Cass Review
Chi Onwurah Excerpts(3 days, 3 hours ago)
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Victoria Atkins
I thank my hon. Friend sincerely for that. Again, she articulates the concerns of many families where a teenager or young person may be suffering complex needs and are asking questions of themselves and their place in society. We must treat not just the child or young person, but the family with care and respect, trying to support them to get to the right place for the child.
Chi Onwurah (Newcastle upon Tyne Central) (Lab)
Some constituents who have contacted me see in the Cass report a vindication of their long-held views on sex and gender following years of abuse, sometimes violent. Others who have contacted me fear that the Cass review represents an attack on their very existence as trans people and fear the abuse to come. Will the Secretary of State set out that she opposes utterly the toxification and politicisation of questions of sex and gender? Will she also set out that she will collect the additional evidence that the Cass review calls for, without which there cannot be an evidence-based approach? Will she also set out that she will put in place the resources our young people need in terms of healthcare to ensure that they receive the healthcare appropriate to them?
Victoria Atkins
I thank the hon. Lady for giving me the opportunity to make it clear again that this report is about gathering the evidence to help support our children and young people to the best care they can have. For a very small number that may well be a medical pathway, but for the overwhelming majority we know from Dr Cass’s report that there may be other ways in which they can be best supported and looked after. I do not want anyone to walk away from this debate thinking that this is somehow a report about those adults who have made that decision of their own free will and are living their lives as freely as we all want them to—it is not. It is about the healthcare and emotional care and support that we give to young people and their families, and the professional confidence we give to clinicians to ensure that we get to the right place for each and every individual child.
Reforms to NHS Dentistry
Chi Onwurah Excerpts(11 months, 3 weeks ago)
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Judith Cummins (Bradford South) (Lab)
I beg to move,
That this House has considered progress on reforms to NHS dentistry.
I thank the Backbench Business Committee for once again granting this important debate, and my co-sponsor, the hon. Member for Waveney (Peter Aldous), for all his work in helping to secure it.
When preparing for the debate, I thought it was useful to consider and reflect on the foundations of our NHS in the Beveridge report, which was published 80 years ago last November. Although it would be an understatement to say that the world has changed since its publication, the identity of this country is still proudly centred around our national health service—an idea so powerfully contained in the pages of the report. For the great British social reformers of the 20th century, dentistry was not some Cinderella service of secondary importance. Beveridge concluded that no one could seriously doubt that a free dental service should become as universal as a free medical service. Eighty years after the report’s publication, it is time that the House reaffirmed our commitment to universal dental care in this country.
It is worth noting that the Beveridge report, in its proposition for universal access to NHS dentistry, was published by a multi-party coalition Government. As I stand here today, Members on both sides of the Chamber will agree that the crisis in NHS dentistry deserves the same cross-party attention that it was afforded 80 years ago, because the system has decayed: access has fallen to an historic low, and inaction over the past 13 years has caused untold damage. There can be no more half measures or excuses. Now is the time to establish a new preventive dental contract that is fit for the 21st century.
The words of my campaigning over the past eight years now serve as a compendium of forecasting doom. In 2016, I warned of a mounting crisis and drew the Government’s attention to a digital report warning that half of dentists were thinking of leaving the profession. Between 2017 and 2019, I warned that 60% of dentists were planning to leave NHS dentistry. In 2020, after years of repeated warnings, I once again informed the Government that 58% of the UK’s remaining dentists were planning on moving away from NHS dentistry within five years. The Government once again fudged and ignored, and more than 1,000 dentists left the NHS.
This NHS dental crisis has been a devastating slow-motion car crash of the Government’s own making, yet year after year, Minister after Minister, they have assured me of their commitment to reform. Last year, when I pressed the Under-Secretary of State for Health and Social Care, the hon. Member for Lewes (Maria Caulfield), for action on this matter, she informed me that she had started work on a dental contract reform. However, just yesterday, we became aware that after 13 years in power, the Government are once again starting with an announcement of a plan to publish a new plan to improve access to NHS dentistry—a plan for a plan.
We would all welcome further clarification on what that plan might involve. I can only hope that sustained campaigning on this issue by me and other Members will mean that the plan will result in positive change for my Bradford South constituents.
