocations can have on wellbeing, retention and workforce planning. Following the 2024 resident doctors agreement, the Department of Health and Social Care conducted a review of rotational training and found that rotations can provide valuable breadth of experience. However, we know that in some cases they can disrupt learning, wellbeing, team integration and patient care. To tackle that, NHS England is developing pilots under the medical education and training review to test longer placements and more flexible arrangements for less-than-full-time trainees. The evaluation of those pilots will inform future policy decisions on placement length and continuity benefits.
I turn now to the wider working conditions for resident doctors. It is essential that we create a supportive environment for doctors throughout their training that looks after their health and wellbeing. NHS England’s resident doctors’ working lives programme continues to implement several measures aimed at supporting resident doctors, encouraging them to stay in training and the NHS and reducing overall attrition. That includes measures such as the less-than-full-time training options to allow trainees to continue to work in the service and progress with their training on a reduced working pattern where that is beneficial for their personal circumstances.
We have made significant progress over the past year to improve the working lives of resident doctors, including agreeing an improved exception reporting system, which will ensure that doctors are compensated fairly for additional work, and rationalising statutory and mandatory training to reduce unnecessary burden and repetition.
Dr Johnson
The Minister talked about less-than-full-time training, which has obviously had an impact on the number of doctors we need. The Secretary of State said before the general election that if Labour was elected, it would double the number of medical school places. Is that still the Government’s intention?
Stephen Kinnock
Yes, that is the Government’s intention. Obviously, we have had some challenges in April around our hope that we could create 1,000 additional places. We have not been able to do that, unfortunately, because of the reckless decision of the BMA to go back out on strike. The absorption of huge capacity, as well as operational issues, has meant that we have not been able to do that.
Dr Johnson
I thank the Minister for that answer, but I believe that it relates to postgraduate training places. I was asking whether it is still the intention to double the number of medical school places?
Stephen Kinnock
Sorry; I misunderstood the question. Yes, it is still our intention to double the number of medical school places.
The Government remain committed to publishing a 10-year workforce plan this spring to set out how we will create a workforce ready to deliver the transformed service that we set out in the 10-year health plan. The 10-year workforce plan will ensure that the NHS has the right people, in the right places, with the right skills to care for patients when they need it.
NHS staff told us through the 10-year health plan engagement that they are crying out for change. The workforce plan will set out how we deliver that change by making sure staff are better treated and have better training, more fulfilling roles and hope for the future.
I thank all hon. Members for taking part in this important debate.
Stephen Kinnock
The short answer is yes, absolutely—our door is always open. We have to find a constructive way through this. I accept that it is not always just about pay; it is also about broader terms and conditions—exactly the things we have been debating today. That is why I was so excited by the fast-track legislation we brought forward specifically to address the bottlenecks and the impact of the disgraceful decision under the previous Government to remove the resident labour market test. We are seeking to fix all those problems, and we need a constructive partner on the other side of the table to do that. We are starting to see in opinion polls that public support for the action taken by the BMA and resident doctors is eroding quite seriously, and I hope they take that into account before they make their next decisions.
Dr Caroline Johnson
As a doctor, I feel uncomfortable with the morality of going on strike and leaving patients to suffer in order to get more money for oneself. I think the morality of the strikes is outrageous. However, does the Minister regret the repealing of the minimum service levels legislation, which could have enabled the Government to put in firmer boundaries around the strikes to prevent harm to patients? Will the Government consider banning doctors from striking altogether, as a Conservative Government would, in the same way that people in the Army and the police are banned from striking?
Stephen Kinnock
The hon. Lady’s point about morality is important and interesting, but people also have to be able to put bread on the table, pay the mortgage or rent, and feed and clothe their kids. Morality is fine, but it does not put bread on the table. The two things are very important.
On the retrograde steps the Conservative party is proposing around industrial relations, that is just not what the Labour party is about. The Labour party is about constructive, positive industrial relations and respect. It is about treating the workforce and unions with the respect they deserve and finding a constructive solution. We do not want to move to some kind of police state, where we restrict the rights of trade unions. We see the right to organise and go on strike as a fundamental right of citizens in our country, and it would be a retrograde step to remove it. It is pretty extraordinary to hear that suggested by the Conservative party when we live in a liberal democracy. So the answer to the hon. Lady’s question is no. I believe we will find a way through this dispute. It will be hard going—it will be two steps forward and one step back, I am sure—but in the end I believe we will get there.
