Coronavirus

Chris Bryant Excerpts

Tuesday 3rd March 2020 Commons Chamber

[Matt Hancock]

That is right; in fact, the document is badged with the emblems of the four nations. There are of course elements of it that are technically different in terms of delivery, but they are set out in the plan.

If I may take a step back, the deputy chief medical officer has already got a note to me to answer the question from the hon. Member for City of Chester (Christian Matheson). The expert committee NERVTAG —the new and emerging respiratory virus threats advisory group—has looked at the issue of nebulisers and does not consider their use an infection-prone procedure.

[Chris Bryant (Rhondda) (Lab)]

Unless something has changed overnight, the 111 service is not available in most of Wales. Most people in Wales would be far better advised to ring 0845 46 47, which is the NHS Direct Wales telephone number. My bigger anxiety is that so far, despite all the good things he has done, the Secretary of State has still not been able to answer the central question of people on zero-hours contracts. They include a large number of my constituents, who would want to do the right thing but, according to what he has said so far, would be financially out of pocket because there is no means of recompensing them. Surely we must put that right; otherwise, we have a massive hole in the plan.

[Matt Hancock]

As I have said many times, we have a robust SSP system and we keep it under review. On the hon. Gentleman’s point about 111, we have changed the system so that if someone dials 111 from Wales, they are automatically redirected to the NHS Direct number in Wales.

Coronavirus

Chris Bryant Excerpts

Wednesday 26th February 2020 Commons Chamber

[Matt Hancock]

My hon. Friend is right about Milton Keynes. The people of Milton Keynes have done exactly the right thing, and I would add to his list Milton Keynes University Hospital, which has done a brilliant job. More broadly, I would also add the media, who have in very large part responded in an incredibly responsible way to a very big story. We have detailed operational plans for dealing with this situation, including if it gets much worse, and those plans are worked on and updated in response to all the information we get, but part of the plan is about the behaviour of people and how people respond in this House and in the country. Thus far we have seen an exemplary response. I hope that continues.

[Chris Bryant (Rhondda) (Lab)]

Many wedding dresses in this country are designed here but made in China, and wedding dress companies in the UK, including in my constituency, have found it difficult because the factories in China have closed; they are suffering as a result. I am aware, having married many women in my time—when I was a vicar—that this is time sensitive. There is a real danger that many of these businesses will suffer enormous financial loss, not to mention the impact on the families. Will the Secretary of State chase up replies from Ministers in other Departments to ensure financial support for those companies?

[Matt Hancock]

The hon. Member raises an important point and through the medium of the wedding dress makes a much broader point, which is that many things are made in China, especially drugs and pharmaceuticals and clothing, which means that the impact in China will have an impact here through the supply chain problems. I am working with the Treasury on the appropriate response. Containing the virus will obviously have health benefits, but it will have economic benefits, too.

Acquired Brain Injury

Chris Bryant Excerpts

Thursday 6th February 2020 Westminster Hall

[Chris Bryant (Rhondda) (Lab)]

I beg to move,

That this House has considered acquired brain injury.

In 1980, I woke up in the middle of the night on a train from Barcelona to Madrid. All I could sense was the world moving in and out. It was not the worst headache that I had ever had or anything that could even be described as a headache; it felt as though my brain was struggling to burst out of my skull. As it turned out, I had viral meningitis. In the end, I was fine after a lumbar puncture and treatment in Madrid, but I feel very lucky, because many people who have had meningitis—with that precise feeling of the world going in and out as the brain pushes against the meninges and the skull—now have permanent brain damage.

Because of the work that I have done on the issue over the last couple of years, I am very conscious that there are some phenomenal people working with those who have brain injuries. Last year, I spent a beautiful day with the Children’s Trust in Tadworth, where a third of the children have had a haemorrhage of some kind, while others have been in road traffic accidents. The trust does phenomenal work to rehabilitate those children—restoring in them a sense of themselves—and to get them back into the education system.

I spent a day with the National Star College near Cheltenham, which does phenomenal work teaching many of these youngsters skills that they can take into the work environment. I saw people whose injuries put them in a challenging position learning to socialise again, and to understand their personal lack of inhibition and its impact on other people. Professionals working in south London explained to me the difficulty in moving people out of hospital and into other forms of community support, especially when families may have been broken up by, for example, the same road traffic accident that led to the injury.