Chi Onwurah (Newcastle upon Tyne Central) (Lab)
I congratulate my hon. Friend on securing this excellent and incredibly important debate. In Newcastle, where NHS dentistry access has become almost impossible for so many of my constituents, a whole generation of young people and children are growing up without access to an NHS dentist. Does she agree that that is causing immense suffering now and storing up not only pain and suffering but additional costs for the future?
Judith Cummins
My hon. Friend makes an important point. I will specifically cover access to NHS dentistry for children later in my remarks.
On the Government’s plan for a plan, experience suggests that positive change for my constituents may well be wishful thinking. My constituents are suffering and take no solace whatever from the Government’s commitment to plan for a plan for reform. The contract has been in place since 2006, and the Government have been undertaking a review of the process since 2011. After 12 years, it is still a work in progress.
NHS Workforce Expansion
Chi Onwurah Excerpts(1 year, 1 month ago)
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Wes Streeting
I wholeheartedly agree with my hon. Friend. We delivered the highest levels of patient satisfaction in the history of the national health service. Now patient satisfaction is at its lowest level since at least 1997. There is a second basic promise of the NHS which, if it is not broken, is under attack today like it has not been for years. When I went through my treatment for kidney cancer I had lots to think and worry about—every cancer patient does—but the one thing I never had to worry about was the bill. That is the thing that people love most about the national health service, but those who have never believed that healthcare should be provided to all, regardless of their means, are using this crisis to attack that principle. The right hon. Member for Gainsborough called the NHS the
“the last example of collective planning and socialist central control”—[Official Report, 22 September 2022; Vol. 719, c. 840.]
and even today called on the Health and Social Care Secretary to look at insurance based systems instead.
The hon. Member for Christchurch (Sir Christopher Chope) has a Bill before the House this week that would extend user charging. The Prime Minister himself pledged last summer to charge patients who miss GP appointments, although he has since ditched that pledge—indeed, he has ditched an awful lot since he became Prime Minister. Two former Health Secretaries have joined in. The right hon. Member for West Suffolk (Matt Hancock) has proposed charging for missed GP appointments. The right hon. Member for Bromsgrove (Sajid Javid) went further and suggested charging patients to see a GP, or even to attend A&E. If he were here, I would happily give way to hear an explanation as to how that would work. The most deeply cynical thing about this, is that the right hon. Members for West Suffolk and for Bromsgrove are the people who bear much of the responsibility for the mess we are in today. They ran down the NHS. They refused to train the staff needed to treat patients on time. Now they say that timely care, free at the point of use, as we enjoyed 13 years ago, and as we have enjoyed for much of the past 75 years, is no longer possible—that we cannot afford it any more, that it is not achievable. That regressive, miserabilist argument cannot be allowed to win. Not only is it unjust, but it is wrong, so let us take it on in its own terms.
Why do patients who are ill enough to need to see a doctor miss appointments? Very often it is because the appointment clashes with work, they are unable to travel, they did not receive the letter, or it arrived too late. The answer is to change the archaic and maddening way that patients are forced to book appointments, and build a new system around patient convenience. If patients could choose whether to have an appointment face-to-face or over the phone, if they did not have to wait on hold at 8 am to book an appointment, then wait for a call back that can come at any time of the day, fewer appointments would be missed. Why is it that those who attack NHS managers as being wasteful bureaucrats want to install far more of them? Because that is what an insurance-based system would mean. One-third of US healthcare costs go to insurance company overheads and providers billing patients. Is that really what the proponents of an insurance system want—more administration, more bureaucracy, and less money spent on delivering healthcare?
What would happen if we charged patients to see a GP? People would stay away. In some cases, yes, that would mean people who did not need to see a GP would not take up an appointment. But it would also mean that many people who needed to see a GP but could not afford the price stayed away. More conditions would go undiagnosed, and left to become more serious until the patient had to go to hospital instead. It would mean worse outcomes for patients, a less healthy society, and greater cost to the taxpayer. While we might save £39 on a GP appointment, it costs far more for patients to go to A&E, which costs £359 on average. Not only are those proposals unfair, but they would mean more bureaucracy, more late diagnosis, more expensive and less effective hospital treatment—exactly the opposite of what the NHS needs. Such proposals are wrong on fairness, wrong on efficiency, and wrong on health outcomes. Those in government have no plan for the NHS, and there are even worse ideas sitting on their Back Benches.
