Recovering Access to Primary Care

Debbie Abrahams Excerpts

Tuesday 9th May 2023 Commons Chamber

[Steve Barclay]

My hon. Friend has a great deal of experience, and he is right to focus on the amount of clinical time often spent on non-clinical issues. Sending reminders through the NHS app will reduce non-attendance. We are also looking at the key interface between secondary care and primary care, as well as considering which appointments can be done elsewhere, such as through pharmacies and the additional roles. The online booking system can better triage people to the right place, and there will be some self-referral in order to take pressure off GPs—not for things that carry a clinical risk, such as internal bleeding, as the Opposition suggest; but for things like hearing aids. If a person has taken a hearing test, they will not need to clear an appointment for a hearing aid through their GP.

[Debbie Abrahams (Oldham East and Saddleworth) (Lab)]

I reinforce what colleagues have said. This is a step in the right direction, but it fails to grapple with the grave situation in which there has been a threefold increase in waiting lists since 2010, including a twofold increase since 2019, before the pandemic. In Oldham we have fewer GPs and more patients with increased acuity, so when will we get our fair share of the promised 6,000 GPs?

[Steve Barclay]

I have recognised throughout that demand has increased. Primary care is treating 10% more patients than before the pandemic, with around 1 million appointments a day. There is more demand, not just because of the pandemic but, as I said in my opening remarks, because we have a third more people over the age of 70, and they are five times more likely than younger people to go to their GP. That demographic change, the impact of the pandemic and a change in public expectations of advances in medicine are all creating additional pressure, which is why it is right that we use the full range of additional roles and that we invest in technology, in addition to the 2,000 more doctors in general practice.

Cancer Care

Debbie Abrahams Excerpts

Tuesday 14th March 2023 Westminster Hall

[Nicola Richards (West Bromwich East) (Con)]

I beg to move,

That this House has considered the future of cancer care.

Cancer will affect every single one of us here today, and every single person in this country, in some way. Statistically, half of us will get cancer in our lifetime. When that happens, both we and our families should expect the best possible care and support from our health service. This time last year, my family and I were coming to terms with losing my mum to secondary breast cancer that spread to her liver. She passed away in April 2022, only six years after her younger sister passed away with the same diagnosis. Their brother, my uncle, has since bravely fought cancer too, and I am pleased to say—not least because he tells the worst dad jokes known to man—that he is doing well.

My family know all too well what the statistics mean in real life. I would like to think that I am one of the few to have lost their mother at an young age, but that is not true. A member of my team, Bradley, reminded me that his mother, Sharon Langer, would have been 58 today. She died in December 2018 from lung cancer.

Thanks to our health and care services, we have taken great strides in improving cancer survival rates. Over the last 40 years, the survival rate has doubled in this country, and now half of the people diagnosed with cancer in England and Wales survive their disease for 10 years or more. However, the number of cancer cases will only rise in the years ahead. Modelling by Cancer Research UK suggests that cases will rise by around a third, with as many as 506,000 people being diagnosed with cancer between in 2038 and 2040. That is not wholly because of a growing and ageing population, as incidence rates are also due to rise, meaning that individuals will be more likely to be diagnosed with cancer than they are now.

[Debbie Abrahams (Oldham East and Saddleworth) (Lab)]

My condolences to the hon. Lady on the loss of her mum, which must have been horrendous. One of my constituents, Jo Taylor, has received an advanced breast cancer diagnosis; hon. Members may have seen her on social media. She is campaigning to make sure that secondary breast cancer, as it is also known, is counted, because currently we only estimate the number of women—and men—with secondary breast cancer. We know that figures drive care. Does the hon. Lady think that that is something the Government will take on board?

[Nicola Richards]

I totally agree. Any statistics and data that we can gather will help us to improve services and understand the landscape when it comes to who is affected and when cancer can recur, and it is important that we take all that into account. It is important to have a long-term plan for making our cancer services fit for what is to come. They need to cope with the increased demand, and deliver the world-leading outcomes that patients deserve.