Whether in Norwich, Lincoln, Birmingham or Manchester, the most extraordinary people are doing what looks like miracle work. They can take somebody from needing five or six people just to be able to clean, feed and clothe themselves during the week to the point where, after a year or two of neurorehabilitation and care and support of every different kind, they can do the vast majority of those things more or less on their own, relying perhaps on only one person. The narrow-minded might say, “That is a great success, because it means that the state will not have to spend so much money on them,” but it is a miracle to see such a transformation of those people’s lives. It is also depressing to see, for example, a young lad who has been sitting in an east London hospital for far too long because there is nowhere else for him to go that is safe and can provide the right kind of care.

In Cardiff, I met a young lad for whom we recently held a fundraising dinner at the football stadium—he is a magnificent chap. He had to go all the way to Tadworth because it is the only place in the country with residential neurorehabilitation of that kind for children. I want to that care to be provided closer to home so that parents do not have to make enormous journeys and children do not feel discombobulated and uncertain about their role in the family and how their life will proceed.

The Disabilities Trust has done amazing research—partly in Cardiff prison, but in other prisons, too—that the Government now wholly accept as factual and as the basis on which we should proceed. Who would have thought, even five or 10 years ago, that analysis of both male and female prisoners arriving in prison would show that more than half had sustained a significant brain injury at some point in their lives? The Government’s website states that someone who has suffered a significant brain injury is twice as likely to commit a serious crime. There is perhaps not just a correlation between the two, but a causal link. Maybe this is not, as some of us have said, a hidden epidemic affecting 1.3 million people across the country, but something much more systemic. If we can spot those who need support, ensure that they get it and deal with brain injuries sooner, so many other societal issues might be addressed.

Work with young offenders in my patch of south Wales, where we have a very good co-ordinated approach, made it clear that a child from a poor background is four times more likely to suffer a brain injury under the age of five, with similar figures for teenagers from poor backgrounds. Those ages are both important developmental periods for the brain, which is a soft organ inside a hard, craggy shell, and is therefore extremely vulnerable if pushed around or jarred. In my patch, three quarters of the youngsters in the criminal justice system who caused the biggest problems were those who had suffered significant brain injuries that had been left largely untreated. If we had dealt with those injuries in the first place, we might have been able to help those children in the education and health systems long before they entered the criminal justice system. That would have meant a much better outcome for those individuals, their families and society, and a much greater saving to the public purse.

Members will know that a brain injury can come about for all sorts of different reasons: a traumatic incident, such as a fall or a crash, or just a single punch. I can remember so many horrific incidents in my constituency, outside pubs and so on, where somebody has been punched in a fight. That punch, or the individual hitting the pavement or the wall, may lead to an injury that completely changes their life. The cause of a brain injury could be that, or it might be a haemorrhage, an aneurism, a tumour or carbon monoxide poisoning. Carbon monoxide poisoning can particularly affect people in rental accommodation, and we have to make sure that landlords properly test all the equipment in the house to ensure that a faulty boiler or heating system does not poison those who live there. We now have a much better understanding of carbon monoxide; not only can one big exposure to it do damage to an individual, but even relatively low levels sustained over a period of time can damage the brain in the same way.

Hypoxia is another cause of similar problems, as is stroke. I am quite conscious of this issue, because quite a lot of people have got in touch with me and said, “Why don’t you talk more about stroke?” It is not because I do not understand the problems in relation to stroke and brain injury—many of the issues are exactly the same; it is an injury, just by a different means—but because there are organisations specifically dedicated to stroke, such as the Stroke Association, which have been dealing with it. We in the all-party parliamentary group on acquired brain injury have tended to leave that to one side. But when we bring it all together, we realise that we still have a limited understanding of how to look after, treat, care for, provide for and protect the part of our body that we think of as the place where our personality resides, and therefore as the bit that is most intimate to us as human beings.

It is only recently that people at the Ministry of Defence have started to think that perhaps some people who have been diagnosed with post-traumatic stress disorder actually had brain injuries that were not treated and that led to all the other issues.

[Sir Mike Penning (Hemel Hempstead) (Con)]

I congratulate the hon. Gentleman on securing the debate. As other Members want to speak, I will not intervene for long. A lot of diagnoses were not made at the time, sometimes because the symptoms were just not there. There needs to be an understanding, not just in the Ministry of Defence but in the medical profession—I will come on to social services—of what a brain injury is. A brain injury does not necessarily show itself straight away, and it does not necessarily have physical symptoms; it is inside this little cocoon that we rely on so much.

[Chris Bryant]

Perhaps we have thought, “Well, a little blow to the head is okay; we don’t mind and we’re not going to worry about that.” The right hon. Gentleman is right; perhaps we have been a bit blasé about it, and perhaps even more so in the armed forces, where people want to show that they are tough and can carry on.