Dr Johnson
I thank the Minister for being extremely generous with his time. He says the Government will not consider removing the right of doctors to strike, but he seems to be going further and suggesting that doing so would be wrong in principle. Do the Government therefore intend to allow the right to strike for those who are currently not allowed to, such as the police and armed forces?
Stephen Kinnock
We have those restrictions on the right to strike in the police and the armed forces for obvious reasons of national security. I think that is a very different issue; our critical national infrastructure must be protected, and there cannot be any dispute about that.
We are dealing with a workforce whose pay and conditions had clearly been neglected. The previous Government used the moral argument the hon. Lady was trying to make as leverage to keep pay and conditions down, which I would say is a deeply immoral position to take. The right to be a member of a trade union and to go on strike is relevant to certain sectors of our labour market, and that right, where it exists, should be protected; where it does not exist, that is a completely different debate.
I thank all Members for taking part in this important debate. The Government are taking important steps, and we remain committed to improving the working lives and prospects of resident doctors, and to ensuring an effective foundation programme.
Maternity Commissioner
Caroline Johnson Excerpts(3 months, 1 week ago)
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Dr Caroline Johnson (Sleaford and North Hykeham) (Con)
It is a pleasure to serve under your chairmanship, Ms Jardine. I declare an interest as an NHS consultant paediatrician. I have attended more than 1,000 deliveries of babies over my career. More recently, they have been more likely to be the ones where things were going wrong and where there were more concerns about the baby, as my role is about looking after the infant.
I have also had my own three children. The hon. Member for Esher and Walton (Monica Harding) described having a mixed experience; I had three healthy children, but the first one was a normal delivery, the second a somewhat chaotic emergency caesarean section and the third a nice and smooth, peaceful elective caesarean section, so I had a range of experiences.
I congratulate the hon. and learned Member for Folkestone and Hythe (Tony Vaughan) on his opening speech. I particularly thank Theo Clarke—my friend and former colleague—and Louise Thompson for their campaign on maternity safety. They have shown incredible bravery in talking about their experiences and challenging the taboos around the troubles related to pregnancy. In particular, I commend Theo for her talk about perineal injuries, because this has been something spoken about in hushed tones and quietly among women and not something discussed in the public arena, but once it is spoken about in the public arena, that courage enables other women to find the courage to come forward and talk about it. That is how we will ensure that these injuries become less likely and the treatment becomes better, so I thank them for their work on that.
Since the petition was launched, it has received more than 150,000 signatures, including 270 from my constituency. As a parent, I know that bringing a child into the world is one of the most rewarding and exciting experiences in life. As has also been said, it generally goes well—reasonably smoothly, if not completely smoothly—and the outcome is generally good. But for too many women, their experience is deeply traumatic. Every year, 30,000 women suffer negative experiences during pregnancy, and one in 20 of those goes on to suffer from PTSD.
The APPG on birth trauma ran an inquiry into birth trauma, soliciting 1,300 submissions. What it detailed painted a shocking picture. It spoke of mothers left unattended to in hospital beds and some left in their own blood or faeces for hours on end; vaginal examinations undertaken without consent and in some cases triggering a mother’s waters to break; mothers belittled; concerns torn from the records; a baby dying during delivery after concerns were raised 44 times in vain; and significant mental health consequences and debilitating effects of perineal injury.
Every single failing we have heard about today is one too many. As I have said, maternity care is generally safe, but it is not safe enough yet. I am proud that the previous Government identified maternity care as a priority and began making some improvements. There is a way to go, but the previous Government launched a maternity and neonatal safety strategy, funded the saving babies’ lives care bundle, setting out evidence-based practices for providers and commissioners of maternity care in England, and rolled out maternal medicine networks in 2023. They established 17 centres of excellence to help women with high-risk conditions to get the care that they need when they need it. The previous Government’s reforms were backed by £127 million of investment specifically for maternity and neonatal care, and much of that was focused on the workforce.