Last year, the Government declared war on cancer. They announced a 10-year plan to ramp up our cancer services and make them the world leader that they ought to be. However, we now know that our plans for cancer care will become part of the five-year major conditions strategy. Although it is clearly important to take a holistic approach to caring for people with life-threatening diseases, there is no killer like cancer. We must ensure that our strategy addresses the key elements of what would be a world-leading cancer care system: research, prevention, diagnosis, treatment and care. I will first discuss one of the most important elements that we need addressed in the strategy: diagnosis.

Finding cancer early and commencing treatment is key to survival rates. For instance, 90% of people diagnosed at the earliest stage of bowel cancer will survive for five years or more, compared with just 10% of those diagnosed at the latest stage. Furthermore, almost everyone diagnosed with breast cancer at the earliest stage can receive treatment and live for five years or more, whereas only three in 10 women diagnosed at the latest stage survive for more than five years. The picture also varies by region. Unfortunately, if someone lives in the west midlands, they are statistically less likely to survive for five years or more after being diagnosed with lung cancer than those across England on average, and all combined mortality rates are significantly higher than average, too. Those stark figures hammer home the need to make sure that we detect cancer and commence treatment at the earliest opportunity.

I welcome the commitment from the Secretary of State for Health and Social Care that the strategy will shift our model towards the early detection and treatment of diseases. I also welcome the ambitious target set to diagnose 75% of cancers early by 2028. I look forward to reviewing how the strategy will address the need for greater capacity in the breast screening programme, ensure that all women at elevated risk of breast cancer are included in the national breast screening programme, and raise the proportion of all cancers that are diagnosed early; at present, just under 60% are.

Of course, it is not enough to detect cancer in its earliest stage. We also have to make sure that people receive treatment promptly, especially after urgent referrals. Much work still needs to be done in that area. Only 54.5% of people starting their treatment after an urgent referral do so within the 62-day target, and around 2,100 people have waited more than 104 days to begin their treatment. In my constituency of West Bromwich East and the wider Sandwell area, there is a mixed picture when it comes to meeting those important targets. It is welcome that our local health service met the two-week target for referring urgent suspected cancer cases to a specialist. However, like much of the rest of the country, other targets, including the 62-day standard, were not met. When I compare those statistics with the survival rates that I mentioned, it is obvious that we have to do more to ensure that people start treatment as early as possible. A critical element of that is ensuring that cancer services are sufficiently well staffed.

It would be remiss of me not to honour the people who work day in, day out, providing care for cancer patients across the country. We have all relied on them to care for us and our loved ones, in sometimes the most desperate circumstances, and to provide comfort for us in our time of need. I put on the record my thanks to the Mary Stevens Hospice in the constituency of my hon. Friend the Member for Stourbridge (Suzanne Webb); it looked after my mum in her last days, and held a last-minute wedding blessing for me and my now husband at my mum’s request.

We need to address the shortfalls in the workforce that are affecting our success in improving cancer outcomes. We have a shortfall of both clinical oncologists and radiologists, who are vital to the effort to diagnose and treat cancer patients in the earliest stages. It is so important to tackle the workforce issues with long-term plans to recruit and train the staff we need to tackle cancer properly. I welcome the Government’s NHS long-term workforce plan, which commits to addressing those and many other issues across the NHS workforce. I ask the Government to ensure that the necessary funding is provided to meet those commitments.

On the major conditions strategy, I hope that the Government will take into account the wealth of views expressed by Cancer Research UK and other key organisations in the cancer community in last year’s call for evidence, and ensure that the strategy lays the groundwork for a longer-term strategy on cancer that also tackles inequalities.

Oral Answers to Questions

Debbie Abrahams Excerpts

Tuesday 24th January 2023 Commons Chamber

[Helen Whately]

I thank my hon. Friend for her excellent and important question about her local share of the £750 million of extra funding for discharge this winter. I can tell her that, in Worcestershire, money is already going into extra placements in homecare, community care and care homes, and into providing practical support to help people when they get home from hospital, in partnership with the voluntary sector. I assure her that we will publish the spending plans for her area and the rest of the country shortly.