Chi Onwurah (Newcastle upon Tyne Central) (Lab)
My hon. Friend is making an excellent speech. Does he agree that the lack of support for a workforce plan, and the deliberate running down of the NHS, will prevent it from being able to take on and take up changes in technology, innovation, processes and treatment that could ensure better healthcare with less cost, enabling the NHS of the future to provide the support and treatment that the British people deserve?
Wes Streeting
I wholeheartedly agree with my hon. Friend. This really is the crux of it after 13 years of Conservative Government: either the NHS is in the mess it is in today through deliberate policy choice, deliberately running down the NHS because they do not believe in it, or the NHS is in this state through negligence and incompetence. [Interruption.] Perhaps the Minister would like to tell us whether it is negligence and incompetence, or deliberate policy choice. [Interruption.] Apparently, it is the pandemic. I wondered how long it would be before we ticked that box on the health debate bingo card.
If the NHS was in its worst crisis in history and we had the longest waiting times in the history of the NHS because of the pandemic, why were NHS waiting lists at their longest historic level before the pandemic? Why were there 100,000 staff shortages before the pandemic? Why were there 112,000 vacancies in social care before the pandemic? I will tell you why, Mr Deputy Speaker. For the entire time they have been in government, whether pre-pandemic or post-pandemic, the Tories have not had the first clue what to do with the NHS. They took a golden inheritance of the shortest waiting times and the highest patient satisfaction in history, and they have squandered it over the last 13 years to the extent that people dial 999 and an ambulance does not come, people ask to see a GP and there are not enough appointments, and cancer outcomes and cancer waiting time targets are not met—not a single one. That is their record. It is the consequence of their choices and it is one of many reasons why this country needs a change and a Labour Government.
The right hon. Member for Gainsborough asked what reform under a Labour Government looks like. I say to him that it is not the model of funding that is broken, but the model of care. The NHS diagnoses too late, by which stage treatment is less effective and more expensive. We focus too much of our spending on hospital care and not enough on primary care, social care and prevention. The reform our health service needs is shifting that focus out of the hospital and into the community, because if we can reach people sooner we can catch illness earlier and even prevent it in the first place—better for patients and better value for money for the taxpayer. That is what a real reform argument looks like.
Of course, we need to retain the necessary NHS staff. There are 133,000 vacant posts in the NHS today. The number of fully qualified GPs is falling, with an extra 140 patients per doctor compared with five years ago, and midwives are leaving faster than they can be recruited. There is no NHS without the people to staff it, so that is the great gamble the Government have taken on the industrial action in the NHS. It is not just that staff walk out for a day on strike; it is that they walk out of the health service altogether. By ignoring the nurses and the ambulance workers for months, the Government have allowed 140,000 appointments and operations to be cancelled, and risk putting off thousands of staff from continuing their careers in the health service.
Have the Government learnt their lesson? Of course they have not. In two weeks’ time, junior doctors are set to walk out on strike for 72 hours. It will mean huge disruption to patient care, yet there has not been a single meeting or minute of negotiation between Ministers and junior doctors. Why on earth are they not trying to stop yet more disruption to NHS care? Instead of ignoring staff, the Government ought to be doing everything they can to retain them in the health service. That means getting around the negotiation table and resolving the dispute on pay; it means getting around the table and fixing the pensions dispute; and it means listening to staff about their everyday experiences and making sure that, finally, they can see some light at the end of this miserable tunnel.
Helen Whately
On the contrary, we have already made progress on some things in our social care White Paper published just over a year ago. We will soon publish next steps, particularly focused on workforce reforms. I have been talking to several stakeholders involved in exactly that area over the last few weeks. If the hon. Lady is patient she will see some of that coming forward.
I was talking about some of the things that we have done to vastly increase the number of healthcare professionals in the NHS. As part of our ambitions for the future, more than 26,000 students were accepted on to nursing and midwifery courses in England last year—a 28% increase on 2019. We are on track to meet our manifesto commitment of 50,000 more nurses by 2024. Much as we continue to strive to go further and faster, those are the figures as they stand. We might wish to make a comparison with Labour-controlled Wales, though it is sometimes hard to do so because it does not collect crucial data such as vacancy rates. One has to wonder why. That is the same Labour-run Wales where patients are twice as likely to be waiting for treatment as in England. Some 50,000 people are currently waiting over two years, while here in England we eliminated two-year waits last year.