Incidentally, the appearance of symptoms some time later is equally an issue in education. A child might come back to school wearing a bandage, at which point everybody is warm, friendly, loving, caring and supportive. Nine months later, when the bandage is gone and everyone presumes that the child is getting on with their life, the child may start becoming difficult in class, finding it difficult to concentrate and falling asleep in lessons. They may be less in control of their inhibitions, and all the rest of it. The teacher may not recognise that as part of what happened nine months before.

Unless teachers and the whole education system are trained to understand fully the concept of neurocognitive stall, there is a real danger that the child will end up becoming increasingly difficult because they do not know anything else; they get shouted at, which sends them into panic rather than making them say, “Please, Miss or Sir, I need some support and help.” Then the child ends up getting excluded and falling into the criminal justice system. If the support had been sustained from day one for at least a year, and if we had made sure that all the teachers in the school understood those issues, we might have been able to save that person’s education.

[Neil Gray (Airdrie and Shotts) (SNP)]

I commend the hon. Member on bringing this debate to the House, and on the work he has done in this area for some time. He is right to point to some obvious potential ABIs and the lack of knowledge and response. Will he reflect on some areas where there are changes in social norms and ideas about how brain injury can be acquired, such as in the heading of footballs? The Scottish Football Association has considered banning children from heading footballs.

--- Later in debate ---

[Chris Bryant]

Interestingly, I had a phone call yesterday morning with Dawn Astle, the daughter of the famous footballer Jeff Astle, who was particularly renowned for heading the ball. I am a Welshman, and we have been boycotting the World cup for very long time—certainly the finals, anyway—so football is not my area of expertise. However, something I have been particularly disappointed about since the APPG produced its report “Time for Change” is that, even though we have been making recommendations about concussion in sport for quite some time, the Government want to wash their hands of it.

There is legislation in every state in the United States of America about sport’s duty of care to participating individuals. Sport is good for you; playing football, rugby and all these things are good for you. I do not want to mollycoddle or wrap anybody in cotton wool, but there may be subtle changes that one can make to each sport to prevent unnecessary damage to people’s brains. Also, I still think that there has not been a cascade of information and understanding of concussion from the professional medics in the organisation down to the grassroots of each sport. That will happen only when there is a shared set of protocols for all sport.

There is clear evidence that a professional footballer is three-and-a-half times more likely to suffer from dementia. There is lots of evidence to suggest that that is to do with heading the ball—not the weight of the ball, as may people say, but the physical process of heading the ball, because it pulls the brain from one side and hits it on the other, which leads to a significantly increased risk of dementia. It seems bizarre that that is not thought of as an industrial injury, which football needs to look at seriously. It also seems bizarre that, at the very highest level of football, a footballer who is taken off to be tested for concussion cannot be replaced, and that player gets only three minutes, which is nowhere near enough time for a proper analysis of whether somebody has suffered concussion.

Football still has some considerable way to go. The Department for Digital, Culture, Media and Sport must play a role in bringing all the sports bodies together round a table to analyse this problem. Otherwise, sports will end up facing massive court cases and very big fines, as has happened in the United States of America. I would prefer us not to go down that route.

There is a spectrum stretching from those who have suffered the worst traffic accidents or have had a severe stroke to those who have had a minor head injury and have lost consciousness for less than 15 minutes. Incidentally, there is a lot of misunderstanding about what losing consciousness and concussion means—I will not go into that, but there are different parts of the brain that might be affected.

[Alex Sobel (Leeds North West) (Lab/Co-op)]

My hon. Friend is making an excellent speech. Regarding road traffic accidents, there is a spectrum of vulnerability, and cyclists are some of the most vulnerable road users. There have been many studies about the efficacy of cycle helmets. The Cochrane review found that using a cycle helmet reduces the likelihood of brain injury by up to 88%. Should the Government not do more to encourage the use of cycle helmets for cycle safety?

[Chris Bryant]

I will not go beyond my area of expertise, so I hope my hon. Friend does not mind that I hesitate to respond. I have read the piece of work that he refers to, and he is right. Other work suggests that there are other things we must do to ensure that cyclists are safe. We need a mixture of all those measures because in future more people will cycle, and we do not want that to lead to a significant increase in road traffic accidents.

The one thing I must praise the Government for, though, is the development of the major trauma centres in England. Despite in many cases not being particularly popular, because it has felt like a service is being made less local and a more regional centre of excellence, the centres have undoubtedly led to at least 1,000 extra lives being saved every year. I praise the Government for their work on that, and I am glad that we will have something similar in south Wales soon. I will not go into the issues about the accident and emergency unit at the Royal Glamorgan hospital today.