[Debbie Abrahams (Oldham East and Saddleworth) (Lab)]

8. What assessment he has made of the implications for his policies of the number of excess deaths in 2022.

[Alex Cunningham (Stockton North) (Lab)]

13. What assessment he has made of the implications for his policies of the number of excess deaths in 2022.

[The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)]

Excess deaths data are published on the gov.uk website, which was most recently updated on 12 January. They show that causes of death from conditions such as ischemic heart disease contributed to excess deaths in England in the past year.

[Debbie Abrahams]

The UK’s all-cause mortality for working-age people was 8.3% above the average for the previous five years and the fifth highest in Europe. On top of that, excess deaths are disproportionately experienced by the most deprived and by people of African, Caribbean and Asian descent. Given that these figures are driven by structural inequalities, and that those inequalities are getting worse—the richest 1% have bagged nearly twice as much wealth as the remaining 99% in the past two years—does the Minister think that it is appropriate to recommend that people pay for their GPs?

[Maria Caulfield]

The Government are not recommending that people pay for their GPs. In fact, we are investing more in primary care than ever before, unlike the shadow Secretary of State who wants to dismantle the GP system and privatise the healthcare system as well. I think the hon. Lady needs to have a conversation with those on her own Front Bench. Not only did the shadow Secretary of State insult primary care teams for running up their vaccination programme, calling it “money for old rope”, but we are the ones who are investing in primary care services and making them more accessible to people.

Sudden Unexplained Death in Childhood

Debbie Abrahams Excerpts

Tuesday 17th January 2023 Westminster Hall

[Kwasi Kwarteng (Spelthorne) (Con)]

I beg to move,

That this House has considered sudden unexplained death in childhood.

It is a great honour for me to give my first speech as a Back Bencher in about six years on this vital subject. We are here to discuss something that is incredibly difficult to deal with, emotionally very taxing, and one of the most serious medical phenomena in our country—something that has not had the public attention it deserves: sudden unexplained death in childhood, or SUDC.

This vital subject was brought to my attention while I was still in Government. Julia and Christian Rogers came to see me at the beginning of October, when I was still Chancellor of the Exchequer. In that role, I would not have been able to raise this vital subject personally. I pay tribute to my constituency neighbour, my hon. Friend the Member for Runnymede and Weybridge (Dr Spencer), for his diligence in pursuing the subject while I was still in Government. Luckily, as a matter of privilege to me, I can now raise it myself. I cannot think of a better, more urgent subject to raise in my first Back-Bench debate for many years.

When Julia and Christian came to see me in October 2022, they told me the story of their son, Louis, who tragically passed away in 2021 before he reached the age of two. Julia and Christian lived with Louis in Shepperton in my constituency, and they loved their little boy with all their hearts. Of course, no occurrence is more tragic than the death of a small child. It was particularly disturbing that they knew very little about the illness that took away Louis’ life. One can only imagine the horror of discovering one’s child lifeless, and the sheer bewilderment of trying to understand the causes of that tragedy.

Julia and Christian introduced me to other bereaved parents who had gone through this heart-wrenching occurrence. The national charity SUDC UK does vital work to promote more understanding and sensitivity around a subject that, as I said, has drawn too little attention in the past. SUDC is among the leading categories of death in England and Wales for children aged between one and four. As a community, we have to engage more vigorously with this phenomenon.

Technically, SUDC is the sudden and unexpected death of a child between one and 18 years of age. Those deaths, by their definition of sudden and unexpected, often remain unexplained after a thorough investigation, including a post-mortem. This is one of those areas that modern medical science has still not really got to the bottom of, despite the great advances we have made.

[Debbie Abrahams (Oldham East and Saddleworth) (Lab)]

It is good that we can unite and collaborate to address some of the issues raised by SUDC. Christian’s aunt is my constituent, so I learned about Louis from her. Many of us here are parents, and this issue is deeply worrying. Like the hon. Member for Runnymede and Weybridge (Dr Spencer), I was a public health consultant and have come here from working in the NHS. This issue has not had the profile it needs—just 50 research papers, compared with 12,000 on sudden infant death syndrome. I hope we can do some joint working on the issue to raise the profile of risk factors and so on.