Because of these efforts, more babies are delivered safely than ever before. Between 2010 and 2022, stillbirths fell by 25% and maternal mortality fell by 17%. The improvements were in large part overseen by my right hon. Friend the Member for Godalming and Ash (Sir Jeremy Hunt). He has saved countless lives with these improvements and deserves much credit for that.
I am concerned about the trajectory that we are currently on, because as has been said, there is still quite a lot left to do. In June, the Health Secretary agreed. He said that
“we’re not making progress fast enough on the biggest patient safety challenge facing our country”,
but he has responded with another inquiry. He did say that it would be a rapid inquiry, but it took months—in fact, till September—to decide which trusts would be involved in that inquiry, and then that was changed in and of itself. It was announced almost a year ago, has been much delayed and has still not reported. Hopefully it will be a great report when it has reported, but the delay means that action is not taking place quickly enough.
As has been mentioned, Baroness Amos found in her interim report that 748 recommendations had been made over the last decade, but progress in delivering on them had been too slow. Could the Minister update the House on how many remained undelivered on at the point of the general election and how many she has delivered on since?
In June, Ministers also announced a maternity and neonatal taskforce; and in November, I tabled questions asking how many times the taskforce had sat and who was on it. The answer was that they had not decided yet. In January, the question was raised again and they still had not decided. It took until last month for the Government to decide who was going to be on their urgently created taskforce from last year.
Michelle Welsh
Does the hon. Member agree that working with the families to get the taskforce right, which has never happened before with any Government, is key? Getting the taskforce working and getting the right people on that taskforce is essential as well.
Dr Johnson
I completely agree with the hon. Lady that it is important to get the taskforce right, I am just not sure that it needed to take quite so long to do so. We heard a statistic earlier about how many babies are born and how often; I think about how many babies have been born in the intervening time, while the membership of the taskforce was being finalised.
Michelle Welsh
There are more than 2,500 families involved in the Nottingham inquiry, some of whose cases were never reported appropriately. Given that, does the hon. Member agree that it is important to get the taskforce right, because so many bad things happened under the previous Government’s watch that were not reported to the inquiry and are not in the statistics and data that she has spoken about?
Dr Johnson
I understand the hon. Lady’s point, but putting together a taskforce should not take months and months, because it is too important that we get on with it quickly. The Minister may be able to give us a reason for the delay because, if this is hitting the ground running, the Government must be wearing lead boots.
I also want to talk about the workforce. The Labour party manifesto included a commitment to train thousands of additional midwives. Can the Minister confirm how many more midwives are in training than under the previous Government, how many additional study places have been funded for each year, and how many places will be available this September? Some midwives have spoken about a lack of more senior midwives on shifts and the balance of care. Can the Minister tell us what figures she has on the number of midwives who are now in more senior roles and not providing clinical care, and what proportion of midwives are still spending at least a day a week providing clinical care?
We know that many midwives are not happy with the Government’s proposed 3.3% pay award—health unions have called it a betrayal and an insult. With resident doctors already striking, what is the Minister doing to avoid yet another industrial dispute, which I worry would contribute to poorer maternity care? At the same time, the Government’s plans to reorganise NHS services and ICBs have put them under financial pressure. Can the Minister confirm what effects she thinks that will have on maternal services and maternal mental health services used by women?
The Government promised 1,000 speciality training places; how many of those that have now been cancelled were for obstetrics and gynaecology? Will the delayed workforce plan, when it comes, have details of the number of obstetrics and gynaecology trainees that are needed, and will the Government have a plan to deliver the right number so that we have the best number of doctors for care?
Hon. Members talked about how births are becoming more complex—there are fewer births, but there are more complex births. What are the Minister’s plans for prevention, for example by ensuring that women have folic acid? We know that around four in five women take folic acid, but what can be done to improve that? I give the Government credit for the Tobacco and Vapes Bill, but what is being done to reduce smoking in particular among women who are planning a pregnancy or who are pregnant? Obesity and the effects of chronic illness are also important in making pregnancies as healthy as they can be. Given the Government’s focus on prevention, can the Minister update the House on what is being done in those areas?