I will move on from the situation in Wales, as I am sure Opposition Members will be glad to do so. The Leader of the Opposition has said that he thinks we are hiring too many people from overseas in health and care. The same gentleman spent several years campaigning for a second referendum on freedom of movement. Whatever his views this week, it is the work of a responsible Government to look at every available option to give this country the health and care workforce that it needs. Alongside training more doctors and nurses, recruiting from overseas and giving people from other countries a chance to work in the NHS is the right thing to do.
Chi Onwurah
I am pleased to hear the Minister say that it is the Government’s duty to look at every available option. During the pandemic, I take it that she clapped on her doorstep for the NHS workforce who did so much to get us through it, so why will she not look at the option of abolishing the non-dom tax loophole, to fund more nurses and doctors and a better NHS in future?
Helen Whately
A responsible Government take a responsible approach to funding our public services, including the NHS. Later I will come to exactly the point about the Opposition’s proposals to use that funding pot again and again for the health service.
Coming to social care and international recruitment, we have put care workers on the shortage occupation list. As a result, social care employers have already been able to offer care worker visas to more than 34,000 people. I welcome international nurses joining our nursing and midwifery register, and I make no apology for continuing to encourage bright and talented international doctors to come and work in the NHS. In fact, that is the very idea of the points-based immigration system that we have so successfully implemented.
As well as recruiting the best and the brightest, it is vital that we retain them. Ultimately, our goal is to make sure that the NHS is one of the very best places to work in the world; both my parents were NHS doctors and, believe me, I have had plenty of conversations about why sometimes it is not. What is most frustrating is when the system prevents them from giving people the very best care.
It is not simply all about pay, as Opposition Members might have us believe. The hon. Member for Ilford North talked about nursing pay, but he will understand that we are currently in talks and now is not the moment to play politics with this issue. We are pleased that the Royal College of Nursing has paused strike action. We have no doubt that both sides are committed to finding a fair and reasonable settlement—one that recognises the vital role that nurses and nursing play in the health service, the wider economic pressure facing the United Kingdom and the Prime Minister’s priority to halve inflation.
NHS Industrial Action: Government Preparations
Chi Onwurah Excerpts(1 year, 4 months ago)
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Will Quince
I thank my hon. Friend for his question. We are constantly looking at how we can improve productivity and increase efficiency in the NHS. We have an acute issue not just with winter, but with proposed strike action. The shadow Secretary of State mentioned that the NHS needs reform, and we are undertaking that. Will further reform need to be undertaken? Yes, and if my hon. Friend the Member for South Dorset (Richard Drax) has particular ideas, I am very happy to meet him to discuss those further.
Chi Onwurah (Newcastle upon Tyne Central) (Lab)
During the dark days of covid, it was the NHS that gave us hope, not Ministers partying in Downing Street. The Tories now seek to demonise the very NHS staff that we clapped from our doorsteps, because they have voted to strike. They are overworked, underpaid, without a proper workforce plan, concerned about the security and safety of patients, and forced to use food banks. Do our NHS staff not deserve at least a face-to-face meeting on pay negotiations with the Government?
Will Quince
I do not know where the hon. Lady got the impression that I or anybody else was demonising NHS staff—far from it. The unions have chosen to bring forward this action. As I said, I hugely value and appreciate all NHS staff. That is why we have given them a pay rise this year, on top of the 3% pay award last year, when pay across the wider public sector was frozen.
Oral Answers to Questions
Chi Onwurah Excerpts(1 year, 5 months ago)
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Neil O’Brien
Absolutely. My hon. Friend has been a formidable campaigner on this issue. I know he met the Secretary of State to talk about it in the summer. It is a pleasure to have talked to him already and I am happy to meet with him further. Seven Derbyshire dental providers have been commissioned to deliver extra weekend activity to improve access this winter and, nationally, we are exploring how to incentivise dentists to work in areas where getting an NHS dentist is proving challenging.