The downside of saving lots of lives is that there is a duty of care to provide the neurorehabilitation needed to ensure that those people have a decent quality of life. It is perfectly possible to do that, but at the moment a quarter of major trauma centres do not have a neuro-rehabilitation consultant. There has been significant progress in relation to neurorehabilitation prescriptions. When I last raised that subject, the Government said that around 90% of people were receiving such prescriptions, but whether they are going to the individual and their families, to ensure that that can be pursued, or whether those prescriptions remain with the doctors only, I do not know.

If the Minister looks only at one specific issue, I am keen she looks at how patients get written to. Some doctors, such as consultants, always write to the patient’s GP or other doctor, sometimes in highly technical language. Some local health trusts copy that letter to the patient, but some doctors are now doing something far more effective—certainly far more effective in this area. They are writing not to the other doctor, but to the patient and copying that to the doctor. Of course, they have to use language that the patient can understand, but it is about empowering the patient. One message that I have heard more than any other from many patients and families I have talked to is that they feel completely powerless. Lots of other people are making decisions about them, but they do not understand how those decisions have been reached. They do not know whose door to knock on—or whose door to knock down for that matter—to ensure that their loved one gets the care and support they need. I wonder whether turning those letters on their heads so that the doctor writes to the patient, putting that information in their hands and empowering them, and similarly giving the prescription to the patient and family rather than to somebody else in the medical establishment, would not have a profound cultural effect.

I want to talk briefly about prejudice, because a degree of prejudice is another thing that sometimes comes with a brain injury. Perhaps the person in front of us in the queue in Morrisons or Sainsbury’s or wherever is slurring their words. It is all too easy to get judgmental and think, “Oh well, they’re drunk, and it’s only eight o’clock in the morning,” or whatever, but it might be because they have had a brain injury. It is great that work has been done on the London underground—it needs to be rolled out across the whole country—to explain that some disabilities are not visible, so we should suspend our tendency to be judgmental. We should probably suspend it more often in life generally, but we should do specifically in relation to potential disability.

In commenting on a story from earlier this week, I make absolutely no criticism of my hon. Friend the Member for Salford and Eccles (Rebecca Long Bailey), who I think mistakenly used the word “vegetable” when she meant to say “vegetative state.” Actually, I would like to get rid of the concept of vegetative state. It just sounds wrong. To any ordinary person, it sounds like vegetable, but these are people with all their humanity still in there, even if their personality may have changed in all sorts of ways because of the damage. The Minister will not do this, but I beg the medical establishment to come up with another term that is more sympathetic and genuinely expresses not just the downside of the condition, but hopefulness about the possibilities that may still be to come.

As I said, brain damage is not a pandemic and it is not catching, but it is in a lot of people’s brains. The damage has been done, and many people who have suffered that brain damage do not know that the reason why they find it terribly difficult to concentrate or to get up in the morning—they suffer from phenomenal fatigue that hits them like a sledgehammer—why they find it difficult not to lose their temper, or why they get frightened of loud noise or chaotic circumstances and so on is because they had a brain injury at some point. That is all out there and it affects so many Departments of Government. We have had many wonderful warm words from lots of Ministers—this is my fifth or sixth debate on the subject—but now I really do want the Cabinet Office or Downing Street to set up a cross-departmental body to look at the issue in the round, rather than in each of the different silos. I am serious about this, and I am not asking for lots of money. I hope that the Minister will take that back to the Cabinet Office and Government. At some point, I would like the Prime Minister to chair that body, because we could bring about real, positive societal changes if we get this right.

I will set out what specific Departments can do. In the Ministry of Justice, we should be screening all new prisoners coming in so that we can give them proper rehabilitation. We know there will be many people who have not had their needs met heretofore. That will make it easier to run prisons and much easier to rehabilitate those people not just physically, but back into society to lead fruitful lives. The Justice Committee produced a report in 2016 on youngsters in the criminal justice system, which made specific reference to brain injury. I really hope that all the recommendations in that report will be taken up by the MOJ.

I turn to the Department for Work and Pensions. All MPs have experience of the assessment process not being able to comprehend varying conditions. That is one of the problems with many brain injuries: someone might be all right today and, probably because of their brain injury, they want to please the person sitting in front of them, assessing them. They say, “Yes, I’m fine. I am absolutely fine. Honestly, I am fine,” but tomorrow they will not be able to get out of bed, not out of laziness, but because of completely debilitating fatigue. All assessors for personal independence payment, disability living allowance, universal credit DLA, universal credit, and employment and support allowance—everyone—must have a full understanding of brain injury and the way it works.