NHS: Long-term Strategy

Debbie Abrahams Excerpts

Wednesday 11th January 2023 Commons Chamber

[Debbie Abrahams (Oldham East and Saddleworth) (Lab)]

The Health Secretary will be aware that our hospital bed numbers are approximately half the OECD average, at fewer than 2.5 per 1,000 compared with 5 per 1,000 in the OECD. He will also have read reports in The Observer about the facility that was made available in the Health and Social Care Act 2012 that allows hospitals to allocate up to 49% of their hospital beds to private patients. Does he regret that?

[Steve Barclay]

The issue of bed capacity does indeed matter. I made the point a few moments ago that flow in hospitals is obviously constrained when bed numbers are high. That is exactly why, in the statement on Monday, I highlighted the importance of discharge, and of things like discharge lounges so that we can better facilitate those patients that are free to leave. But this is not simply about hospital bed capacity; it is about step-down intermediate care capacity and also, as we heard a moment ago, about the innovation that means we are better able to facilitate those patients who want to recover at home but want the safety net of some clinical support when they are doing so. It is about looking at the capacity in the whole of the system, not simply in the hospital; otherwise, the hospital itself becomes a magnet.

NHS Workforce

Debbie Abrahams Excerpts

Tuesday 6th December 2022 Commons Chamber

[Steve Barclay]

He does not want to intervene, so let me deal first with what he left out. His speech, like his motion, ignored a number of salient points. He did not mention, for example, the autumn statement, which one would have thought was fairly significant, providing an extra £6.6 billion for the NHS over the next two years. The NHS Confederation, no less, has described the day of that settlement as a “positive day for the NHS”, and the chief executive of NHS England has said that it should provide “sufficient” funding to fulfil the NHS’s key priorities.

The hon. Gentleman chose not to mention that significant funding. He also—much to the surprise of the House, perhaps—chose not to mention the uplift for social care that was announced in the autumn statement. Opposition Members often call for more funding, so I would have thought that they would be keen to hear about the extra £6.6 billion of additional funding for the NHS, about the biggest funding increase for social care provided by any Government in history, and about the £8 billion that we have committed to elective care. That, bizarrely, was also missing from his speech. He talked about the backlogs—those in England, that is; the backlogs in Wales are much greater—but he did not talk about that £8 billion for elective care, which will fund the building of diagnostic centres and surgical hubs in the constituencies of many Opposition Members.

[Debbie Abrahams (Oldham East and Saddleworth) (Lab)]

rose—

[Steve Barclay]

I do not know whether there is a community diagnostic centre for a surgical hub in the hon. Lady’s constituency, but perhaps she will share with the House what extra investment is being made there.

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[Debbie Abrahams]

As someone who worked in the NHS during the last period of Labour government, I was proud of being able to ensure that my constituents would have an appointment with a GP within 24 hours. I was proud of the fact that someone who needed elective care would receive it within 18 weeks. I was proud of the fact that the treatment of someone diagnosed with cancer would start within 60 days. That is not what is happening on the Secretary of State’s watch. Can he tell me why my constituency has fewer GPs than it had in 2015, along with an increase in demand? How is this delivering the quality care that I know we had on my watch and that of the last Labour Government?

[Steve Barclay]

We are investing in more doctors. We have 2,300 more doctors—a 3% increase. We also have 3% more nurses than we had last year. In fact, under the former Prime Minister, my right hon. Friend the Member for Maidenhead (Mrs May), there was the biggest ever increase in medical undergraduate places—a 25% increase—along with the opening of five new medical schools. Of course, the training takes about seven years, so that is still in progress. As was pointed out during Health questions this morning, we are dealing with the consequences of the pandemic, which is why we are investing in more checks, scans and other procedures, and there will be an extra 9 million of those by March 2025.