The speech by the hon. Lady for Morecambe and Lunesdale (Lizzi Collinge) explained the workforce culture extremely effectively. Where errors happen—I agree with her that errors will always happen—it is important that the response is honest, open and transparent. Those who blow the whistle should be safe to do so, and the balance between accountability and blame needs to be in the right place so that we get improvements in maternity care. I share the hon. Lady’s concerns about the “normal birth” culture.
As many hon Members have said, listening to women is important. I asked the Minister about the abolition of Healthwatch the other day, but I do not think I got an answer. Organisations will always try to represent their interest group as effectively as they can, but there may be women who fall through the cracks. The benefit of Healthwatch is that it will listen to all and any women, whereas groups will just represent cohorts of women.
On travel, it is not uncommon, where there is a baby with a cardiac or neurological condition or extreme prematurity requiring surgery, for the baby to have to be transported significant distances, sometimes hours away from their parents’ home, in order to receive the best care. That can be very challenging for people in the cost of travel, and accommodation local to those units. Some units have excellent accommodation onsite in the hospital for mothers and fathers who have a baby who is particularly sick, but others do not. I asked some written questions on this topic following the neonatal estate review, but I got answers back about bereavement suites, which are a different issue.
I have heard examples of women being asked to stay on the postnatal ward when they have a baby in the neonatal unit. One woman described to me being in a bay with three other women who all had their babies with them; that woman was told to stop pressing the buzzer for help after a caesarean section, as there were other women with babies who needed to be looked after—I thought that was particularly cruel.
In summary, I understand that the Minister is very dedicated to this cause, and I am sure that the Secretary of State is too, as we all are. However, I feel that the delay, the report and the endless inquiries are not creating the actions that we need, so I would be grateful for the Minister’s response.
Women’s Health Strategy
Caroline Johnson Excerpts(3 months, 2 weeks ago)
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Dr Caroline Johnson (Sleaford and North Hykeham) (Con)
I am glad to see that the much-delayed women’s health strategy is finally here, and I thank the Minister for her work on that and for advance sight of her statement. I am particularly pleased that Ministers have pledged to prioritise medical health conditions such as endometriosis and to continue the roll-out of the HPV testing that we piloted.
Today it is one year since the For Women Scotland judgment in the Supreme Court confirmed that sex is biological sex. At the time the Secretary of State told the public:
“We will be issuing guidance in the coming weeks before the summer”.
To be fair to him, he did not say which summer. This week, a Minister told the House that the guidance on single-sex spaces could not be published under purdah rules until after the local elections. Will the Minister explain why it is okay to announce policy on other aspects of women’s health but not on single-sex provision in the NHS?
I find it remarkable that the Minister has the audacity to talk about women harmed by pelvic mesh when, after almost two years in office, the Government have still not responded to the Hughes report. When do they intend to do so?
I was disappointed not to find a commitment in the strategy to the lobular breast cancer moon shot project. Will the Minister give us a timeline for what I understand is a commitment to that project by the Government?
The Minister talked about waiting lists. While it is welcome that gynaecology waiting lists have fallen in the past year by 1.9%, for those requiring some sort of procedure or admission, waiting lists are 4.5% higher than they were a year ago. One way to make waiting lists shorter is to not start counting until someone has been waiting for a few days already—more targets can certainly be hit that way—so will the Minister clear something up for me? The Government have decided to prevent GPs from directly referring patients to consultants, insisting that they request advice from consultant-led teams instead. If the consultant then decides to offer an appointment, the clock starts, but that will be a few days after the original request is received, making the waiting time a few days shorter. This is where it gets really confusing: the Minister for Care said that the rules are going to change so that the clock will start when the advice request is received, so that patient waiting times are accurately reflected, but the Minister for Secondary Care has said that that will only happen from October.