In the NHS, I know there are shortages in many categories of personnel. If I have one hope for something that might come out of a Government who have a significant majority, it is for more long-term personnel planning. Specific work needs to be done, because we are falling a long way short in the number of beds needed for neurorehabilitation and, in particular, in being able to take children out of hospital and into community services. I have already referred to the rehab prescription.

There are two other bodies that I want to thank as I end. The first is the United Kingdom Acquired Brain Injury Forum, run by Chloe Hayward. The all-party parliamentary group has worked extremely closely with it, and later this year we intend to do more roundtables to gather more evidence to take this work forward. I have discovered there are many spheres in medicine where all the organisations do not speak to one another or sit round the same table. I have been doing work on melanoma, and I would love to bring all the many melanoma charities together so that we have a co-ordinated approach. UKABIF provides that co-ordinated approach, I really want the Government to adopt that model. We could really crack something here if we manage to work on it not just with one Department at a time but with all of them co-ordinated together.

Finally, I am sure my hon. Friend the Member for Mitcham and Morden (Siobhain McDonagh) will refer to this in a moment, but I want to thank Headway. I had an amazing day speaking to the Headway conference last year. I have referred to some of the professionals, but the most amazing people are probably those who have been through a version of hell that none of us would ever want to experience, having sometimes lost significant members of their family as well. I remember one woman said to me, “I know I have to use all the energy in my head to make my head better, but I am using all the energy in my head to try to work out this DWP form.” That is not what the state should be doing. That is when we really do want a nanny-state to help, to sustain and to support. All too often, of course, it is charities that provide exactly that, and I pay an enormous tribute to Headway for the work it has done.

[Several hon. Members rose—]

--- Later in debate ---

[The Minister for Care (Caroline Dinenage)]

It is a great pleasure to serve under your chairmanship, Mr Robertson. I add my congratulations to the hon. Member for Rhondda (Chris Bryant) on again securing a really important debate on this issue. He is such a brilliant and effective champion of people with acquired brain injuries. His passion is incredibly infectious and set the tone for the rest of the debate, which I think everybody would agree has been incredibly constructive and thoughtful; there have been excellent contributions from everybody. The hon. Gentleman leads the all-party parliamentary group on acquired brain injury, about which all its members are very passionate. They have done superb work.

I thank everybody who took part in the debate: my right hon. Friends the Members for South Holland and The Deepings (Sir John Hayes) and for Hemel Hempstead (Sir Mike Penning) and the hon. Members for Airdrie and Shotts (Neil Gray), for Mitcham and Morden (Siobhain McDonagh) and for Washington and Sunderland West (Mrs Hodgson).

As hon. Members will know, it is estimated that the total cost of brain injury in the UK is at least £1 billion per annum and that the number of people living with ABI is more than half a million and could be as high as 1 million. Many hon. Members have explained that, as with many long-term conditions, the impact of ABI is not limited to an individual’s health but is felt across many aspects of their life, including family, work, relationships and finances. Of course, such an injury could happen to any one of us. My right hon. Friend the Member for Hemel Hempstead spoke about traffic incidents and collisions. That could happen to any one of us on our way home today.

I join the hon. Member for Rhondda in taking this opportunity to recognise, first, the outstanding work done by professionals in this field and, secondly, the wonderful work undertaken by charitable organisations such as Headway, the United Kingdom Acquired Brain Injury Forum and the Children’s Trust, which he mentioned. They are incredibly highly valued by those affected. They do invaluable work in raising not only money but awareness and by providing incredible support to those with the condition, as well as to their families and carers.

I have had quite a long-standing involvement with Headway in my region of Portsmouth and Gosport, since before I became an MP; as an MP, I have met my local team on a number of occasions. They are remarkable and offer the most fantastic support to people in my area. They certainly make a difference to people’s lives and they are so inspiring. On one occasion, I visited them with a member of my team, and she was so buoyed up by the visit that she decided to go off and do the Great South Run to raise funds for the Headway charity. I am not going to follow her example: literally nothing apart from someone chasing me would make me run 13 miles, but people can see how—

[Chris Bryant]

It could be arranged.

[Caroline Dinenage]

Thank you; that is a very generous offer. People can see what an inspiring group Headway is.