Urgent and Emergency Care

Debbie Abrahams Excerpts

Monday 5th September 2022 Commons Chamber

[Steve Barclay]

I fear that the question was written before the statement. In the course of the statement, we have covered the significant additional funding that is going in, whether that is in primary care with the £1.5 billion on GP capacity, the £450 million on A&E capacity, the £150 million on ambulances, the £50 million on 111 call-handling or the £30 million on St John auxiliary ambulance capacity—to name just a few areas.

As to the hon. Gentleman’s wider charge on Government funding for the NHS, I remind him that health funding is on track to be £4 in every £10 of day-to-day Government expenditure, which is a significant increase on 2010. We have also just been through a pandemic in which the fiscal response, as the former Chief Secretary to the Treasury, my right hon. Friend the Member for Chelsea and Fulham (Greg Hands) will know, was about £400 billion. Significant funding has gone in, and the statement today has shown that a number of factors, in particular the integration between social care and the NHS, are at the heart of solving the issue of delays on ambulance handovers.

[Debbie Abrahams (Oldham East and Saddleworth) (Lab)]

For the week ending 12 August, there were nearly 1,000 excess deaths. We know that that is just the tip of the iceberg and it is likely to get worse; that is about 10% more than the five-year rolling average. What are the Secretary of State’s estimates of how much worse it is going to get over the winter months, and what is he going to do about it?

[Steve Barclay]

I have set out a range of things that we are doing to tackle what we recognise are significant pressures facing the NHS, whether that is through the taskforce that we have set up, which is targeted on delayed discharge; the intensive work that has been undertaken with, in particular, the 10 trusts that account for 45% of ambulance delays; the improved capacity within our call handling; or looking at our data, as was raised earlier, on the variation in performance between ambulance trusts on areas such as conveyancing or within the integration between the NHS and social care. I pay tribute to the huge amount of work that is being done within the NHS and social care in recognising that there are significant challenges within the system, which is why so much work has gone into addressing that over the summer.

Health and Care Bill

Debbie Abrahams Excerpts

Consideration of Lords amendments
Wednesday 30th March 2022 Commons Chamber

[Edward Argar]

I will make a little progress, then I will give way to the hon. Lady, as I tend to do. She is a regular participant in health debates.

We are already committed to improving workforce planning. In July 2021, as I said, we commissioned that important work with partners to review long-term strategic trends. It is also important to note in that context that my right hon. Friend the Secretary of State announced that we are merging NHS England and Health Education England, which is a hugely important move that brings together the workforce planning and the provision of places and of new members of the workforce with the funding available for that and the understanding of what is needed in the workforce. It brings supply and demand considerations together.

[Debbie Abrahams (Oldham East and Saddleworth) (Lab)]

Will the Minister give way?

[Edward Argar]

I will make a little more progress, then I will give way to the hon. Member for York Central (Rachael Maskell) and then, if I have time, I will give way to her. I want to address the points of the hon. Member for Lewisham East (Janet Daby) in good time and I am conscious that the votes took up a chunk of the time allowed for this group of amendments.

We are also committed to increasing transparency and accountability. The unamended clause already increases transparency and accountability on the roles of the various actors within the NHS workforce planning system.

[Edward Argar]

The hon. Lady will be pleased to know, or will I hope be reassured to a degree to know, that underpinning our strategy to grow the workforce—for example, the nursing workforce or other specialisms—is the fact that we have multiple strands to the strategy. Those coming from overseas who wish to work in the NHS are always going to be an important and valued part of our NHS workforce, but of course we are also committed to growing the number, for want of a better way of putting it, that we grow at home through training places and medical schools. Crucially, however, a key element here is retention of our existing staff, so that we are not simply recruiting and training lots more staff to replace those who are leaving. All of those factors are important.

[Debbie Abrahams]

Does the Minister want to comment on the fact that 100-plus organisations—and not just those 100 organisations, including the BMA, but former chief executives of NHS England—are still very concerned that the Government’s measures on workforce planning do not go far enough?