Chi Onwurah (Newcastle upon Tyne Central) (Lab)
Effective dental provision is essential not only for quality of life but for nutrition and confidence. Indeed, not being able to access it at important points in life is storing up more trouble for later, yet nine out of 10 dentists are not accepting NHS patients and, with the soaring cost of living, my constituents cannot afford dental treatment. What will the Minister say to them and do to address the millions who cannot get the dental treatment that they need?
Neil O’Brien
The hon. Lady asks a powerful question. As well as the reforms that we started this summer and I announced in our plan for patients, as we start to think about the next dental contract, we are thinking about all the different things we can do to incentivise dentists to work in particularly poorer areas where there is difficulty accessing services. We are also working with the General Dental Council to review the processes that overseas dentists have to complete before they start to provide NHS care, which are sometimes more arduous than those for doctors. We are also thinking about the internal market of the UK and making it easier for dentists in Scotland to practise in England as well.
Women’s Health Strategy for England
Chi Onwurah Excerpts(1 year, 9 months ago)
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Steve Barclay
That was one of the key issues that came out of the consultation responses. Indeed, in my conversation with Dr Watson at Homerton, we looked at different pathways for treatment that avoid the need for theatre. Key to that is some of the innovation on pain management that physicians are looking at, and how, through NICE, we socialise that innovation across the NHS.
Chi Onwurah (Newcastle upon Tyne Central) (Lab)
The north-east has some of the highest levels of health inequality in the country. North-east women spend more than a quarter of their lives in not good or poor health, which is almost 3 percentage points above the national average. Will the Secretary of State set out the steps that he plans to take to target those areas that already have high levels of inequality? Does he agree that, when he talks about research—I very much welcome the additional research—that should also target areas with high levels of existing inequality, which, unfortunately, is not the case at the moment?
Steve Barclay
We are already doing so on things such as the 75 family hubs that we have put in place. Again, a key part of this strategy is to then look at having women’s hubs, particularly in those areas where there is greatest disparity.
Ambulance Services and National Heatwave Emergency
Chi Onwurah Excerpts(1 year, 9 months ago)
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Maria Caulfield
When we look at our figures, of course we look month on month, but we also compare them with previous years. As I said in my opening remarks, we are seeing an increase in calls—over 100,000 more compared with May 2019. The hon. Member shakes his head, but those are the facts. We are comparing month on month, and comparing with previous years. We are seeing an improvement in response times and in the amount of ambulance hours lost to ambulances queuing at A and E.
Chi Onwurah (Newcastle upon Tyne Central) (Lab)
Of the 22,000 people who visited Newcastle’s Royal Victoria Infirmary A&E in May, 13%—more than 3,000 people—faced a wait of more than four hours. In the last month, people were facing waits of seven hours, and constituents with rapid heart fluctuations were told that they faced a wait of 11 hours for an ambulance and that they needed to get a cab. Is not it negligent of the hon. Lady’s Government to leave our NHS unable to protect my constituents, particularly facing a heatwave, and what is she going to do to ensure that they have the resources necessary?
Maria Caulfield
As I explained in answer to the shadow Secretary of State, these are problems facing all devolved nations. I highlighted the four-hour waits in Wales, but in Scotland there are similar pressures—in Ayrshire there is a three-hour wait. These problems are not specific to any one Government. I have set out what we are doing to help all ambulance trusts and regions of the country. We have put in funding to support the ambulance service and to support NHS 111 to try to take some pressure off the ambulance service. We are looking at the novel approaches that in some parts of the country are working well—whether that is having GPs in A&E to try to take pressure off people who are waiting a long time, or having paramedics in GP surgeries. Whatever works we will look at, to help to take pressure off the system.
Elective Care Recovery in England
Chi Onwurah Excerpts(2 years, 2 months ago)
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Urgent Questions are proposed each morning by backbench MPs, and up to two may be selected each day by the Speaker. Chosen Urgent Questions are announced 30 minutes before Parliament sits each day.
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Edward Argar
The reason this plan is delayed is, as I have alluded to, the omicron variant and the impact it had on our NHS. My right hon. Friend makes an important point about our prioritising tackling waiting lists and waiting times. He is also absolutely right: this is a once-in-a-generation challenge, and it is right that we get the right answer—the right outcomes for patients and for taxpayer. That is what we will do with this plan.