We have heard a lot about the excellent and wide-ranging APPG report from 2018. As the hon. Member for Rhondda said, the Department of Health and Social Care co-ordinated with officials from across Whitehall to deliver the response, which was a truly cross-Government response, but I certainly feel his frustration at how silo working across Whitehall can be an impediment to getting the change that he wants. A number of right hon. and hon. Members have mentioned that today, and I will certainly take forward the idea of a real, collaborative cross-Whitehall group to discuss this. Even from the issues raised today, the Department of Health and Social Care, the Department for Work and Pensions, the Department for Digital, Culture, Media and Sport, the Department for Transport, the Department for Education, the Ministry of Defence and the Cabinet Office—I am sure there will be others—all need to be involved in the conversation.

--- Later in debate ---

[Chris Bryant]

Well, yes and no is the answer. Of course it is great—all the Ministers that I have ever heard speak to any of these debates have wanted to be warm, friendly and nice and to say nice things. However, I note that Ministers still stick to a number of 500,000 to 1 million, whereas I think most of the people who work in this field think that it is more like 1.3 million or 1.4 million. If there is a difference between 500,000 and 1.4 million, then there is a hidden epidemic, which even the Government are not really recognising yet.

That is my fundamental central point: it is not as though this were a disease out there that people might catch from each other; it is just that in many people’s brains there are things that are not quite working right because they have had a brain injury. That is leading to all sorts of medical, societal and educational problems that we are not able to address because we have not gone to the root cause.

Let me take one single issue: homelessness and veterans. I would bet my bottom dollar that a very large percentage of the veterans sleeping on the streets in Westminster and London—and, for that matter, around the country—have had a significant brain injury at some point in their life and have not had the proper support and treatment that they required.

We will not be able to solve any of these individual issues unless we go to the centre and deal with this in a co-ordinated way. The right hon. Member for South Holland and The Deepings (Sir John Hayes) is absolutely right: David Lidington was clear that this was going to happen. There were some other things going on last year, but none the less, this was going to happen. I hope that the Minister will go back and kick some shins, metaphorically and physically, to ensure that we get the co-ordinated approach that we need across the whole of Government.

I went to John Bercow’s book launch last night; in his book, he says of me that I am not shy of repetition. I can assure the Minister that I will not be shy of repetition. I will not be shy of repetition.

Question put and agreed to.

Resolved,

That this House has considered acquired brain injury.

Wuhan Coronavirus

Chris Bryant Excerpts

Monday 3rd February 2020 Commons Chamber

[Matt Hancock]

We have put £500,000 towards an immediate communications campaign—not just on social media, although there is a lot there, but in newspapers and on radio—to make sure people get the message that there is something everybody can do: vigilantly wash your hands and if you have a cough or a sneeze, use a tissue and throw it away. These sound like simple things, but they matter, and they also protect you from the flu.

[Chris Bryant (Rhondda) (Lab)]

Do face masks work?

[Matt Hancock]

There are circumstances in which they work, but we are not recommending that people wear them generally—but of course it’s a free country.

NHS Funding Bill

Chris Bryant Excerpts

2nd reading & 2nd reading: House of Commons
Monday 27th January 2020 Commons Chamber

[Matt Hancock]

I can guarantee that the mental health funding will be ring-fenced; and I want us, from the House, to pay tribute to the hon. Lady’s mum.

We are going to have more nurses, and I am delighted that we already have a record number of registered nurses, a record number of midwives, a record number of nursing associates and a record number of nurses in training. If the current trends continue, 36,000 nurses will join the NHS each year from the domestic and overseas workforce, which means that we will have more than 140,000 new nurses by 2024. However, we need more nurses now, and we will have 50,000 more by the end of this Parliament. That is a critical manifesto commitment on which we intend to deliver.

We need the right number of nurses and we need them to have the right skills, with nursing increasingly becoming a highly skilled as well as a caring role. From September this year, we will give every student nurse a training grant worth at least £5,000 to support them in their studies and ensure recruitment and retention. We are also expanding the routes into nursing with more nursing associates and nursing apprenticeships, making it easier to climb the ladder to become a fully registered nurse, and prioritising the care of our nursing staff to encourage more of them to stay in the NHS.

Of course, that training grant will also apply to midwives, paramedics, dieticians and all allied health professionals. Too often, the media use “doctors and nurses” as shorthand, and sometimes, if I am honest, we do that in this House, too. We should instead recognise the essential contribution of our allied health professionals, without whom our NHS family is incomplete and on whom our increasing move to multidisciplinary teams depends. This £2 billion training package is in addition to the funding contained in this Bill.

Finally, as well as revenue and training, the NHS also needs more money for infrastructure. On that point, I will give way to the hon. Member for Rhondda (Chris Bryant).