Who is right? Do the Government intend to try and fiddle the figures by making people’s waits look shorter between now and the autumn? Given that we have heard different answers from two different Ministers, do they not know what is going on? Or can they confirm that with their new process and with immediate effect waiting times will be calculated from the moment that the advice and guidance request is received, in the same way as happens with referrals now?
The first chapter of the strategy is about acting on women’s voices and listening to women, which of course is welcome, but the Government plan to abolish Healthwatch in favour of listening to organisations. Why are the views of organisations that may or may not accurately represent the voices of women more generally being prioritised, and the voices of women themselves being somewhat deprioritised?
In the strategy, the Government commit to increasing capacity for surgical—in other words, later—abortions. They commit to making the morning after pill available free from pharmacies; they have made the oral contraceptive pill available from pharmacies too, and they have said that they will improve workforce capacity to provide long-acting reversible contraception. At a time when sexually transmitted infections are on the rise, with potential significant short-term and long-term consequences for women, there is no mention of condoms in the strategy. Given that some men can be reluctant to use condoms and there is discussion of eliminating misogyny throughout the document, will the Minister explain the choice not to include those too?
Another issue I want to raise is that of fracture liaison services. On entering Government, the Secretary of State said that one of his first jobs would be to establish universal fracture liaison services by 2030, yet that is moving at such a slow pace that he will not meet his target. Will the Minister set out how many of the dual-energy X-ray absorptiometry—DEXA—scanners are new, how many are replacements and how many will be used to set up new fracture liaison services?
There are many more questions that I can ask, but I understand that I have run out of time. In summary, while there are a few good points, it has taken a long time to produce a strategy that is rather disappointing. Women deserve much better.
Karin Smyth
It is hard to know where to start. I heard the word “welcome” somewhere in the hon. Lady’s remarks, so thanks for that.
In launching what we call a “renewed strategy” we have given credit to the previous strategy, which we welcomed when we were in opposition. However, on issues where there could be cross-party agreement, from going to war to the women’s health strategy, the Conservatives’ modus operandi is now to give nothing for us to work on together on behalf of the people who we represent. It is disappointing that they choose to start on a negative and really they could have done better.
In opposition, we welcomed the initiative to have a women’s health strategy and we supported that work going forward, which has led to the publication of this renewed strategy, because the diagnosis of many of the issues was right. However, as I have made clear, we are upending the system because for decades the health service was built around the work and health needs of men and the predominance of men working in the system, despite the fact that 77% of our nursing staff are women. We are upending that to put women’s voices and choices front and centre, including control of the budget and through NHS Online. Those are the game changers.
The Conservatives do not recognise the total game-changing nature of NHS Online in facilitating services for women wherever they live across the country, whether they live near highly specialised centres, such as those that I am privileged to have in my city of Bristol, in the coastal and rural communities represented by Members from across the House, or near tertiary centres. Any woman, from any part of our country, can access NHS Online and have that specialist service. We are trialling that with gynaecology. They will then get support from our rapidly expanding community diagnostic centres, about whose expansion we made an announcement this week, in order to get quicker diagnosis and the support that they need, closer to home in their neighbourhood health services.
I am happy to respond to the other issues that the hon. Lady raises, including the For Women Scotland judgment, and to set out the work that we have had to do to clear up the mess that the Conservatives left. Everything that happened to women under that system happened on the watch of the Conservative Government, from self ID to the issues at the Tavistock and everything else. There was a lack of rules, a lack of governance and a lack of clarity, and they did not take control. That is the mess that we inherited from the Conservative Government.
The Minister for Women and Equalities, my right hon. Friend the Member for Houghton and Sunderland South (Bridget Phillipson), is doing an excellent job: she is made of steel and good experience, and she has had to navigate a difficult landscape. The Conservatives understand the rules of purdah like the rest of us, so let us not pretend that they do not. My right hon. Friend will be laying that guidance as soon as she can after the election.
I will go on to talk about the DEXA scanners that we are investing in and fracture liaison services bringing people together, which were promises in our manifesto. This strategy is about specialists coming together and working together in fracture liaison services and women’s health hubs. Those have led the way among clinicians about how we can work better for women. That is why we are building on and expanding them, and it is disappointing that the Conservatives do not want to work with us on that.