[Edward Argar]

I am grateful to the hon. Lady, and she and I have worked together on a number of issues in the past. We always engage—and the since the inception of the Bill and throughout its passage, we have engaged collaboratively—with a whole range of organisations, such as professional bodies and trade unions, including some of those she mentioned. We believe that the approach we have adopted in the commissions from the Secretary of State, coupled with the merger with Health Education England, will be a significant step forward, and we believe it is the right approach to take. I suspect that the hon. Lady may disagree, and I always respect her opinion, although I may not always agree with it.

--- Later in debate ---

[Edward Argar]

I can reassure my hon. Friend that under the changes we are putting in place through the integrated care systems, ICBs will continue to be able to commission services and to send patients to hospitals outside the ICS area. They will also be obliged to co-operate and work with other organisations in the patient’s best interests. We are setting this alongside the broader work that we are doing in the Department on the interoperability of data. I hope that that has reassured her to a degree.

We are also committed to supporting research, and I ask the House to agree to Lords amendments 6, 15, 26 and 28, which further embed research and provide increased clarity, transparency and oversight in respect of ICBs, NHS England and the Secretary of State’s research duties.

[Debbie Abrahams]

I want to ask the Minister about two matters. First, why are health inequalities not explicitly mentioned among the triple aims of the Bill? Secondly, on the membership of ICBs, I am sorry if I misheard, but I did not hear him discuss the amendment on how to avoid any conflict of interest involving private providers on those boards.

[Edward Argar]

The reason for that is that an amendment was brought forward on Report, and the matter was settled at that stage; things have not changed since. In lieu of what had been tabled, we tabled our own amendment on Report, which—even though in our view it was unnecessary—we felt further clarified how to avoid conflicts of interest. In the previous group of amendments, we tabled an amendment to extend that conflict of interest policy and approach to the sub-committees of the boards, in order to ensure that it is explicit that the policy applies to both. It is essentially the same principle, but widened out to the sub-committees to avoid them being inadvertently left out of the legislation.

[Edward Argar]

I can give my hon. Friend an assurance that we expect that to be the case. I will turn to palliative care in the context of other amendments shortly, and I might address some of his points then.

We are also committed to tackling climate change. Lords amendments 9, 18, 33 and 40 place duties on NHS trusts, foundation trusts, ICBs and NHS England to have regard to the Government’s key ambitions on climate change and the natural environment in everything they do. The amendments include a guidance-making power for NHS England that will assist in the discharge of these duties by different bodies.

There are also a number of amendments relating to how integrated care boards should operate as statutory bodies. Amendments 19 to 21 and 23 require an ICB to consider the skills, knowledge and experience it needs to discharge its functions and, where there are gaps, to consider what steps it can take to mitigate them. The amendments also require the forward plan to include detail on how the ICB intends to arrange for the provision of health services, as well as its duties under sections 14Z34 to 14Z45. The annual report must also include an explanation of how it has discharged these duties.

The hon. Member for Oldham East and Saddleworth (Debbie Abrahams) mentioned conflicts of interest. We amended the Bill in this place, and the Lords amended it further with Lords amendment 11. We understand the motivation, but the drafting does not fulfil the stated aim, which is why we tabled an alternative amendment in lieu of that amendment.

[Debbie Abrahams]

Will the Minister give way?

[Edward Argar]

I want to make a little progress. If I make good time, I may be able to give way, but I am conscious of the need to give the shadow Minister and other colleagues plenty of time to speak—about, I suspect, one aspect of this group of amendments in particular, but we will see.

We commend a number of additional amendments to the House. Lords amendments 34 to 37 limit the powers to set capital expenditure limits for NHS foundation trusts, so that they cannot apply for periods longer than a financial year. I reaffirm my commitment to ensuring that these powers on expenditure limits are used only as a last resort, as NHS England agreed with NHS Providers. I also ask the House to accept Lords amendments 50, 65, 104, 106 and 107, which are minor and technical changes required to ensure that the Bill functions as intended.