Chi Onwurah (Newcastle upon Tyne Central) (Lab)
These waiting times are misery, pain, frustration and agony for my constituents, and then there is the mental anguish of not knowing what is happening or going to happen. I have constituents who are begging and borrowing the money to go private because they cannot stand the pain. Is that the Minister’s plan for the NHS: driving people into the private sector? If it is not, what is his plan?
Edward Argar
The hon. Lady is right in some of what she says. We can all appreciate what she says about the impact that a wait for treatment can have on those waiting, in terms of health outcomes and, as she rightly mentions, challenges for people’s mental health as they worry about their diagnosis or when they are going to receive the treatment they need. That applies not only to those who are diagnosed with a life-threatening condition, but to those who have a life-limiting condition or who need orthopaedic surgery, eye surgery or similar, where it has an impact on their quality of life, their ability to work and so on. She makes an important point about that.
As I have set out to the House, we have already made significant strides, as we have come out of this pandemic, in setting out—through the community diagnostics hub and through our approach to surgical hubs—how we can rapidly ramp up the number of planned surgeries that are undertaken. We have to be honest with people that that list will get worse before it gets better, because people who have not come forward will do so. Equally, the golden thread running through is our NHS workforce, and we have to recognise that the people who will be tackling this waiting list are the same people who were working flat out through the pandemic. We have to make sure we give them the space and the support to recover physically and emotionally.
Oral Answers to Questions
Chi Onwurah Excerpts(2 years, 3 months ago)
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Edward Argar
We remain fully committed to the delivery of the important new women’s and children’s hospital in Truro for the Royal Cornwall Hospitals NHS Trust as part of our new hospital programme. My right hon. Friend the Secretary of State remains committed to it, and of course I would be delighted to meet my hon. Friend.
Chi Onwurah (Newcastle upon Tyne Central) (Lab)
Sajid Javid
First, I commend everyone working in the Newcastle hospitals trust and across the NHS for everything they are doing. The hon. Lady is right to talk about the importance of the workforce—that is why we have asked Health Education England to come up with a 15-year workforce framework—but she knows that the resources that the NHS has make a big difference, and it would have helped if she had supported the Government’s record investment of £36 billion over the next three years in the NHS and social care.
Covid-19 Update
Chi Onwurah Excerpts(2 years, 3 months ago)
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Sajid Javid
First, I commend my right hon. Friend for the scrutiny that he has constantly provided of the Government’s covid policy. He did that long before I was Secretary of State and I am pleased that he has continued to provide that scrutiny, which is very valuable. It is most valuable to me when he supports the policy, as he did on self-isolation today, but it is still valuable when he challenges the Government to think again about policy. That is very important. I addressed the policy he raised of the vaccine as a condition of deployment in the health and social care sector a bit in my statement. He will have heard that we are committed to it, but that is because it is right that, in those settings where there are people who are more vulnerable than others, they are put first. We know that vaccines limit transmission and that as a result it is safer for patients if the individuals who provide that care—the health and care workers—are vaccinated. The policy is about putting patients first, was voted for by the House with an overwhelming majority, and the Government intend to implement it.
Chi Onwurah (Newcastle upon Tyne Central) (Lab)
The Secretary of State put a lot of emphasis on testing in his statement. Inspired Outsourcing in my constituency would agree with him. It provides contact centre services, and some of its workers are key workers so cannot work from home. It has been using twice-weekly testing to keep its workers safe, but has run out of tests. It cannot get hold of any tests apart from by paying what would effectively be £2,000 a month to a private provider recommended on the Government’s website. Does the Secretary of State believe that small businesses such as Inspired Outsourcing should have access to free lateral flow tests? How can it get hold of those tests today in Newcastle, because that is what it needs to keep its workers safe and provide protection to us all?
Sajid Javid
That is an important point. When the country first discovered omicron, the tests that were in stock were not designed for another huge wave. However, the people who run testing at UKHSA responded very quickly by ordering almost any lateral flow tests that meet our standards that they could find. As I said in my statement, in December, we had 300 million as opposed to the 100 million that was originally planned and, in January, there will be four times the pre-plan amount. In answer to the hon. Lady’s specific question, whether for a workplace, for visiting a care home or other reasons, people will be able to get access to the lateral flow tests now that millions more have arrived in the country. They have been distributed and people can get them online or from pharmacies.