[Chris Bryant (Rhondda) (Lab)]

My question is not about infrastructure. It is about the Secretary of State’s last paragraph, on the training element. He referred to the fact that we often refer just to “doctors and nurses”. Actually, radiologists are absolutely vital to ensuring, first, that you get a swift diagnosis of cancer and, secondly, that you get swift and proper treatment for it. The Royal College of Radiologists reckons that we will be 2,000 radiologists short by 2023. How are we going to fill that gap?

[Matt Hancock]

As in so many other areas, we are hiring. My response to hearing about problems of shortages is, of course, to use all the tools available to ensure that we help those who are currently working in the NHS—for instance, with new technology—but also to hire and train more.

--- Later in debate ---

[Chris Bryant (Rhondda) (Lab)]

I agree with many of the things that the hon. Member for Birmingham, Northfield (Gary Sambrook) just said, and I congratulate him on his speech. I slightly differ with him on the stewardship of the NHS under the present Prime Minister and the rest of the health team, but I am not going to stray too far into partisan politics because, to be honest, I have a profound worry about the future of the NHS. I think we politicians are sometimes too proud of the NHS. We puff out our chests and say, “What a wonderful nation we are. We have the best NHS in the world,” but too often we are not prepared to look at the nitty-gritty of whether we are really delivering for people around the country. I say that equally about Wales, England, Scotland or, for that matter, Northern Ireland.

Statistics never tell the whole story, but some of them show that we do not have the best NHS in the world. Cancer care has obviously already been referred to several times in the debate, and we have worse outcomes than nearly all the equivalent countries with a free health care system in the world. Australia, Canada, Denmark, Ireland, New Zealand and Norway produce markedly better survival rates for pancreatic cancer, lung cancer and rectal cancer. Even more markedly, the gap between us and those other countries, although we are improving, is not getting any smaller. Our complacency about the NHS is sometimes our biggest downfall.

There are all sorts of reasons why our cancer survival rates are not as good as they might be. Sometimes patients do not present early enough, for example. We in the UK, men in particular, are worse at presenting. In working-class areas, such as my constituency, men are much more reluctant to take things to their GP that others might immediately spot as being potential cancer symptoms. Likewise, GPs in many parts of the country are too reluctant to send people on for tests when they would have been sent for further examinations in other parts of the country or in other countries.

This country has half the number of MRI scanners per 100,000 people compared with all the comparators everywhere else in the world. It has already been mentioned that we need more radiologists, but we need more MRI scanners and other equipment, too. Wales has only one PET scanner, but if we were measuring ourselves against other countries, we would probably have seven or eight. We also have a shortage of radiologists. I said to the Secretary of State earlier that the Royal College of Radiologists reckons that we will need an extra 2,000 radiologists by 2023 just to cope with the demand that we currently know about. At this instant, there are more than 1,000 vacancies for consultant radiologists in England alone, meaning that people are being seen later than they need to be, scans are taking longer, people are getting their results later, and it is more difficult to provide treatment on time.

Three fifths—60%—of consultant radiologist vacancies in England have been vacant for more than a year. That also applies to histopathologists—the people who cut up the biopsy to check whether cancer is present—and only 3% of pathology labs in England reckon that they have enough staff at the moment, with 45% of them are relying on locums and agency staff. That, in the end, is neither good practice nor economically sustainable, because it is more expensive for the NHS. The figures can be replicated in so many other areas. There is a 10% shortage in consultant psychiatrists. One in six eating disorder posts are vacant across the UK—one in three in England—one in eight CAMHS consultant vacancies have existed for more than a year, and 25% of perinatal psychiatric posts in the west midlands are vacant as I speak.

The same situation applies to A&E. We simply do not have enough A&E consultants, and we are short of 1,500 across the whole UK. The Royal College of Emergency Medicine reckons that hospitals need to double their number of emergency consultants in the next few years, which means increasing the number of training places to at least 425. The Government have no plan to get anywhere near there at the moment.

All this has an impact on constituencies such as mine, even though it is in Wales, because we do not have enough A&E consultants. We should have roughly one for every 4,000 admittances. England is getting along with something like one for every 10,000 admittances. Some 180,000 people go to the three A&Es that are close to my constituency in Wales, so that should mean 45 consultants, but we have 10 and a half. In my local hospital, the Royal Glamorgan, there is one consultant, and he is leaving at the end of March, which means that our local A&E will be completely unsustainable.