Although we have made progress on a number of amendments, we urge the House to disagree with the other place on others. First, we ask the House to disagree with amendment 90 on dispute resolution in children’s palliative care, and instead support the amendment we tabled in lieu. Our approach will require the Secretary of State to commission a full independent review of the causes of disagreements between the providers of care and persons with parental responsibility on the care of critically ill children, how these disagreements can be avoided, and how we can sensitively handle their resolution.

We also seek to reject Lords amendment 81. Although we agree on the need to make good progress on the Care Act 2014, it is not in the interests of good government to be forced to implement reform of this complexity and scale through a deadline set in primary legislation. We are getting on with implementing social care reform, and operational guidance is out for consultation. We have announced a small number of local authorities that will act as trailblazers to test the reforms from January 2023, but we must take time to engage with local authorities as they build the necessary infrastructure, and use these trials to refine delivery systems and guidance ahead of the national roll-out. We encourage the House to reject Lords amendment 81, which we believe affects the financial arrangements to be made by this House and, as such, is subject to financial privilege.

[Debbie Abrahams]

I would be grateful if the Minister answered my question about the triple aims, and the impact of not including in them an explicit reference to health inequalities. The Bill refers to health and wellbeing, but not to health inequalities. My main point is on the care cap. More than one in six of my constituents with dementia will not reach the cap, as it stands. The Lords amendments mean it would be one in five, so I would be grateful if the Minister could say exactly why he is prepared to let one in six of my constituents not reach the care cap.

[Edward Argar]

I will address the care cap, because there is a fair bit to say. I was just addressing the noble Lord Lansley’s amendment. I apologise for missing the hon. Lady’s first point. We do not think it is necessary to have health inequalities explicitly among the triple aims, as we believe that the issue runs through everything that ICBs do and everything the Bill sets out. We therefore feel that the Bill is effective, and that each ICB’s ICS will have regard to health inequalities and will see them as central to its objectives.

Before I turn to Lords amendment 80, I will briefly address Lords amendment 51, which relates to consultation with carers during hospital discharge planning. We have heard about the strength of feeling in the other place on that issue. We wholly agree that we must ensure that, where appropriate, unpaid carers are involved in planning around discharge. Although the Government appreciate the intention behind the amendment and want to address the concerns raised, we want to do so in the most effective way, and in a way that does not create unintended delays to discharge. I ask Members to support our amendment in lieu, which would achieve much of what Lords amendment 51 sought to achieve. It will introduce a new duty on trusts and foundation trusts to involve carers during adult discharge planning. Unlike schedule 3 to the Care Act 2014, this duty applies to all carers where the patient has care and support needs following discharge; and it applies to young carers as well as adults. Our amendment in lieu and the new statutory guidance will ensure that patients and carers are involved in discussions about post-discharge care as soon as they start.

Ockenden Report

Debbie Abrahams Excerpts

Wednesday 30th March 2022 Commons Chamber

[Sajid Javid]

The answer is yes.

[Debbie Abrahams (Oldham East and Saddleworth) (Lab)]

I, too, pay tribute to the families named in what is a truly shocking report.

I am sorry, but I have not read all the recommendations, so may I ask the Secretary of State whether, as well as identifying issues relating to the culture in this particular trust, the report includes recommendations concerning governance for boards? Boards have a key role in holding their executives to account. Will he be writing to them to make them aware of their responsibilities in that regard? May I also ask him what the implications are for the national clinical audit of the confidential inquiries into maternal and infant deaths?

[Sajid Javid]

If I may, I will write to the hon. Lady about the national clinical audit. As for her important point about boards, the report refers to their importance and the importance of ensuring that the people on them are vetted, understand their responsibilities, and have the information that they need in order to fulfil those responsibilities. In, I think, 2014 or thereabouts, the Care Quality Commission changed the rules relating to NHS trust board members, requiring them to meet a new “fit and proper” test.