The plans that the South Wales programme came up with in 2014 are undeliverable. We are going to end up with the most-used A&E on my patch, which sees 65,000 admittances every year, closing simply because there are no staff to staff it. It is not because there is no money, but because there are no staff. My patch has some of the worst levels of deprivation across the whole UK and some of the worst levels of health need in the whole of Europe, with high levels of ischaemic heart disease, high levels of diabetes, and poor health in every regard—every single measure of the health need that one can imagine. On top of that, we have the lowest number of people who have cars and are able to transport themselves to an A&E and mountains that are impassable in the winter. All that is going to make for an impossible situation for my constituents if the A&E at the Royal Glamorgan closes.

I am not laying blame anywhere. All I am saying is that we have to believe more in our national health service so that more people want to work as radiologists, pathologists or receptionists—the receptionist is sometimes the most important person in the cancer clinic, because they make sure everyone calms down and gets to their appointment when they are needed so that no time is wasted, and all the rest of it. We need to believe far more in our NHS if we are really to transform it in the years to come.

--- Later in debate ---

[Andrew Bowie]

I thank the hon. Lady for her intervention, but my figures were from the Scottish Parliament Information Centre, and that is a Parliament oft quoted by SNP Members. Moving away from funding, the story of the SNP’s record on the NHS in Scotland is also one of failed waiting time targets. The 12-week treatment time guarantee unveiled by Nicola Sturgeon when she was Health Secretary in 2011 has never been met—not once. For the quarter ending September 2019, just shy of 30% of in-patient and day cases were not treated within 12 weeks. The situation is even worse for my constituents living under the NHS Grampian umbrella, where more than a quarter of patients—34.6%—were not seen within the mandated 18-week referral time in the month ending September 2019. That is not the fault of the amazing people at NHS Grampian; how can they hope to meet targets when they are being so chronically underfunded by the SNP? According to the Scottish Parliament Information Centre, the 2019-20 cash allocated to the NHS Grampian health board was £7.7 million short of the target set by the NHS Scotland Resource Allocation Committee. The total shortfall over the decade for NHS Grampian is estimated to be £239 million.

I am sorry to say that the cancer waiting times are little better, with a fifth of people with urgent cancer referrals waiting more than two months for treatment. The target is that 95% of patients with urgent referrals are seen within 62 days, but this was met for only 83.3% of patients in the quarter ending September 2019. We have a GP crisis in Scotland—a shortage. It is shameful that the Royal College of General Practitioners expects a shortfall of 856 doctors across Scotland by 2021. There are delays to the promised Inverness medical centre, and fears over the same happening at the Aberdeen cancer and maternity units. There is a completed children’s hospital in Edinburgh, but it is sitting empty due to “ongoing safety concerns”. We also face a shameful, tragic situation at Queen Elizabeth University Hospital in Glasgow, where children have died and it has emerged that Health Protection Scotland reports had identified contamination risks as far back as 2016, with dozens of individual cases.

[Chris Bryant]

The hon. Gentleman says that in Scotland the figure is 82% in respect of people meeting the cancer treatment target, yet the figure in England is only 75%. I am not sure that throwing party political stuff around is going to make the blindest bit of difference to delivering for those people.

[Andrew Bowie]

I thank the hon. Gentleman for his intervention, and I tend to agree with him, but I have deliberately avoided getting into, “England is better than Scotland.”

[Dr Whitford]

indicated dissent.

[Chris Bryant]

indicated dissent.

[Andrew Bowie]

I am agreeing with the hon. Lady and the hon. Gentleman; I am trying not to get into that debate. What I am saying is that it could be better in Scotland. The SNP has been responsible for more than 10 years for the NHS in Scotland and it is missing its own targets and the service is underfunded. When SNP Members come into this Chamber to harangue, castigate and berate this Government for the record investment they are giving the NHS south of the border, perhaps they should look closer to home and sort the problems in Scotland, where they are failing to meet their own targets.

I know that Members from all parties, and especially on the SNP Benches, care deeply for the health and wellbeing of the Scottish people, as do I, but I ask them to bear in mind the record of the Scottish Government when they attack this Government, who are investing record amounts in the health service. I ask them to join me in welcoming the record boost to the block grant and calling for the NHS in Scotland to be funded to a level equivalent to the funding we are putting in here in England.

I welcome the Bill and hope that when the Scottish Government receive the unprecedented boost to the block grant made possible by Conservative decisions, they spend it wisely and where it is needed, fix the health service where it is broken up north, and invest in our healthcare workers, so that throughout the United Kingdom—in England, Wales, Scotland and Northern Ireland—we can have an NHS that all the British people deserve.