Civil Proceedings

Debbie Abrahams Excerpts

Tuesday 29th March 2022 Commons Chamber

[Maggie Throup]

Throughout the pandemic, the Government have done everything in our power to protect the lives and livelihoods of people across the country .The Coronavirus Act has been a vital tool, allowing us to do that. Last week marks two years since the Act gained Royal Assent and the automatic expiry date for its temporary provisions. This is an opportunity to reflect on the progress we have made in our fight against covid-19 and on how the Act has supported us in that fight, as well as in encouraging important innovations in some of our public services, which we want to take forward.

First, I come to the support the Act has given us. It was an extraordinary piece of legislation for an extraordinary time in this country’s history, giving us the powers we needed to keep the country safe, and the economy and public services open at the time of need. It helped us to bolster the health and social care workforce by suspending rules in the NHS pension schemes for England and Wales, and allowing the creation of temporary registers enabling recently retired NHS and social care staff to return to the workforce and play their part. Almost 15,000 nurses, midwives and, in England, nursing associates joined these temporary registers to help deal with the impact of the pandemic, as well as more than 10,000 paramedics, operating department practitioners and other professionals, and about 6,500 social workers.

The Act also helped the Government to offer unprecedented economic support and to help people and businesses at a time when so many businesses faced disruption. That includes the coronavirus job retention scheme, also known as furlough, which has supported 11.7 million jobs.

[Debbie Abrahams (Oldham East and Saddleworth) (Lab)]

Will the Minister comment on the figures released by the Office for National Statistics today, which state that men and women living in the most deprived parts of the country were five and six times more likely to die from covid than those in the least deprived areas? What can she say about the adequacy of the regulations for those people?

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[Andrew Gwynne]

I thank my hon. Friend for his kind remarks. I have met numerous groups representing the clinically vulnerable, the clinically extremely vulnerable and the immunosuppressed communities, and the level of anxiety and worry in those communities is clear. While we have all, to some extent, been able to get back to as near a normal life as possible, those communities still feel isolated, under pressure and incredibly concerned about what mixing and social interaction would mean for them, were they to get coronavirus.

[Debbie Abrahams]

On top of those groups, which my hon. Friend is right to mention, there are also family carers, who are concerned that they may be prevented from having access to their family members in care homes without adequate testing, which they will be forced to pay for if it is not clear that they are included in the free testing.

[Andrew Gwynne]

My hon. Friend is absolutely right. Many of the people who are classed as clinically vulnerable, clinically extremely vulnerable or immunosuppressed are looked after by members of the family or friends who will come into the house to look after them, rather than by paid carers. Were free lateral flow testing to be extended at least to the CV, CEV and IS communities—not for those people themselves, but for the people coming in to communicate and interact with them—it would at least give them some degree of confidence that coronavirus is not being brought through the front door.

--- Later in debate ---

[Andrew Gwynne]

It does stick in the throat a little hearing “personal responsibility” regurgitated time and again when we now know what happened in Downing Street, that the rules were broken and that the laws made in this House were broken. [Interruption.] The Minister says, “We don’t know that”, but we do, because 20 people have just received fines, and that means the law was broken.

We must not simply turn the clock back and pretend that covid never happened. Over the past two years we have seen the impact of painfully inadequate sick pay, and we have seen the benefits of access to free testing. We must learn from both those things. We have also lost more than 160,000 citizens in the course of this pandemic. I fear that, although the numbers are much smaller than they were, that toll will rise day on day, week on week, and year on year. We have real lessons to learn.

[Debbie Abrahams]

We would also make sure that we fulfilled our commitment to the international community on providing the vaccinations that it needs. There are still more than 2 billion people who are unvaccinated, and that will accelerate the risk of new variants that may be even more lethal.

[Andrew Gwynne]

My hon. Friend is absolutely right.

Although we will continue to hold this Government to account, we will not oppose these measures today. There are real questions about covid that have to be asked by us and answered by Ministers, because too many are still unanswered. We owe that to the families of those who did not survive the pandemic, and we owe it to the whole country that stood by the rules throughout thick and thin to get us to where we are today, even when some in Government were not doing that. It is time for the Government to get serious. It is time for the Government to treat the British public with the respect that they deserve. It is time for a proper plan to live with covid.